Civil Stalking Injunction Case Number: _______ District: __________ County: _____________ State: Utah Judge: _______________________________ Petitioner (person who asked for the stalking injunction): ________________ First Name ____________ Middle ____________ Last Other people protected by this order: Address and phone # (to keep private, leave blank): Name Age Relationship to Petitioner ___________________________________ Street ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____ _____________ ____ _____________ ____ _____________ ____ _____________ ____ _____________ ____ _____________ ___________________________________ City --- State --- Zip ___________________________________ Phone # Petitioner's attorney (if any):________________________________________Phone #_______________ Name Respondent (person who must obey this stalking injunction): Describe Respondent Sex ____ Eye Color ____ Race _______ Hair Color ______ Date of Birth ______ Height _______ Weight ______ ____________ _________ _________ First Name Middle Last Other Names Used _______________________ ____________________________________ Address Social Security Number (last four digits only) _____ ____________________________________ Street Distinguishing features (like scars, tattoos, limp, etc.) __________________________________________ Driver's license issued by ____________________________________ City --- State --- Zip (State):____________ Expires ______________ Warning! [__] Weapon involved (Box to be initialed by Court, if applicable) Civil Stalking Injunction Approved by Board of District Court Judges, June 2013 Revised December 15, 2014 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com There was a hearing on (date): . The Respondent was given notice and an opportunity to be heard in the hearing that gave rise to this order. The following people were present at the hearing: [__] Petitioner [__] Petitioner's attorney (name): [__] Respondent [__] Respondent's attorney (name): [__] Other (name) The Court reviewed the Request for Civil Stalking Injunction and: [__] received argument and evidence, [__] accepted the stipulation of the parties, [__] entered the default of the Respondent for failure to appear, [__] other:______________, and finds that there is reason to believe that stalking has occurred and that the Respondent is the stalker. (Utah Code Sect77-3a-101) Violence Against Women Act of 1994, 18 U.S.C. Sect 2265, 2262, 18 U.S.C. Sect 922(g)(8) The Respondent must obey all orders initialed by the judicial officer. These orders replace any previous temporary stalking injunction in this case. Violation of these orders is a criminal Class A Misdemeanor, punishable by up to one year in jail and a fine. A second or subsequent violation can result in more severe penalties. 1 [___] Personal Conduct Order Do not stalk the Petitioner. This means you must not follow, threaten, annoy, harass, or cause distress to the Petitioner. For a legal definition of stalking, see Utah Code, sections 76-5-106.5 and 77-3a-101. 2 [___] No Contact Order Do not contact, phone, text, mail, e-mail, or communicate either directly or indirectly in any way with the Petitioner and any person listed on page 1 of this order and any person listed below. Other people you must not contact: 3 [___] Stay Away Order Stay away from: [__] a. The Petitioner's current or future: [__] Vehicle and property (list current addresses below) Home address: Work address: School address: Describe vehicle: b. Other (specify): [__] Job [__] School [__] Home, premises [__] 4 [___] Child Custody & Parent-time Orders The Petitioner will have temporary custody of the minor children listed below. If you do not obey the custody and parent-time orders listed here, the Petitioner may ask for the court's help (such as an order to show cause for contempt): Civil Stalking Injunction Approved by Board of District Court Judges, June 2013 Revised December 15, 2014 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com _____________________________________________________________________ _____________________________________________________________________ You will have parent-time as follows: _________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ You can only communicate with the Petitioner about parent-time through the following person: _____________________________________________________________________ The custody and parent-time orders are effective until modified by this court or superseded by another court order. 5 [___] Other Orders: _____________________________________________________________________ _____________________________________________________________________ Warnings to the Respondent: Attention: This is an official court order. No one except the court can change it. If you disobey this order, the court may find you in contempt. You may also be arrested and prosecuted for the crime of stalking and any other crime you may have committed in disobeying this order. This order is valid in all U.S. states and territories, the District of Columbia, and tribal lands. If you go to another U.S. state, territory or tribal land to violate this order, a federal judge can send you to prison. It may be a federal crime for you to have, possess, transport, ship, or receive any firearm or ammunition, including hunting weapons, while this civil stalking injunction is in effect. This order expires in three years on: ____________________________________ Month Day Year _ Date: _______________ ___________________________________________________ Judge (printed name) _____________________________________ Respondent's Waiver of Notice I received a copy of this Civil Stalking Injunction, and waive my right to be personally served with the order. Respondent's Address Street _______________________________ City __________________ State _____________ Zip ___________ Respondent's Signature: ______________________________________________________________________________ Civil Stalking Injunction Approved by Board of District Court Judges, June 2013 Revised December 15, 2014 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com