FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Per R.C. 3113.31(F)(3),this Order is indexed at Case No. Judge State LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) OHIO PHONE NUMBER PETITIONER: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (R.C. 3113.31) WITH SUPPORT ORDER PERSON(S) PROTECTED BY THIS ORDER: Petitioner: Petitioner's Family or Household Members: ( Additional forms attached.) DOB: DOB: First Middle Last DOB: DOB: DOB: RESPONDENT IDENTIFIERS SEX EYES First Middle Last DRIVER'S LIC. NO. Relationship to Petitioner: Address where Respondent can be found: Distinguishing features: EXP. DATE RACE HAIR HT WT DATE OF BIRTH / / STATE v. RESPONDENT: 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 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 acts of abuse or threats of abuse against the Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until / / (DATE CERTAIN ­ 5 YEARS MAXIMUM) WARNING TO RESPONDENT: See the warning page attached to the front of this Order. FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: March 1, 2014 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com [Page 2 of 6 Form 10.01-J] Case No.__________________________ This proceeding came on for a hearing on Order filed on / / / before the Court and the Ex Parte / . The following individuals were present: The parties agree to waive their notice and hearing rights. RESPONDENT SHALL NOT ABUSE harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02] ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO THE RESPONDENT 1. RESPONDENT SHALL IMMEDIATELY VACATE the following residence: 2. 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 or interrupting telephone service, mail delivery, or the delivery of any other documents or items. [NCIC 03] 3. 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: 4. 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] 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] 5. FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: March 1, 2014 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com [Page 3 of 6 Form 10.01-J] Case No.__________________________ 6. 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, landline, cordless, cellular or digital telephone; text; instant messaging; fax; e-mail; voice mail; delivery service; social networking media; blogging; writings; electronic communications; or communications by any other means directly or through another person. Respondent may not violate this Order even with the permission of a protected person. [NCIC05] RESPONDENT SHALL IMMEDIATELY SURRENDER POSSESSION OF ALL KEYS TO THE FOLLOWING MOTOR VEHICLE: to the law enforcement agency that served Respondent with the Order or as follows: 7. and Petitioner is granted exclusive use of this motor vehicle. 8. 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: 9. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this Order. 10. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON at any time while this Order remains in effect, unless Respondent is excepted for official use pursuant to 18 U.S.C. 925(a)(1). [NCIC 07] RESPONDENT SHALL TURN OVER ALL DEADLY WEAPONS AND CONCEALED CARRY WEAPON LICENSE 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] Upon the expiration of this Order, any deadly weapons, including firearms and ammunition, held in protective custody by law enforcement pursuant to this Order shall be disposed of as unclaimed property pursuant to R.C. 2981.12 unless the Respondent files a motion for return with this Court within 30 days before the expiration of this Order. FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: March 1, 2014 Discard all previous versions of this form American LegalNet, Inc. www.FormsWorkFlow.com [Page 4 of 6 Form 10.01-J] Case