) ) COUNTY OF _____________________________ ) ) ) Petitioner, ) ) vs. ) ) ) Respondent. ) ) PETITIONER IDENTIFIERS Date of Birth of Petitioner STATE OF SOUTH CAROLINA IN THE FAMILY COURT _____JUDICIAL CIRCUIT FAMILY COURT ORDER PROTECTION FROM DOMESTIC ABUSE ACT (For Use By Family Court Judges) Docket No. Judge: Attorney for Petitioner: Attorney for Respondent: Court Reporter: RESPONDENT IDENTIFIERS SEX * EYES HAIR HEIGHT DRIVERS LICENSE # Relationship to Petitioner: RACE * DOB* SOCIAL SECURITY # WEIGHT STATE And/or on behalf of minor family member(s) or other Protected persons: (list name and DOB) 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: Phone Number - Sheriff Phone Number ­ Clerk of Court Page 1 of 4 SCCA 426 (3/2013) American LegalNet, Inc. www.FormsWorkFlow.com A Petition for Order of Protection was filed on (date) ____________________. I held a hearing on (date) ________________________. 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 have this child/children in common: are household or family members pursuant to S.C. Code § 20-4-20(a)(2) are cohabiting were cohabiting 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) ______________at ______ o'clock ( a.m. / p.m) at ____________________________ in this manner: ____________________________________________________________________________________ _________________________________________________________________________________________________. 4. ___________________________________________________________ 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 victim. The ( Respondent / Petitioner) used, attempted to use, or threatened to use physical force against ( Respondent / Petitioner) that is reasonably expected to cause bodily injury. 7. The ( Petitioner / Respondent) is a fit and proper person to have custody of the minor child or children. 8. ( Respondent / Petitioner) is employed at ___________________________________________ and earns approximately $_______________ gross per month and has reasonable monthly expenses of $_________________. 9. ( Respondent / Petitioner) is employed and earns approximately $_______________ gross per month, and has reasonable monthly expenses of $______________ for ( himself / herself) and the minor children. 10. ( Petitioner / _______________ and ( Respondent) has shown a need for child support in the amount of $_______________ per Petitioner / Respondent) has the ability to make these payments. 11. ( Petitioner / Respondent) has shown a need for temporary financial support in the amount of $_____________________ per __________________and ( Petitioner / Respondent) has the ability to make those payments. 12. ( Petitioner / Respondent) should have the use and possession of the home and furnishings located at ___________________________________________ in __________________________, S.C., with ( Respondent / Petitioner) making the mortgage and/or rental payments plus any taxes and/or insurance on the property. 13. ( Petitioner / Respondent) retained an attorney, $________________ is a reasonable attorney's fee, and ( Respondent / Petitioner) should contribute to this expense. 14. Other: . Page 2 of 4 SCCA 426 (3/2013) 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, ( Petitioner / Respondent) or engage in any other conduct that would place ( Petitioner / Respondent) in reasonable fear of bodily injury. B. ( Respondent / Petitioner) is temporarily restrained and prohibited from using, attempting to use, or threatening to use physical force against ( Petitioner / Respondent) that would reasonably be expected to cause bodily injury. C. ( Respondent / Petitioner) is temporarily restrained, prohibited and forbidden to communicate or attempt to communicate with ( Petitioner / Respondent) in any way or to enter or attempt to enter ( Petitioner's / Respondent's) place of residence, employment, education or the following locations: _____________________________ _________________________________________________________________________________________________. D. ( Petitioner / Respondent) is awarded temporary custody of the minor child(ren) named _________________________________________________________________________________________________. E. ( Respondent / Petitioner) is awarded temporary visitation rights with the minor child(ren) as follows: ________________________________