IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Case No. Per ORC 2903.214(F)(2), this order is indexed at Judge/Magistrate State County OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - . CIVIL STALKING PROTECTION ORDER (CSPO) EX PARTE (R.C. 2903.214) PHONE NUMBER 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 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 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 . WARNINGS TO RESPONDENT: See the warnings page attached to the front of this Order. FORM 10.03-E CIVIL STALKING PROTECTION ORDER (CSPO) EX PARTE REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com [Side 2 of Form 10.03-E] Case # ___________________________ This proceeding came on for an ex parte hearing on , (Respondent not being present), upon the filing of a petition by Petitioner for a civil stalking protection order (CSPO) against the Respondent, pursuant to Ohio Revised Code 2903.214. In accordance with R.C. 2903.214(D)(1), the court held an ex parte hearing not later than the next day that the court was in session after the petition was filed. The court finds that the Respondent has threatened the Petitioner with bodily harm, has caused mental distress, or has been convicted of or pleaded guilty to a violation of section 2903.211 of the Revised Code against the protected persons named in this order. For good cause shown, the court finds the following temporary orders are necessary for the safety and protection of the person to be protected by this order. 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 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 03] 3. RESPONDENT SHALL NOT INTERFERE with protected persons' right to occupy the residence including, but not limited to canceling utilities, insurance, interrupting phone service, mail delivery, or the delivery of any other documents or items. 4. RESPONDENT SHALL SURRENDER all keys and garage door openers to the following 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 STAY AWAY from protected persons named in this order, and shall not be present within 500 feet (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 protected persons' 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] 6. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY OR PETS owned or possessed by the protected persons named in this Order. 7. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named is this order at their residences, businesses, places of employment, schools, day care centers, and babysitters. 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. [NCIC 05] 8. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY OTHER PERSON to do any act prohibited by this order. 9. 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] 10. IT IS FURTHER ORDERED: [NCIC 08] FORM 10.03-E CIVIL STALKING PROTECTION ORDER (CSPO) EX PARTE REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com [Side 3 of Form 10.03-E] Case # ___________________________ 11. 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. 12. ALL OF THE TERMS OF THIS ORDER REMAIN IN FULL FORCE AND EFFECT UNTIL , unless earlier modified or dismissed by order of this Court. IT IS SO ORDERED. JUDGE/MAGISTRATE 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 shall be held before Judge or Petitioner Respondent (by personal service) Police Department Where Petitioner Resides: Magistrate on TO THE CLERK: COPIES OF THIS ORDER SHALL BE DELIVERED TO: , at a.m./p.m. Police Department Where Petitioner Works: at the following location: The Other: FORM 10.03-E CIVIL STALKING PROTECTION ORDER (CSPO) EX PARTE Sheriff’s Department REVISED 9/1/04 Discard all previous versions of this form American LegalNet, Inc. www.USCourtForms.com