Superior Court of Washington County of _______________________ Juvenile Court No: State of Washington v. Respondent(s). D.O.B.: Sexual Assault Protection Order Pre-Adjudicatory Hearing Post-Adjudication (ORSXP) (JIS order code: SXP) Clerk’s Action Required The court finds that the respondent has been charged with, arrested for, or adjudicated of a sex offense as defined in RCW 9.94A.030, a violation of RCW 9A.44.096, a violation of RCW 9.68A.090, or a gross misdemeanor that is, under chapter 9A.28 RCW, a criminal attempt, criminal solicitation, or criminal conspiracy to commit an offense that is classified as a sex offense under RCW 9.94A.030. This Sexual Assault Protection Order is entered pursuant to Laws of 2006, ch.138, §16. This order protects:______________________________________________________________________. (Write protected person’s name or if minor you may use initials and DOB. RCW 7.96A.030, 10.52.100, 10.97.130.) It is Ordered: This Pre-Adjudicatory Hearing Sexual Assault Protection Order Expires on: __________________. This Post Adjudication Sexual Assault Protection Order Expires on: _________________________. (A final sexual assault protection order entered in conjunction with a criminal prosecution shall remain in effect for a period of two years following the expiration of any sentence of confinement and subsequent period of community supervision, conditional release, probation, or parole.) Respondent is Prohibited from: A. Having any contact with the protected person(s) directly, indirectly or through 3rd parties regardless of whether those 3rd parties know of the order. B. Knowingly coming within or knowingly remaining within ______________________ [distance] of the workplace other: protected person(s)’s residence school _________________________________________________________________________________ _________________________________________________________________________________ . Warnings to the Responent: Violation of this order is a criminal offense under chapter 26.50 RCW and will subject a violator to arrest. You can be arrested even if any person protected by the order invites or allows you to violate the order’s prohibitions. You have the sole responsibility to avoid or refrain from violating the order’s provisions. Only the court can change the order. Sexual Assault Protection Order (ORSXP) - Page 1 of 2 WPF JU 07.0520 - (6/2006) Laws of 2006, ch. 138, § 16 American LegalNet, Inc. www.USCourtForms.com This order is issued in accordance with Full Faith and Credit provisions of VAWA: 18 U.S.C. § 2265. The court determines that the defendant’s relationship to a person protected by this order is: current or former spouse parent of a common child current or former cohabitant as intimate partner current or former dating partner. Therefore, 18 U.S.C. §§ 2261 (federal violation penalties) may apply to this order. It is further ordered that the clerk of the court shall forward a copy of this order on or before the next judicial day to:____________________________________________ County Sheriff’s Office Police Department Where the Case is Filed, which shall enter it in a computer-based criminal intelligence system available in this state used by law enforcement to list outstanding warrants. This Sexual Assault Protection Order Expires on the Date Shown on Page One. Done in open court in the presence of the respondent this date:___________________________. Judge/Commissioner Print or Type Name: Deputy Prosecuting Attorney WSBA No. Print or Type Name: Attorney for Respondent WSBA No. Print or Type Name: Respondent Print or Type Name: Sexual Assault Protection Order (ORSXP) - Page 2 of 2 WPF JU 07.0520 - (6/2006) Laws of 2006, ch. 138, § 16 American LegalNet, Inc. www.USCourtForms.com