IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Case No. Per ORC 3113.31(F)(2), this order is indexed at Judge County State OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) FULL HEARING (R.C. 3113.31) - PHONE NUMBER WITH SUPPORT ORDER PETITIONER: First Middle PERSON(S) PROTECTED BY THIS ORDER: DOB: Petitioner: Petitioner’s Family or Household Member(s): DOB: DOB: DOB: DOB: Last v. RESPONDENT: SEX EYES First Middle RESPONDENT IDENTIFIERS RACE HT HAIR WT DATE OF BIRTH Last DRIVERS LIC NO. & EXP. DATE STATE Relationship to Petitioner: Address where Respondent can be found: Distinguishing Features: FIREARMS ACCESS – PROCEED WITH CAUTION (Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this form is not required for enforcement.) THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and the Respondent was provided with reasonable notice and opportunity to be heard within the time required by Ohio law. Additional findings of this order are set forth below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing further acts of abuse or threats of abuse against the Petitioner and other protected persons named in this order, as set forth below. Additional terms of this order are set forth below. The terms of this order shall be effective until / / (DATE CERTAIN – FIVE YEARS MAXIMUM) WARNINGS TO RESPONDENT: See the warnings page attached to the front of this Order. FORM 10.01-I DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com [Side 2 of Form 10.01-I] Case # ___________________________ This proceeding came on for a hearing on , before the Court and the Ex Parte Order filed on , . The following individuals were present: . The Court hereby makes the following findings of fact: The Court further finds by a preponderance of the evidence: 1) that the Petitioner or Petitioner’s family or household member(s) are in danger of or have been a victim of domestic violence, as defined in Ohio Revised Code 3113.31(A), committed by Respondent; and 2) the following orders are equitable, fair, and necessary to bring about a cessation or prevention of domestic violence against the family or household member(s) named in the Petition. ALL OF THE PROVISIONS CHECKED BELOW APPLY TO THE RESPONDENT 1. RESPONDENT SHALL NOT ABUSE the protected persons named in this Order by harming, attempting to harm, threatening, molesting, following, stalking, bothering, harassing, annoying, or forcing sexual relations on them. [NCIC 01 and 02] 2. RESPONDENT SHALL IMMEDIATELY VACATE the following residence: 3. EXCLUSIVE POSSESSION OF THE RESIDENCE located at: is granted to: . Respondent shall not interfere with this individual’s right to occupy the residence including, but not limited to canceling utilities or insurance, interrupting phone service, mail delivery, or the delivery of any other documents or items. [NCIC 03] 4. RESPONDENT SHALL SURRENDER all keys and garage door openers to the above residence at the earliest possible opportunity after service of this Order to the law enforcement agency that serves Respondent with this Order or as follows: 5. RESPONDENT SHALL NOT ENTER the residence, school, business, place of employment, or day care centers of the protected persons named in this order, including the buildings, grounds and parking lots at those locations. [NCIC 04] 6. RESPONDENT SHALL STAY AWAY FROM PETITIONER and all other protected persons named in this order, and shall not be present within 500 feet or (distance) of protected persons, wherever protected persons may be found, or any place the Respondent knows or should know the protected persons are likely to be, even with Petitioner’s permission. If Respondent accidentally comes in contact with protected persons in any public or private place, Respondent must depart immediately. This order includes encounters on public and private roads, highways, and thoroughfares. [NCIC 04] 7. RESPONDENT SHALL NOT HAVE OR INITIATE ANY CONTACT with the protected persons named in this Order or their residences, businesses, places of employment, schools, day care centers, or babysitters. Contact includes, but is not limited to, telephone, fax, e-mail, voice mail, delivery service, writing, or communications by any other means in person or through another person. [NCIC 05] 8. RESPONDENT SHALL IMMEDIATELY SURRENDER POSSESSION OF ALL KEYS TO THE FOLLOWING MOTOR VEHICLE: to: who is granted exclusive use of this motor vehicle. 9. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY OR PETS owned or possessed by the protected persons named in this Order. Personal property shall be apportioned as follows: FORM 10.01-I DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) American LegalNet, Inc. www.USCourtForms.com REVISED 9/1/04 Discard all previous versions of this form [Side 3 of Form 10.01-I] Case # ___________________________ 10. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this order. 11. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON. Respondent shall turn over all deadly weapons in Respondent’s possession to the law enforcement agency that serves Respondent with this Order or as follows: Any law enforcement agency is authorized to take possession of deadly weapons pursuant to this paragraph and hold them in protective custody until further Court order. [NCIC 07] 12. PARENTAL RIGHTS AND RESPONSIBILITIES ARE TEMPORARILY ALLOCATED AS FOLLOWS: [NCIC 09] This order applies to the following child(ren): 13. VISITATION ORDERS DO NOT PERMIT RESPONDENT TO VIOLATE THE TERMS OF THIS ORDER. (A) Respondent's visitation rights are suspended; or (B) As a limited exception to paragraph 6, temporary visitation rights are established as follows: [NCIC 06] This order applies to the following child(ren): 14. LAW ENFORCEMENT AGENCIES including but not limited to Petitioner in gaining physical custody of the child(ren) if necessary. are ordered to assist 15. RESPONDENT SHALL SUPPORT the protected persons named in this Order as follows: 16. RESPONDENT MAY PICK UP CLOTHING and personal items from the above residence only in the company of a uniformed law enforcement officer within 7 days of the filing of this Order. Arrangements may be made by contacting: 17. RESPONDENT SHALL NOT CONSUME, USE, OR POSSESS illegal drugs or beverages containing alcohol. 18. IT IS FURTHER ORDERED: [NCIC 08] 19. RESPONDENT SHALL COMPLETE THE FOLLOWING COUNSELING PROGRAM: Respondent shall contact this program days after receiving this Order and immediately arrange for an initial appointment. The counseling program is requested to provide the Court a written notice when Respondent attends the initial appointment, if the Respondent fails to attend or is discharged, and when Respondent completes the program. Respondent is required to sign all necessary waivers to allow the court to receive information from the counseling program. Respondent is ordered to appear before Judge or Magistrate , on at m., to review Respondent’s compliance with this counseling FORM 10.01-I DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) American LegalNet, Inc. www.USCourtForms.com REVISED 9/1/04 Discard all previous versions of this form [Side 4 of Form 10.01- I] Case # ___________________________ order. Respondent is warned: If you fail to attend the counseling program you may be held in contempt of court. If you fail to appear at this hearing, the court may issue a warrant for your arrest. 20. IT IS FURTHER ORDERED that the Clerk of Court shall cause a copy this Order to be delivered to the Respondent as required by law. The Clerk of Court shall also provide certified copies this Order to Petitioner upon request. This Order is granted without bond. Under state and federal law, the Clerk shall not charge any fees for filing, issuing, registering, or serving this protection order. 21. ALL OF THE TERMS OF THIS ORDER SHALL REMAIN IN FULL FORCE AND EFFECT FOR A PERIOD OF , unless earlier modified or FIVE YEARS FROM ISSUANCE, OR UNTIL dismissed by order of this court. Except for paragraphs 12, 13, 14, and 15 above, this order survives a divorce, dissolution of marriage, or legal separation. Until this order is delivered to Respondent, the terms of the Ex Parte CPO remain in effect. IT IS SO ORDERED. APPROVED and ADOPTED by: MAGISTRATE JUDGE NOTICE TO RESPONDENT: THE PERSONS PROTECTED BY THIS ORDER CANNOT GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THIS ORDER. IF YOU VIOLATE ANY TERMS OF THIS ORDER, EVEN WITH THE PROTECTED PERSON’S PERMISSION, YOU MAY BE ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. IF THERE IS ANY REASON WHY THIS ORDER SHOULD BE CHANGED, YOU MUST ASK THE COURT TO CHANGE IT. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. TO THE CLERK: COPIES OF THIS ORDER SHALL BE DELIVERED TO Petitioner Attorney for Petitioner Respondent Attorney for Respondent Counseling Program: The County Sheriff Police Department Where Petitioner Resides: NOTICE OF FINAL APPEALABLE ORDER Copies of the foregoing Order, which is a final appealable order, were mailed by ordinary U.S. mail or hand-delivered to the parties indicated on the day of , 20 . By: CLERK OF COURT Police Department Where Petitioner Works: CSEA Other: FORM 10.01-I DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) American LegalNet, Inc. www.USCourtForms.com REVISED 9/1/04 Discard all previous versions of this form