STATE OF SOUTH CAROLINA ) ) ) ) ) Petitioner ) ) ) ) ) Respondent. ) ) COUNTY OF vs. IN THE FAMILY COURT JUDICIAL CIRCUIT FAMILY COURT ORDER PROTECTION FROM DOMESTIC ABUSE ACT (For Use By Family Court Judges) FILE NO. Judge: Attorney for Petitioner: Attorney for Respondent: Court Reporter: PETITIONER IDENTIFIERS RESPONDENT IDENTIFIERS SEX * RACE * DOB* Date of Birth of Petitioner EYES And/or on behalf of minor family member(s) or other Protected persons: (list name and DOB) HAIR SOCIAL SECURITY # DRIVERS LICENSE # STATE Relationship to Petitioner: Respondent’s Address CAUTION: Weapon Involved *Indicates required information for entry into NCIC Weapon Present on Respondent’s Property Access to weapons THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, Respondent has been provided with reasonable notice and opportunity to be heard. Additional findings of this order are as set forth below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing further acts of abuse or threats of abuse. That the above named Respondent be restrained from any contact with the Petitioner/Plaintiff as set forth on the attached pages. The terms of the this order shall be effective until , . WARNINGS TO RESPONDENT; This order shall be enforced in any county of South Carolina and by the courts of any state, District of Columbia, any U. S. Territory, and may be enforced by Tribal Lands (18 U.S.C. Section 2265). Crossing state, territorial, or tribal boundaries to violate this order may result in federal imprisonment (18 U.S.C. Section 2262). State and federal law provides penalties for possessing, transporting, shipping, or receiving any firearm or ammunition (18 U.S.C. Section 922). Only the Court can change this order. For Additional Information Call: Sheriff Phone Number SCCA/426ABCD (07/08) Clerk of Court Phone Number Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com A Petition for Order of Protection was filed on . I held a hearing on . Respondent was / was not given actual notice and an opportunity to participate. Respondent did / did not appear. After hearing the evidence, and examining the affidavits and verified pleadings, I have determined that the petition should be GRANTED, based on these facts: 1. That the Respondent and the Petitioner (check one or more): are husband and wife were husband and wife are cohabiting were cohabiting have this child/children in common: are household or family members pursuant to S.C. Code § 20-4-20(a)(2) 2. Venue is properly in this county, since this is the county where a. the act of abuse occurred; or b. the Respondent resides; or c. the parties last resided together. 3. Abuse occurred on (date) manner: 4. at o’clock M. at in this committed this abuse. 5. was / were the victim(s) of this abuse. Check here if the victim is less than 18 years old and name: 6. The evidence establishes that Respondent / Petitioner represents a credible threat to the physical safety of the Respondent / Petitioner used, attempted to use, or threatened to use physical force against Petitioner / victim. The Respondent that is reasonably expected to cause bodily injury. 7. The 8. $ Petitioner / Respondent is a fit and proper person to have custody of the minor child or children. Respondent / Petitioner is employed at gross per month and has reasonable monthly expenses of $ 9. Petitioner / monthly expenses of $ and earns approximately Respondent is employed and earns approximately $ for herself and the minor children. gross per month, and has reasonable 10. Petitioner / Respondent has shown a need for child support in the amount of $ Petitioner has the ability to make these payments. Respondent / per 11. Petitioner / Respondent has shown a need for temporary financial support in the amount of $ Respondent / Petitioner has the ability to make those payments. and 12. and Petitioner / per Respondent should have the use and possession of the home and furnishings located at Respondent / Petitioner making the mortgage and/or rental in , S.C., with payments plus any taxes and/or insurance on the property. 13. Petitioner / Respondent retained an attorney, $ Petitioner should contribute to this expense. is a reasonable attorney’s fee, and Respondent / 14. Other: SCCA/426ABCD (07/08) Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com IT IS THEREFORE ORDERED THAT: A. Respondent / Petitioner is temporarily restrained, prohibited and forbidden to abuse, threaten to abuse, or molest, Respondent or engage in any other conduct that would place Petitioner / Respondent in reasonable fear Petitioner / of bodily injury. B. Respondent / Petitioner is temporarily restrained and prohibited from using, attempting to use, or threatening to use Petitioner / Respondent that would reasonably be expected to cause bodily injury. physical force against C. Respondent / Petitioner is temporarily restrained, prohibited and forbidden to communicate or attempt to Petitioner / Respondent’s place of communicate with Petitioner/Respondent in any way or to enter or attempt to enter residence, employment, education or the following locations: D. Petitioner / E. Respondent is awarded temporary custody of the minor children named: Respondent / Petitioner is awarded temporary visitation rights with the minor children as follows: F. Respondent / Petitioner shall pay the sum of $ each support through the clerk of court, plus 5% court costs, making a total payment of $ and each and every thereafter. as temporary child , commencing on G. Respondent / Petitioner shall pay the sum of $ each support through the clerk of court, plus 5% court costs, making a total payment of $ , and each and every thereafter. as temporary financial , thereafter commencing on , H. The sole, exclusive possession of the residence and furnishings located at the aforementioned address (appearing Respondent with Respondent / Petitioner under number “11” of this order) is awarded to Petitioner / making the mortgage and/or rental payments plus any taxes and/or Insurance on the property. I. Respondent / Petitioner is temporarily restrained, prohibited, and forbidden to transfer, encumber, destroy, sell or otherwise dispose of, except in the ordinary course of business, real or personal property jointly owned or leased Petitioner / Respondent claims an equitable interest including, but not limited to, the by the parties or in which following: J. Respondent / as a contribution toward Petitioner shall pay $ , to the Petitioner / Petitioner / Respondent’s attorney fees. Respondent by (date) K. The following law enforcement agencies be served with a copy of this Order by the clerk of court: L. The law enforcement agencies listed below are directed to assist Petitioner / Respondent as follows: (1) Accompany Respondent / Petitioner to remove his personal property at: . (2) Accompany located at: Petitioner / Respondent to assist in placing her in possession of the residence, . (3) Other: RESPONSIBLE LAW ENFORCEMENT AGENCIES: M. IT IS FURTHER ORDERED, pursuant to S.C. Code Ann. § 20-7-420-, that . N. Federal Firearms Prohibition, pursuant to 18 U.S.C § 922. 1. Does this Order protect an intimate partner, a child of an intimate partner, or a child of the Respondent? 2. Did the person restrained have actual notice and an opportunity to participate in the hearing? 3. Does the Order find the restrained person a credible threat or explicitly prohibit the use, attempted use, or threatened use of physical force? SCCA/426ABCD (07/08) YES NO YES YES NO NO Page 3 of 4 American LegalNet, Inc. www.FormsWorkflow.com THE PROVISIONS OF THIS ORDER SHALL EXPIRE ON (a date which is not less than 6 months and does not exceed 12 months from the date of this Order) UNLESS OTHERWISE PROVIDED BY S.C. CODE ANN. §20-4-70. VIOLATION OF THIS ORDER IS A CRIMINAL OFFENSE PUNISHABLE BY NOT MORE THAN THIRTY DAYS IN JAIL AND A FINE OF NOT MORE THAN FIVE HUNDRED DOLLARS OR MAY CONSTITUTE CONTEMPT OF COURT PUNISHABLE BY UP TO ONE YEAR IN JAIL AND/OR A FINE NOT TO EXCEED FIFTEEN HUNDRED DOLLARS. PURSUANT TO § 16-25-125 OF THE SOUTH CAROLINA CODE OF LAWS, IT IS UNLAWFUL FOR A PERSON WHO HAS BEEN CHARGED WITH OR CONVICTED OF CRIMINAL DOMESTIC VIOLENCE OR CRIMINAL DOMESTIC VIOLENCE OF A HIGH AND AGGRAVATED NATURE, WHO IS SUBJECT TO AN ORDER OF PROTECTION, OR WHO IS SUBJECT TO A RESTRAINING ORDER, TO ENTER OR REMAIN UPON THE GROUNDS OR STRUCTURE OF A DOMESTIC VIOLENCE SHELTER IN WHICH THE PERSON’S HOUSEHOLD MEMBER RESIDES OR THE DOMESTIC VIOLENCE SHELTER’S ADMINISTRATIVE OFFICES. A PERSON WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND, UPON CONVICTION, MUST BE FINED NOT MORE THAN THREE THOUSAND DOLLARS OR IMPRISONED FOR NOT MORE THAN THREE YEARS, OR BOTH. IF THE PERSON IS IN POSSESSION OF A DANGEROUS WEAPON AT THE TIME OF THE VIOLATION, THE PERSON IS GUILTY OF A FELONY AND, UPON CONVICTION, MUST BE FINED NOT MORE THAN FIVE THOUSAND DOLLARS OR IMPRISONED FOR NOT MORE THAN FIVE YEARS, OR BOTH. AND IT IS SO ORDERED. Date FAMILY COURT JUDGE , SC COPY GIVEN TO PETITIONER BY (initials) COPY GIVEN TO RESPONDENT BY (initials) RESPONDENT'S HOME ADDRESS: RESPONDENT’S PLACE OF EMPLOYMENT: Information which may be of assistance to law enforcement: Respondent’s height DL number weight ATTACH PHOTOSTATIC COPY OF RESPONDENT’S DRIVERS LICENSE, IF AVAILABLE. SCCA/426ABCD (07/08) Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com