RCW 26. 10 . 115 , 26.50; CR 65 (b) Mandatory Form ( 07/2017 ) FL Non - Parent 422 Immediate Restraining Order (Ex Parte) and Hearing Notice p. 1 of 4 Superior Court of Washington, County of In re custody of: Children : Petitioner/s (person/s who started this case) : Respondents ( parents and any guardian or custodian) : No. Immediate Restraining Order (Ex Parte) and Hearing Notic e (Non - Parent Custody) (TPROTSC / ORTSC) : 2 , 13 Immediate Restraining Order (Ex Parte) and Hearing Notice (Non-Parent Custody) Use this form in non-parent custody cases only. For marriage/domestic partner cases, use form FL Divorce 222. For parentage cases, use form FL Parentage 322. 1. This Order starts immediately and ends after the hearing listed below. 2. Hearing Notice The court will consider extending this order and the other requests made by the protected person at a court hearing: on: at: a.m. p.m. date time at: , room or department docket / calendar or Warning! If you do not go to the hearing, the court may make orders against you without hearing your side. American LegalNet, Inc. www.FormsWorkFlow.com RCW 26. 10 . 115 , 26.50; CR 65 (b) Mandatory Form ( 07/2017 ) FL Non - Parent 422 Immediate Restraining Order (Ex Parte) and Hearing Notice p. 2 of 4 3. This Order restrains (name): Warning! You must obey this order or you may be jailed. Violation [of sections 6-8] of this order with actual notice of its terms is a criminal offense under Chapter 26.50 RCW and will subject a violator to arrest. Violation of any part of this order may result in financial penalties or contempt of court. This order is enforceable in all 50 U.S. states, the District of Columbia, and U.S. territories and tribal lands (18 U.S.C. 247 2265). 4. This Order protects (name/s): and the following children, who are under 18 (if any) Age Age 1. 4. 2. 5. 3. 6. 5. Findings The court has reviewed the Motion for Immediate Restraining Order, supporting documents, and any other evidence considered on the record, including . The court finds there would be irreparable harm as described in the Motion if this order is not granted. If hearing date is more than 14 days away There is good cause to keep this order in effect until the hearing date (which is between 14 and 28 days after this order is issued) because (describe the good cause): Other findings: Court Orders to the Restrained Person listed in 3: 6. Do not disturb Does not apply. The Restrained Person must not disturb the peace of the Protected Person or of any child listed in 4. American LegalNet, Inc. www.FormsWorkFlow.com RCW 26. 10 . 115 , 26.50; CR 65 (b) Mandatory Form ( 07/2017 ) FL Non - Parent 422 Immediate Restraining Order (Ex Parte) and Hearing Notice p. 3 of 4 7. Stay away Does not apply. The Restrained Person must not go onto the grounds of or enter the home, workplace, or school, and the daycare or school of any child listed in 4. The Restrained Person must not knowingly go or stay within feet of the P rotected 4. 8. Do not hurt or threaten Does not apply. The Restrained Person must not: Assault, harass, stalk or molest the Protected Person or any child listed in 4; or Use, try to use, or threaten to use physical force against the Protected Person or children that would reasonably be expected to cause bodily injury. 9. Surrender weapons Does not apply. The Restrained Person must follow the Order to Surrender Weapons Issued Without Notice (form All Cases 2-030) signed by the court and filed separately. Findings The court finds irreparable injury could result if an order is not issued until the time for response has elapsed. 10. Protect children (Name/s): must not take the children listed in 4 out of Washington state. Until the hearing, the children listed in 4 will live with (name): . Other: 11. Bond No bond or security is required. (Name): must file a bond or post security. Amount: $ . 12. Other immediate orders Does not apply. American LegalNet, Inc. www.FormsWorkFlow.com RCW 26. 10 . 115 , 26.50; CR 65 (b) Mandatory Form ( 07/2017 ) FL Non - Parent 422 Immediate Restraining Order (Ex Parte) and Hearing Notice p. 4 of 4 13. To the Clerk: Provide a copy of this order and the Law Enforcement Information Sheet to the agency listed below within one court day. The law enforcement agency must enter Name of law enforcement agency where the protected person lives: Ordered. Date Time Judge or Commissioner Presented by: Petitioner Respondent Sign here Print name (if lawyer, also list WSBA #) Date To the Protected Person: Warning! You must have this o rder served on the Restrained Person before it can be enforced. 1. Fill out a Law Enforcement Information Sheet (form All Cases 01.0400) and give it to the clerk. 2. You must have this Order, and the paperwork you filed with the court to get this Order, persona lly served on the Restrained Person by someone 18 or older who is not a party to this case. (Do not serve the Law Enforcement Information Sheet on the Restrained person it is only for law enforcement.) 3. After serving, the server fills out a Proof of Pers onal Service (FL All Family 101) and gives it to you. Then: File the original Proof of Personal Service with the court clerk. Give a copy of the Proof of Personal Service to the law enforcement agency listed above. Go to the hearing. Bring proposed orde rs to the hearing. American LegalNet, Inc. www.FormsWorkFlow.com