Order for Protection (ORPRT) - Page 1 of 6 WPF DV-3.015 Mandatory (08/2017) - RCW 26.50.060, RCW 9.41.800 Court of Washington For Order for Protection No. Court Address Telephone Number:( ) (Clerk's Action Required) (ORPRT) Petitioner (First, Middle, Last Name) DOB vs. Respondent (First, Middle, Last Name) DOB Names of Minors: No Minors Involved Respondent Identifiers (List first, middle and last name/s and age/s) Caution: Access to weapons: yes no unknown Sex Race Hair Height Weight Eyes Respondent222s Distinguishing Features : The Court Finds Based Upon the Court Record: The court has jurisdiction over the parties, the minors, and the subject matter. Respondent had reasonable notice and an opportunity to be heard. Notice of this hearing was served on the respondent by personal service service by mail pursuant to court order service by publication pursuant to court order other . Respondent received actual notice of the hearing. Respondent was was not present at the hearing. This order is issued in accordance with the Full Faith and Credit provisions of VAWA: 18 U.S.C. 247 2265. Respondent222s relationship to the victim is: spouse or former spouse current or former dating relationship in-law parent or child parent of a child in common stepparent or stepchild blood relation other than parent or child current or former domestic partner current or former cohabitant as roommate current or former cohabitant as part of a dating relationship Respondent committed domestic violence as defined in RCW 26.50.010. Respondent represents a credible threat to the physical safety of the protected person/s. Additional findings may be found below. The court concludes that the relief below shall be granted. Court Order Summary (additional provisions are listed on the following pages): Respondent is restrained from committing acts of abuse as listed in provisions 1 and 2, on page 2. No-contact provisions apply as set forth on the following pages. Prohibition and surrender of weapons apply. This order is effective immediately and for one year from today222s date, unless stated otherwise here (date): American LegalNet, Inc. www.FormsWorkFlow.com Order for Protection (ORPRT) - Page 2 of 6 WPF DV-3.015 Mandatory (08/2017) - RCW 26.50.060, RCW 9.41.800 It is Ordered: 1. Respondent is restrained from causing physical harm, bodily injury, assault, including sexual assault, and from molesting, harassing, threatening, or stalking petitioner the minors named in the table above these minors only: (Respondent: If the petitioner is your spouse or former spouse, current or former domestic partner, the parent of a child in common, or a current or former cohabitant as part of a dating relationship, you will not be able to own or possess a firearm, other dangerous weapon, ammunition, or concealed pistol license under state or federal law for the duration of the order.) 2. Respondent is restrained from harassing, following, keeping under physical or electronic surveillance, cyberstalking as defined in RCW 9.61.260, and using telephonic, audiovisual, or other electronic means to monitor the actions, locations, or wire or electronic communication of petitioner the minors named in the table above only the minors listed below members of the victim222s household listed below the victim222s adult children listed below: 3. Respondent is restrained from coming near and from having any contact whatsoever, in person or through others, by phone, mail, or any means, directly or indirectly, except for mailing or service of process of court documents by a 3rd party or contact by Respondent222s lawyer(s) with petitioner the minors named in the table above these minors only: If both parties are in the same location, respondent shall leave. 4. Respondent is excluded from petitioner's residence workplace school; the day care or school of the minors named in the table above these minors only: Other Petitioner's address is confidential. Petitioner waives confidentiality of the address which is: 5. Petitioner shall have exclusive right to the residence that petitioner and respondent share. The respondent shall immediately vacate the residence. The respondent may take respondent's personal clothing and tools of trade from the residence while a law enforcement officer is present. This address is confidential. Petitioner waives confidentiality of this address which is: 6. Respondent is prohibited from knowingly coming within, or knowingly remaining within (distance) of: petitioner222s residence workplace school; the day care or school of the minors named in the table on page one these minors only: Other: American LegalNet, Inc. www.FormsWorkFlow.com Order for Protection (ORPRT) - Page 3 of 6 WPF DV-3.015 Mandatory (08/2017) - RCW 26.50.060, RCW 9.41.800 7. Petitioner shall have possession of essential personal belongings, including the following: 8. Petitioner is granted use of the following vehicle: Year, Make & Model License No. 9. Other: Protection for minors : This state has exclusive continuing jurisdiction; is the home state; has temporary emergency jurisdiction that may become final jurisdiction under RCW 26.27.231(2); other: 10. Petitioner is granted the temporary care, custody, and control of the minors named in the table above these minors only: The respondent will be allowed visitations as follows: Petitioner may request modification of visitation if respondent fails to comply with treatment or counseling as ordered by the court. If the person with whom the child resides a majority of the time plans to relocate the child, that person must comply with the notice requirements of the Child Relocation Act. Persons entitled to time with the child under a court order may object to the proposed relocation. See RCW 26.09, RCW 26.10 or RCW 26.26 for more information . 11. Respondent is restrained from interfering with petitioner's physical or legal custody of the minors named in the table above these minors only: 12. Respondent is restrained from removing from the state the minors named in the table above these minors only: Additional requests: 13. Respondent shall participate in treatment and counseling as follows: domestic violence perpetrator treatment program approved under RCW 26.50.150 or counseling at: parenting classes at: drug/alcohol treatment at: other: American LegalNet, Inc. www.FormsWorkFlow.com Order for Protection (ORPRT) - Page 4 of 6 WPF DV-3.015 Mandatory (08/2017) - RCW 26.50.060, RCW 9.41.800 14. Petitioner is granted judgment against respondent as provided in the Judgment, WPF DV 3.030. 15. Parties shall return to court on , at .m. for review. Protection for pets : 16. Petitioner shall have exclusive custody and control of the following pet(s) owned, possessed, leased, kept, or held by petitioner, respondent, or a minor child residing with either the petitioner or the respondent. (Specify name of pet and type of animal): . 17. Respondent is prohibited from interfering with the protected person222s efforts to remove the pet(s) named above. 18. Respondent is prohibited from knowingly coming within, or knowingly remaining within (distance) of the following locations where the pet(s) are regularly found: petitioner's residence (You have a right to keep your residential address confidential.) Park other: Prohibit Weapons and Order Surrender The Respondent must: not possess or obtain any firearms, other dangerous weapons, or concealed pistol license; and comply with the Order to Surrender Weapons filed separately. Findings 226 The court (check all that apply): must issue the orders referred to above because: the first restraint provision is ordered above, and the court found on page one that the Respondent had actual notice, represented a credible threat, and was an intimate partner. Respondent: If the court checked this box, then effective immediately, and continuing as long as this protection order is in effect, you may not possess a firearm under state law. Violation is a felony. RCW 9.41.040(2). the court finds by clear and convincing evidence that the restrained person has: used, displayed, or threatened to use a firearm or other dangerous weapon in a felony; or previously co