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Sexual Assault Protection Order Form. This is a Washington form and can be use in Sexual Assault Statewide.
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Tags: Sexual Assault Protection Order, SA-3.015, Washington Statewide, Sexual Assault
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
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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
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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