FILING OF FOREIGN PROTECTIVE ORDER Commonwealth of Virginia Case No. ........................................................................................ VA. CODE § 16.1-279.1 ................................................................................................................................................................................................................................................................. Name of Party Filing Foreign Protective Order: Virginia Address of Party Filing Order: Court .................................................................................................................................................................... ...................................................................................................................................................................................... Name of Person(s) Protected by the Order: ............................................................................................................................................................................... Name of Defendant/Respondent: ..................................................................................................................................................................................................... Issuing Jurisdiction: ................................................................................................................................................................................................................................. STATE Name of Court which issued Order: Date of Entry: COUNTY OR CITY .......................................................................................... ...................................................................................................... Case No. .......................................................................... Expiration Date (if any): ...................................................................... ______________________________________________________________ SIGNATURE OF PARTY FILING ORDER Defendant/Respondent’s Description (for VCIN entry): Full Name: ................................................................................................................................................................................................................................................................................ Address: ..................................................................................................................................................................................................................................................................................... Telephone No. COMPLETE DATA BELOW IF KNOWN ............................................................................................. RACE SEX BORN MO. DAY HT. YR. FT. WGT. EYES HAIR IN. SSN CLERK’S CERTIFICATION An attested or exemplified copy of the above-identified foreign protective order has been filed with this Court. ....................................................................... DATE FORM DC-684 MASTER 07/09 ______________________________________________________________ [ ] CLERK [ ] DEPUTY CLERK American LegalNet, Inc. www.FormsWorkFlow.com