STATE OF SOUTH DAKOTA COUNTY OF ) ) ) IN CIRCUIT COURT JUDICIAL CIRCUIT , Petitioner, TPO NO. -vs- ORDER OF PROTECTION AGAINST DOMESTIC ABUSE , Respondent VIOLATION OF THIS PROTECTION ORDER IS A CRIMINAL OFFENSE. This matter came before this Court on this day and the following parties appeared personally: Petitioner Petitioner’s Attorney Respondent Respondent’s Attorney Other 1. This Court FINDS that, without admitting to the allegations in the Petition, the Respondent waives further hearing, findings of fact, and conclusions of law, and stipulates to the entry of an Order of Protection on the terms specified below. 2. Having considered the evidence presented and any affidavits and pleadings on file, this Court FINDS: 1. That jurisdiction and venue are properly before this Court; 2. That the above-named Petitioner and Respondent are "family or household members" within the meaning of SDCL 25-10-1(2); 3. By a preponderance of the evidence that "domestic abuse" as defined by SDCL 25-10-1(1) has occurred; and 4. That the Respondent had actual notice of the hearing and an opportunity to participate. THEREFORE, THIS COURT ORDERS THAT: 1. The Respondent shall be restrained from committing any acts resulting in physical harm, bodily injury or attempting to cause physical harm or bodily injury, or from inflicting fear of imminent physical harm of bodily injury against family or household members, SDCL 25-10-1. / / and ending on / / . 2. This Protection Order is in effect beginning THIS COURT FURTHER ORDERS THE FOLLOWING: 3. The Respondent shall immediately be excluded from the Petitioner’s residence or the dwelling at the following address: (street,apt/box) (city) , South Dakota (zip code) 4. The Petitioner shall have temporary custody of the minor child(ren), whose names are: 5. Temporary visitation for the abusing party with the minor child(ren) named above shall consist of: Form UJS-092A Rev. 07/01/2002 6. The Respondent shall not come within a distance of of the Petitioner personally or of the child(ren) named above, except as provided in an existing visitation order, nor shall the Respondent contact the Petitioner in any manner except as follows: 7. The Respondent shall pay temporary: child support in the amount of $ a month starting on and continuing until further order of the Court; Child support shall be paid to: Office of Child Support Enforcement Kneip Building 700 Governors Drive Pierre, SD 57501 spousal support in the amount of $ a month starting on and continuing until further order of the Court. Spousal support shall be paid to the Clerk of Courts Office in the county this order was filed. 8. The parties shall receive instruction on parenting approved or provided by the Department of Social Services, SDCL 25-10-5. 9. The parties shall obtain counseling as follows: 10.Other relief as follows: AND IT IS FURTHER ORDERED THAT: the Petitioner shall, immediately upon the granting of this Order, deliver two copies of this Order to the sheriff of this county. One copy shall be personally served by the sheriff upon the Respondent, unless personal service has been acknowledged below. This Protection Order will remain in effect until the above expiration date, unless modified by this Court. DATED / / . I hereby authorize service of this order on a Sunday Judge Attest: By: , Clerk of Courts , Deputy ACKNOWLEDGMENT OF PERSONAL SERVICE I hereby acknowledge receipt of a copy of this Order of Protection. Petitioner Respondent Form UJS-092A Rev. 07/01/2002 NOTICE TO PETITIONER: Pursuant to federal law (18 U.S.C. § 2265), this Protection Order may be afforded full faith and credit and may be enforceable in other state and tribal jurisdictions. NOTICE TO THE RESPONDENT RESTRAINED BY THIS ORDER: You are subject to the following federal laws: (1) Effective immediately, you may not possess, carry, ship or transport any firearm or ammunition that has been transported in interstate or foreign commerce while this Protection Order is in effect. Title 18 United States Code Section 922(g)(8). (2) If you violate this Protection Order and are convicted of an offense of domestic violence, you will be forbidden for life from possessing, carrying, shipping or transporting, any firearm or ammunition that has been transported in interstate or foreign commerce. Title 18 United States Code Section 922(g)(9). Violation of these federal laws carries a maximum penalty of ten years in prison, a $250000 fine, or both. Form UJS-092A Rev. 07/01/2002