FAPA 226 Restraining Order Page 1 of 8 (Aug 2019) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF Case No: Petitioner v. RESTRAINING ORDER TO PREVENT ABUSE Respondent (Person restrained) (Family Abuse Prevention Act) NOTICE TO RESPONDENT Review this order carefully You must obey all of the provisions of this Restraining Order, even if Petitioner contacts you or gives you permission to contact him/ her You may be arrested and subject to civil and criminal penalties if you violate this order This order is enforceable anywhere in Oregon and in every other state See the attached 223Notice to Respondent224 and 223Request for Hearing224 for information about your right to a hearing THE COURT FINDS: Judge Initials 1. Relationship 1. The Petitioner and Respondent: (check all that apply) are or were spouses or Registered Domestic Partners are related by blood, marriage, or adoption live or lived together in a sexually intimate relationship have a sexually intimate relationship (or did within the past 2 years) and Petitioner is under 18, Respondent is over 18 are the parents of a minor child 2. Incidents of Abuse 2. Respondent has abused Petitioner (as defined by ORS 107.705) within the past 180 days as provided in ORS 107.710. Respondent represents a credible threat to the physical safety of Petitioner or Petitioner222s children. Petitioner is in imminent danger of further abuse. 3. Minor Children This Order involves minor children TO PETITIONER AND RESPONDENT: (for court use only) NOTICE OF EXCEPTIONAL CIRCUMSTANCES HEARING: Date: Time: Courtroom: Both parties must appear at this hearing. See Section 16 below for information. American LegalNet, Inc. www.FormsWorkFlow.com FAPA 226 Restraining Order Page 2 of 8 (Aug 2019) A. Jurisdiction (for court use only) 3A. Oregon has jurisdiction over issues of custody and parenting time under the UCCJEA because: Oregon is the children222s home state Oregon was the home state within 6 months before the Petition was filed. The children are not in Oregon, but a parent (or person acting as a parent) lives in Oregon. Emergency grounds exist for the exercise of temporary jurisdiction. The children are in Oregon and have been abandoned, or the children (or a parent) have been subjected to or threatened with abuse or mistreatment. Other: B. Prior Cases 3B. Existing Orders A previous custody, parenting time, guardianship, or juvenile dependency order exists The order was entered in: (state, tribe, or country): Pending Cases A custody, parenting time, guardianship, or juvenile dependency case is pending in (state, tribe, or country): No Pending or Existing Orders No custody, parenting time, guardianship, or juvenile dependency case has been started or finished in any state, tribe, or country. The custody and parenting time provisions in this order are final for purposes of the UCCJEA if Oregon becomes the children222s home state. C. Interstate Judicial Communication Needed 3C. A custody, parenting time, or child placement matter is PENDING in another state, tribe, or country or Oregon is exercising Temporary Emergency Jurisdiction under the UCCJEA and another state, tribe, or country has entered an order regarding custody, parenting time, or child placement 4. Emergency Monetary Assistance 4. Emergency monetary assistance is necessary to provide for the safety and welfare of Petitioner and any children in the care of Petitioner American LegalNet, Inc. www.FormsWorkFlow.com FAPA 226 Restraining Order Page 3 of 8 (Aug 2019) THE COURT ORDERS: 1. Respondent is restrained (prohibited) from intimidating, molesting, 1. interfering with, or menacing Petitioner, or attempting to do so, directly or through another person 2. Respondent is prohibited from intimidating, molesting, interfering with, 2. or menacing minor children in Petitioner222s care or attempting to do so, directly or through another person 3. Except as otherwise stated in this order, Respondent is prohibited from 3. entering, attempting to enter, or remaining in the area within 150 feet or feet of buildings and land at the following locations: (include names and addresses unless withheld for safety reasons) Petitioner222s current or future residence: Petitioner222s current or future business or place of employment: Petitioner222s current or future school: Other: 4. Respondent is prohibited from knowingly being or staying within 4. 150 feet or of Petitioner except as otherwise ordered (explain): 5. Contact A. Nothing in this restraining order prevents Respondent from appearing at or participating in a court (or administrative) hearing (or other related legal process) as a party or witness in a case involving the Petitioner. At these times, Respondent must stay at least 10 feet or (initial: ) feet away from the Petitioner and follow any additional protective terms ordered in that case. Nothing in this order prevents Respondent from serving or providing documents related to a court (or administrative) case to the Petitioner in a manner permitted by law. Respondent may not personally deliver documents to the Petitioner. B. Except as otherwise ordered, Respondent is prohibited from 5B. contacting or attempting to contact Petitioner: in person, directly or through another person by private or commercial delivery, including mail, except for court-ordered emergency monetary assistance, checks, or money orders American LegalNet, Inc. www.FormsWorkFlow.com FAPA 226 Restraining Order Page 4 of 8 (Aug 2019) by email, social media, or any other electronic method, directly or through another person by phone or text message exceptions to restrictions on contact (list name and purpose): 6. Respondent is prohibited from entering, attempting to enter, 6. remaining at, or removing the children from the children222s current or future: day care provider school 7. Respondent is ordered to move from and not return to the residence: 7. (address): except with a peace officer to remove Respondent222s essential personal items, and, if Respondent is the custodial parent, essential personal items of Respondent222s children including (but not limited to) clothing, toiletries, diapers, medications, Social Security cards, birth certificates, identification, and tools of the trade 8. A peace officer will accompany Petitioner to the residence to remove 8. Petitioner222s essential personal items and, if Petitioner is the custodial parent, essential personal items of Petitioner222s children including (but not limited to) clothing, toiletries, diapers, medications, Social Security cards, birth certificates, identification, and tools of the trade 9. Emergency Monetary Assistance 9. Respondent is ordered to pay Petitioner $ as emergency monetary assistance by the 45th day after Respondent is served with this Restraining Order. Payment must be made by check money order mailed to (SAFE contact address): 10. Animals 10. To prevent neglect and protect the safety of animals kept for service, therapy, protection or companionship, the court makes the following orders: 11. Firearms 11. Respondent is prohibited from purchasing or possessing any firearms or ammunition (Event: FQOR) Other orders regarding firearms (court use only) the attached Firearms Surrender and Return Terms apply and are made part of this Order 11A. American LegalNet, Inc. www.FormsWorkFlow.com FAPA 226 Restraining Order Page 5 of 8 (Aug 2019) 12. Other Orders 12. CHILD CUSTODY 13. Temporary Custody is ordered as follows 13. Parenting time is ordered in Sections 17 and 18, below Child222s Name Age Party to have custody petitioner respondent petitioner respondent petitioner respondent petitioner respondent Additional page attached labeled 223Additional Custody Orders224 FIREARMS NOTIFICATION If Box 11 is initialed by the judge, you are immediately prohibited from purchasing or possessing any FIREARM, including a rifle, pistol, or revolver, and AMMUNITION (ORS 107.718(1)(h)). Whether or not Box 11 is checked, you will be prohibited from purchasing or possessing any firearms or ammunition under ORS 166.255 if: 267 You request a hearing to contest this Order but then withdraw your request 267 You request a hearing to contest th