Modified Temporary Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 1 of 6 Modified Temporary Protective Order Ex Parte Order Case Number: District: County: State: Utah Judge: Petitioner (protected person): Commissioner: First Name Middle Last Address and phone # (to keep private, leave blank): Other people protected by this order Street Name (Initials only if under 18) Age Relationship to Petitioner City --- State --- Zip Phone # Respondent Describe Respondent (person Petitioner is protec ted from): Sex Race Date of Birth Ht. Wt. First Name Middle Last Other Names Used Eyes Hair Social Se curity # (only the last 4 numbers) Relationship to Petitioner: Address (street): Distinguishing features (like scars, tattoos, limp, etc.) City --- State --- Zip (State): Expires: Warning! [] Weapon involved (Box to be initialed by Court, if applicable) Findings: The Court has reviewed the Request to Modify the Temporary Protective Order and finds it has continuing jurisdiction over the parties and this case; there is reason to believe the existing order listed immediately below should be modified; the Respondent will be served notice of his/her opportunity to be heard at the scheduled hearing, and there is a substantial likelihood that Respondent immediately threatens American LegalNet, Inc. www.FormsWorkFlow.com Modified Temporary Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 2 of 6 The Court orders the Respondent to obey all orders initialed on this form and to not abuse, or threaten to abuse, anyone protected by this order. [] You must not have any contact with the Petitioner. (The court fills out this section) This order lasts until the hearing on: Month Day Year Or later, if the Court extends time for service. Warnings to the Respondent: This is a court order. No one except the court can change it. You can tell your side when you go to court. If you do not obey this order, you can be arrested, fined, and face other charges. 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. No guns or firearms! (See item 5.) Violence Against Women Act of 1994, 18 U.S.C. Sect 2265, 2262, 18 U.S.C. Sect 922(g)(8) To: Go to the court hearing on the date listed below. If you do not go to the hearing, the judge can make orders without hearing your side. Date: Time: [] a.m. [] p.m. Judicial Officer: Address: Room: Obey all orders initialed by the judge. Violation of orders 16 below 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 commit, try to commit or threaten to commit any form of violence against the Petitioner or any person listed on the first page of this form. This includes stalking, harassing, threatening, physically hurting, or causing any other form of abuse. 2 [] No Contact Order Do not contact, phone, mail, e-mail, or communicate in any way with the Petitioner and the people listed on the first page of this order either directly or indirectly except as allowed by the parent-time provisions of this order. American LegalNet, Inc. www.FormsWorkFlow.com Modified Temporary Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 3 of 6 3 [] Contact for Mediation You are allowed to have contact with the Petitioner only during court mediation sessions for your divorce or custody case that are scheduled with a Court Qualified Mediator. 4 [] Stay Away Order [ ] a. Stay at least (distance) from the Petitioner. [ ] b. Stay away from Petitioner's Home: (address) Work : (address) School: (address) Place of worship: (address) [ ] c. Must comply with the following restrictions while at Respondent's and Petitioner's Work : (address) School: (address) Place of worship: (address) [ ] d. Stay away from the people listed on the first page of this form at their: Home: (address) Work : (address) The respondent [ ] does [ ] does not work at the same place as the people listed on the first page of this form. School: (address) The respondent [ ] does [ ] does not go to the same school as the people listed on the first page of this form. Place of worship: (address) The respondent [ ] does [ ] does not attend the same place of worship as the people listed on the first page of this form. [ ] e. Must comply with the following restrictions while at Respondent's and the people listed on the first page of this form's: Work : (address) American LegalNet, Inc. www.FormsWorkFlow.com Modified Temporary Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 4 of 6 School: (address) Place of worship: (address) [] f. Other (specify): 5 [] No Guns or Other Weapons The Court finds that your use or possession of a weapon poses a serious threat of harm to the Petitioner. You cannot possess, have, or buy a gun or firearm or any of these weapons: Warning! If a final protective order is issued against you after the hearing, you will then become subject to the federal law making it a crime to possess, transport, ship or receive any firearm or ammunition, including a hunting weapon. 6 [] Property Orders Until the hearing, only the Petitioner can use, control and possess the following property and things, but cannot dispose of this property without court approval: [] a. Home at (address): [] b. Car, truck or other property (describe): If you violate orders 7 14, you will be in contempt of court and may be punished. 7 [] Property Orders [ ] You cannot interfere with or change Petitioner's phone, utility or other services. [ ] You must maintain Petitioner's existing wireless phone contracts or accounts. 8 [] Transfer Wireless Phone Number(s) You must transfer the Petitioner's current wireless phone number(s) to a new account of their choice. The court will issue a separate order to the wireless service provider to transfer Petitioner's wireless phone number(s) to a new account. 9 [] Proof of Income You and Petitioner must bring the following proof of income to the hearing: American LegalNet, Inc. www.FormsWorkFlow.com Modified Temporary Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 5 of 6 pay stubs or employer statements for this year, and complete tax returns for the most recent year. 10 [] Child Custody & Parent-time Orders [ ] The Petitioner (the person asking for protection) [ ] (name) will have temporary custody of the minor children of the parties listed below. The person with custody daycare. If you do not obey the custody and parent-time orders listed here, the person with custody contempt): [] You will have parent-time as follows: or the person with custody only about parent-time matters through: 11 [] No Parent Time No parent time is allowed until the scheduled hearing. 12 [] No Alcohol or Illegal Drugs Do not use alcohol or illegal drugs before or during visitation. 13 [] No Travel with Children Do not take the children listed above out of the state of Utah. 14 [] Other Orders (List below): Orders to Agencies 15 [] Law Enforcement to Assist A law enforcement officer from: will enforce the orders checked below: [] a. Help the Petitioner gain and keep control over home, car or other personal belongings. [] b. Help the Petitioner obtain custody of the children. [] c. Help the [] Respondent or [] Petitioner remove essential personal belongings from the home. personal records sol Warning to the Respondent: Do not go to the home or other protected places without the officer. Law enforcement can evict you or keep you away from protected places, if needed. 16 [] Investigate Possible Child Abuse This matter will be referred to the Division of Child and Family Services for review and possible investigation of child abuse. 17 [] Guardian for your children American LegalNet, Inc. www.FormsWorkFlow.com Modified Temporary Protective Order Approved Board of District Court Judges May 21,