FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) EX PARTE IN THE COURT OF COMMON PLEAS COUNTY, OHIO Case No. Order of Protection Per R.C. 3113.31(F)(3), this Order is indexed at Judge State County OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) – DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) EX PARTE (R.C. 3113.31) PHONE NUMBER PETITIONER: First Middle PERSON(S) PROTECTED BY THIS ORDER: DOB: Petitioner: Petitioner’s Family or Household Member(s) (May attach additional forms): DOB: DOB: DOB: DOB: Last v. RESPONDENT: SEX RESPONDENT IDENTIFIERS RACE HT EYES First Middle HAIR WT DATE OF BIRTH Last DRIVER’S LIC. NO. EXP. DATE STATE Relationship to Petitioner: Address where Respondent can be found: Distinguishing features: WARNING TO LAW ENFORCEMENT: RESPONDENT HAS FIREARMS ACCESS – PROCEED WITH CAUTION (Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement.) THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and the Respondent will be 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 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). WARNING TO RESPONDENT: See the warning page attached to the front of this Order. FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) EX PARTE Amended: July 1, 2010 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com [Page 2 of Form 10.01-H] Case No.___________________________ This proceeding came on for an ex parte hearing on (Respondent not being present), upon the filing of a Petition by Petitioner for a domestic violence civil protection order (CPO) against the Respondent, pursuant to R.C. 3113.31. In accordance with R.C. 3113.31(D)(1), the Court held an ex parte hearing on the same day that the Petition was filed. The Court finds that the protected persons herein are in immediate and present danger of domestic violence and for good cause shown, the following temporary orders are necessary to protect the persons named in this Order from domestic violence. 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, following, stalking, harassing, forcing sexual relations upon them, or by committing sexually oriented offenses against 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 telephone 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 or interfere with the residence, school, business, place of employment, day care centers, or child care providers of the protected persons named in this Order, including the buildings, grounds, and parking lots at those locations. Respondent may not violate this Order even with the permission of a protected person. [NCIC 04] 6. RESPONDENT SHALL STAY AWAY FROM PETITIONER and all other protected persons named in this Order, and not be present within 500 feet or (distance) of any protected persons wherever those 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 INITIATE OR HAVE ANY CONTACT with the protected persons named in this Order or their residences, businesses, places of employment, schools, day care centers, or child care providers. Contact includes, but is not limited to, telephone, fax, e-mail, voice mail, delivery service, writings, or communications by any other means in person or through another person. Respondent may not violate this Order even with the permission of a protected person. [NCIC 05] 8. RESPONDENT SHALL IMMEDIATELY SURRENDER POSSESSION OF ALL KEYS TO THE FOLLOWING MOTOR to the law enforcement agency that served Respondent with the Order VEHICLE: or as follows and Petitioner is granted exclusive use of this motor vehicle. FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) EX PARTE Amended: July 1, 2010 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com [Page 3 of Form 10.01-H] Case No.___________________________ 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: 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 paragraphs 6 and 7, 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, are ordered to assist Petitioner in gaining physical custody of the child(ren) if necessary. 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 seven days of the filing of this Order. Arrangements may be made by contacting: 17. RESPONDENT SHALL NOT USE OR POSSESS alcohol or illegal drugs. FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) EX PARTE Amended: July 1, 2010 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com [Page 4 of Form 10.01-H] Case No.___________________________ 18. IT IS FURTHER ORDERED: [NCIC 08] 19. IT IS FURTHER ORDERED that the Clerk of Court shall cause a copy of the Petition and this Order to be delivered to the Respondent as required by law. The Clerk of Court shall also provide certified copies of the Petition and this Order to Petitioner upon request. This Order is granted without bond. Under federal and state law, the Clerk shall not charge any fees for filing, issuing, registering, or serving this protection order. 20. ALL OF THE TERMS OF THIS ORDER SHALL REMAIN IN FULL FORCE AND EFFECT UNTIL , unless earlier modified by or 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. IT IS SO ORDERED. 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. A FULL HEARING on this Order, and on all other issues raised by the Petition, shall be held TO THE CLERK COPIES OF THIS ORDER SHALL BE DELIVERED TO: before Judge Petitioner Respondent (by personal service) Police Department Where Petitioner Resides: or Magistrate on the day of , 20 at a.m./p.m. at the following location: The County Sheriff’s Office Police Department Where Petitioner Works: Other: FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (CPO) EX PARTE Amended: July 1, 2010 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com