Court of Washington Sexual Assault Protection Order For No. ______________________________ __________ Petitioner (Protected Person) DOB v. ______________________________ __________ Respondent (Restrained Person) DOB Court Address Telephone Number: ( ) (ORSXP) (JIS Order Code: SXP) Clerk's Action Required Court Administrator’s Action Required, ¶ 4 Respondent Identifiers Respondent’s Distinguishing Features: ______________________________________ ______________________________________ Sex Race Hair Height Weight Eyes Caution: Access to weapons: yes no unknown The Court Finds: The court has jurisdiction over the parties and the subject matter, and Chapter 26.50 RCW does not apply. Respondent has been provided reasonable notice and an opportunity to be heard. Notice of this hearing was personally served on the respondent. Additional findings of this order are set forth below. The Court Orders: The terms of this order shall be effective for two years from today’s date, unless stated otherwise here [date not to exceed two years]: Warnings to the Respondent: A knowing violation of this sexual assault protection 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 Prot Order (ORSXP) - Page 1 of 3 WPF SA-3.015 Mandatory (7/2007) - RCW 7.90.090, .120, .130 American LegalNet, Inc. www.FormsWorkflow.com The Court Finds: The respondent petitioner is under the age of 16 years of age and his or her parent(s) or guardian(s) had notice of this proceeding. ___________________________________________ __________________________________________appeared at this hearing and is a responsible and proper person and is appointed guardian ad litem for _____________________________________ ________________________________________________ solely for purposes of this proceeding. __________________________________________________________ is appointed attorney for _________________________________________________ solely for purposes of this proceeding. The court further finds by a preponderance of the evidence that the petitioner has been a victim of nonconsensual sexual conduct or nonconsensual sexual penetration by the respondent. It is Ordered: 1. Respondent is Restrained from having any contact with petitioner, including but not limited to telephone calls, mail, e-mail, fax and written notes, directly, indirectly, or through third parties regardless of whether those third parties know of the order. 2. Respondent is Excluded from the following places: Petitioner’s residence Petitioner’s workplace Petitioner’s school Petitioner’s day care Other: 3. Respondent is Prohibited from knowingly coming within, or knowingly remaining within __________________ (distance) of: Petitioner’s residence Petitioner’s workplace Petitioner’s school Petitioner’s day care Other: 4. Respondent is Restrained from attending _________________________________ school at _________________________________________________ (address) attended by petitioner and the respondent is Ordered to transfer to a different school. Respondent or respondent’s parents or legal guardians are responsible for transportation and all other costs associated with change of school. See Appendix A, which is attached and incorporated by reference. 5. Other: Sexual Assault Prot Order (ORSXP) - Page 2 of 3 WPF SA-3.015 Mandatory (7/2007) - RCW 7.90.090, .120, .130 American LegalNet, Inc. www.FormsWorkflow.com 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 Petitioner Lives which shall enter it in a computer-based criminal intelligence system available in this state used by law enforcement to list outstanding warrants. Service The clerk of the court shall also forward a copy of this order on or before the next judicial day to County Sheriff's Office Police Department Where Respondent Lives which shall personally serve the respondent with a copy of this order and shall promptly complete and return to this court a Return of Service. The clerk of the court shall also forward a copy of this order on or before the next judicial day to County Sheriff's Office Police Department for service upon ________________________________________________ (Respondent’s Parent(s) or Legal Guardian(s)) at: _______________________________________ _______________________________________________________and law enforcement shall promptly complete and return to this court a Return of Service. Petitioner shall make private arrangements for service of this order. Respondent appeared and was served a copy of the order by the court; further service is not required. This Order is in Effect Until the Expiration Date on Page One. Dated: __________________________________ at ______________________ a.m./p.m. Judge/Commissioner Presented by: Petitioner I acknowledge receipt of a copy of this Order: Date Person Filing Petition on Behalf of Petitioner/Date Respondent Date Respondent’s Guardian ad Litem, if any/Date A Law Enforcement Information Sheet (LEIS) must be completed. Sexual Assault Prot Order (ORSXP) - Page 3 of 3 WPF SA-3.015 Mandatory (7/2007) - RCW 7.90.090, .120, .130 American LegalNet, Inc. www.FormsWorkflow.com