ORDER RENEWING RESTRAINING ORDER - PAGE 1 OF 4 (EPPDAPA 8/2016) IN THE CIRCUIT COURT OF THE STATE OF OREGON COUNTY OF (See CIF) ) Petitioner (Date of Birth) ) (name of person to be protected) ) ORDER RENEWING RESTRAINING ORDER ) (Elderly Persons / Persons w/Disabilities by and through his/her Guardian Petitioner: ) Abuse Prevention Act) ) (name of Guardian Petitioner) ) ) Case No. v. ) (See CIF) ) Respondent (Date of Birth) ) (person to be restrained) ) NOTICE TO THE RESPONDENT : If granted, this renewal order continues the original or modified restraining order and becomes effective immediately. Violation of the continued restraining order may result in your arrest or in civil and/or criminal penalties. This order is enforceable in every state, the District of Columbia, and all tribal lands and territories of the United States. If you wish to contest the continuation of this order, see your rights to a hearing in the 223Notice to Respondent/Request for Hearing224 form attached to this Order. The court, having reviewed the Petition to Renew Restraining Order, makes the following findings: Good cause exists to renew the order. No further service is necessary because the Respondent appeared in person before the court. IT IS HEREBY ORDERED that: The Restraining Order in this matter is RENEWED for a period of one year, expiring on: (date). Other: THE SECURITY AMOUNT FOR VIOLATION OF ANY PROVISION OF THIS ORDER OR THE ORIGINAL RESTRAINING ORDER IS $5,000 unless otherwise specified here: $ The Petition to Renew Restraining Order is dismissed: American LegalNet, Inc. www.FormsWorkFlow.com ORDER RENEWING RESTRAINING ORDER - PAGE 2 OF 4 (EPPDAPA 8/2016) FIREARMS PROHIBITIONS MAY APPLY TO YOU! If the original Restraining Order to Prevent Abuse ordered you not to possess or purchase firearms and has not been changed, it is unlawful for you to possess or purchase a FIREARM, including a rifle, pistol, or revolver, and AMMUNITION. ORS 124.020(1)(f). As a result of this Order, or any Order continuing or changing this Order, it may be unlawful for you to possess or purchase a firearm, including, a rifle, pistol, or revolver, or ammunition under federal law. 18 U.S.C. 247 922(g)(8). In addition, state law or local laws may prohibit you from such possession or purchase as a result of this Order or any Order continuing or changing this Order. ORS 166.250 to 166.270; and local law. This Order also may negatively affect your ability to serve in the Armed Forces of the United States or to be employed in law enforcement. If you have any questions whether these laws make it illegal for you to possess or purchase a firearm, you should consult an attorney. You may also be subject to further restrictions and prohibited from: 225 Traveling across state lines or tribal land lines with the intent to violate this Order and then violating this Order. 225 Causing the Petitioner to cross state lines or tribal land lines for the purpose of violating the order 225 Possessing, receiving, shipping or transporting any firearm or firearm ammunition. Other Laws May Also Apply To You Whether or not a Restraining Order is in effect, federal law may prohibit you from: 225 Traveling across state lines or tribal land lines with the intent to injure the Petitioner and then intentionally committing a crime of violence causing bodily injury to the Petitioner. 225 Causing the Petitioner to travel across state lines or tribal land lines if your intent is to cause bodily injury to the Petitioner or if the travel results in your causing bodily injury to the Petitioner. CERTIFICATE OF COMPLIANCE WITH THE VIOLENCE AGAINST WOMEN ACT This protective Order meets all full faith and credit requirements of the Violence Against Women Act, 18 U.S.C. 2265. This court has jurisdiction over the parties and the subject matter. The Respondent is being afforded notice and timely opportunity to be heard as provided by the law of the jurisdiction. This Order is valid and entitled to enforcement in this and all other jurisdictions. DATED this day of , 20 Judge Signature: American LegalNet, Inc. www.FormsWorkFlow.com ORDER RENEWING RESTRAINING ORDER - PAGE 3 OF 4 (EPPDAPA 8/2016) Certificate of Document Preparation and Readiness for Judicial Signature. You are required to truthfully complete this certificate regarding the document you are filing with the court. Check all boxes and complete all blanks that apply: I selected this document for myself and I completed it without paid assistance. I paid or will pay money to for assistance in preparing this form. This proposed order is ready for judicial signature under UTCR 5.100 because this order is submitted ex parte as allowed by statute or rule. Dated: Submitted by (signature): Print Name, Petitioner Attorney for Petitioner OSB No. (if applicable) Address or Contact Address City, State, Zip Telephone or Contact Telephone Number Use a Safe Contact address Use a Safe Contact number American LegalNet, Inc. www.FormsWorkFlow.com ORDER RENEWING RESTRAINING ORDER - PAGE 4 OF 4 (EPPDAPA 8/2016) RELEVANT DATA Protected Person: Female Male Name ***Residence/Contact Address (Use a safe address***): Number, Street and Apt. Number (if applicable) City County State Zip Telephone/Contact Telephone Number (Use safe contact number) Birthdate (See CIF) Age Race/Ethnicity Height Weight Eye Color Hair Color RESPONDENT: Female Male Name Residence Address Telephone Number Birthdate (See CIF) Age Race/Ethnicity Height Weight Eye Color Hair Color PLEASE FILL OUT THIS INFORMATION TO AID IN SERVICE OF THE RESTRAINING ORDER Where is Other Party most likely to be located? Residence Hours Address Employment Hours Address (See CIF) Other Hours Address Description of Vehicle Is there anything about the other party222s character, past behavior, or the present situation that indicates that he or she may be a danger to others? to him/herself? EXPLAIN: Does the other party have any weapons, or access to weapons? EXPLAIN: Has the other party ever been arrested for or convicted of a violent crime? EXPLAIN: ***The Respondent will receive a copy of this information. If you wish to have your residential address or telephone number withheld from Respondent, use a contact address in the state where you reside or a contact telephone number so the Court and the Sheriff can reach you if necessary. Please check for mail at this address frequently. American LegalNet, Inc. www.FormsWorkFlow.com