Adult Protective Order

Extended Order for Protection Against Domestic Violence

Case No.    Dept. No.

In the Justice Court of Township

County of , State of Nevada

VIOLATION OF THIS ORDER IS A CRIME

YOU, THE ADVERSE PARTY, ARE NOTIFIED THAT YOU CAN BE ARRESTED even if the person who obtained this Order invites or allows you to contact him or her. You have the sole responsibility to avoid or refrain from violating the terms of this Order. Only the Court can change this Order upon written application.

YOU ARE FURTHER NOTIFIED THAT IF YOU ARE ARRESTED FOR VIOLATING THIS ORDER, you will not be admitted to bail sooner than 12 hours after your arrest if certain conditions apply.

YOU ARE FURTHER NOTIFIED that child stealing/kidnapping is a felony.

THIS ORDER is valid and enforceable throughout the State of Nevada and under federal law.

The Court having considered the filings, testimony, and any evidence presented at hearing, and the Court having found the above-named Adverse Party received actual notice of hearing...

Person had an opportunity to participate, and the Adverse Party was present was not present was represented by counsel , and the above-named Applicant was present was not present was represented by counsel

Orders and Restrictions

1. You are excluded and ordered to stay at least 100 yards away from Applicant’s residence located in , Nevada, confidential, or at:

Street: City:

2. The Court grants to the Applicant temporary custody of the following minor child(ren):

3. You are granted visitation with the minor child(ren):

4. You are ordered to pay support and maintenance of the minor child(ren) as set forth in the attached Child Support Addendum.

5. You are ordered to pay the rent or make mortgage payments or pay towards support and maintenance of the Applicant as follows:

6. Custody, visitation, and support shall remain as ordered in the Decree of Divorce/Order entered in Case Number in the Court of the State of .

7. You are excluded and ordered to stay at least 100 yards away from the minor child(ren)’s school(s) or day care:

School 1: Address:

City: County:

School 2: Address:

City: County:

School 3: Address:

City: County:

8. You are excluded and ordered to stay at least 100 yards away from the place(s) of employment:

Employment 1: Address:

City: County:

9. You are excluded and ordered to stay at least 100 yards away from the following places frequented regularly:

Place 1: Address:

City: County:

Place 2: Address:

City: County:

10(a). You are prohibited from physically injuring or threatening to injure any animal owned or kept by the Applicant, the minor child(ren), or you.

10(b). You are prohibited from taking possession of any animal owned or kept by the Applicant or the minor child(ren).

10(c). Arrangements for possession and care of any animal(s):

11. You are ordered to comply with the attached Firearms Addendum.

12. The following provisions and exceptions are made a part of this Order:

Financial Terms

This Order will remain in effect until 11:59 P.M. on the date set forth on page 1 unless otherwise ordered.

Deferred court costs and fees: $ payable to by

Pursuant to NRS 33.030(2) the Adverse Party is ordered to pay $ to Applicant by

Child Support Addendum

You are ordered to pay the amount of $ for the support and maintenance of the minor child(ren).

Payments commence on and are due on the day of each month.

A. Adverse Party gross monthly income $ ; formula amount equals $ per month or other

B. Withholding of income for the payment of support must be carried out immediately, or withheld until delinquent for good cause.

Payments shall be made directly to the Applicant by mail at:

C. Adverse Party shall provide health insurance coverage for the minor child(ren), if available.

Insurance premium: $ per month payable to

Proof of coverage mailing address:

Within days of today’s date

Both parties shall split equally all medical expenses not covered by insurance.

Firearms Addendum

Any violation of the following is a gross misdemeanor under Nevada law.

You are prohibited from possessing or having under your custody or control any firearm while this Order is in effect.

Within 24 hours after service you shall: surrender sell transfer

Transfer firearms to:

Other:

You are granted a limited employment exception from the firearm prohibition.

Employer Name:

Employer Representative:

Employer Address:

Employer County, City, State:

Employer Telephone Number:

Other: