Fill and Sign the Adult Protective Order Porter County in Form

1 1 23 4 56789 1011 12 13141516171819202122232425262728 Case No. _____________Dept. No _____________ IN THE JUSTICE COURT OF _________________________ TOWNSHIP COUNTY OF ___________________________, STATE OF NEVADA _________________________________, EXTENDED ORDER FORApplicant, PROTECTION AGAINST DOMESTIC VIOLENCE vs. Date Issued: ___________ _________________________________, Adverse Party. Date Expires: ___________ The Court having considered the filings, testimony, and any evidence presented at hearing, and the Court having found that the above-named Adverse Party received actual notice of hearing at which such 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: (1) the arresting officer determines that the violation is accompanied by a direct or indirect threat of harm; or (2) you have previously violated a temporary or extended order for protection of the type for which you have been arrested; or (3) at the time of the violation or within 2 hours after the violation, you have: (a) a concentration of alcohol of 0.08 or more in your blood or breath; or (b) an amount of a prohibited substance in your blood or urine that is equal to or greater than the amount set forth in subsection 3 of NRS 484.379. YOU ARE FURTHER NOTIFIED that child stealing/kidnapping is a felony. THIS ORDER is valid and enforceable throughout the State of Nevada. This Order meets all Full Faith and Credit provisions of the Violence Against Women Act, and is enforceable in all 50 states, the District of Columbia, U.S. Territories, and Indian Nations. All other courts and law enforcement agencies with jurisdiction within the United States and all Indian Nations shall give full faith and credit to this Order pursuant to 18 U.S.C. § 2265. Possession, shipment, transportation, or receipt of a firearm or ammunition while this Order is in effect may constitute a felony under federal law 18 USC § 922(g)(8), and is punishable by a fine of up to $250,000 and/or a prison sentence of up to ten (10) years. Further, if prohibited by this Order, possession, custody, or control of a firearm while this Order is in effect is a gross misdemeanor under NRS Chapter 33. 2 1 23 4 56789 1011 12 13141516171819202122232425262728 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, ________________________________, and the Court having jurisdiction over the parties and this matter pursuant to NRS 33.010, et seq., and it appearing to the satisfaction of the Court from specific facts shown that an act of domestic violence has occurred, there exists a threat of domestic violence, and/or you represent a credible threat to the physical safety of the Applicant or the minor child(ren), the Court enters this Order, and as a result: YOU ARE PROHIBITED, either directly or through an agent, from threatening, physically injuring, or harassing the Applicant and/or the minor child(ren). YOU ARE FURTHER PROHIBITED from selling, damaging, destroying, giving away, or otherwise disposing of, or tampering with, any property owned by the Applicant, or in which the Applicant has an interest; YOU ARE PROHIBITED from any contact whatsoever with the Applicant, but not limited to, in person, by telephone, through the mail, through electronic mail (e-mail), facsimile, or through another person. 1. _____ YOU ARE EXCLUDED AND ORDERED to stay at least 100 yards away from Applicant’s residence located in  __________________, County, Nevada,  CONFIDENTIAL, or at:  ______________________________________________, _________________________________, (Street) (City) or any other place that Applicant may reside. YOU shall not interfere with Applicant’s possession and use of the residence, including utilities, phones, leases, and other related residential services;2. _____ The Court, having jurisdiction under and meeting the requirements of Chapter 125A of the Nevada Revised Statutes (UCCJA), grants to the Applicant temporary custody of the following minor child(ren) of the parties: ____________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________; YOU ARE PROHIBITED from interfering with the Applicant’s custody of the minor child(ren) named in this paragraph. It is in the best interest of the child(ren) that no negative, insulting, or disparaging comments be made by one party against the other party in the presence of the minor child(ren). 3 1 23 4 56789 1011 12 13141516171819202122232425262728 3. _____ YOU ARE GRANTED visitation with the minor child(ren): ___________________ ____________________________________________________________________________________, under the following terms and conditions: ________________________________________________________________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________.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 payments on a mortgage on the Applicant’s place of residence or pay towards the support and maintenance of the Applicant, as follows: ____________________________________________________________________________________ ____________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________.6. _____ Custody, visitation, and support of the minor child(ren) of the parties shall remain as ordered in the Decree of Divorce/Order entered between the parties 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, including, but not limited to, the places listed below:CONFIDENTIAL (a) Name of School______________________________________________________________Address_______________________________________________________________________City________________________________County ___________________ Nevada.(b) Name of School______________________________________________________________Address_______________________________________________________________________City______________________________County ______________________Nevada. 4 1 23 4 56789 1011 12 13141516171819202122232425262728 (c) Name of School______________________________________________________________Address________________________________________________________________________City______________________________County ______________________ Nevada.6. ________ YOU ARE EXCLUDED AND ORDERED to stay at least 100 yards away from these place(s) of employment or any other place that Applicant may be employed. YOU ARE PROHIBITED from any contact whatsoever with these place(s) of employment in person, by telephone, by mail, or any other means of communication. CONFIDENTIAL (a) Name_________________________________Address_______________________________City________________________________County ____________________ Nevada.(b) Name________________________________Address_______________________________City______________________________County ______________________Nevada.(c) Name_________________________________Address_______________________________City______________________________County ____________________ Nevada. 9. _____YOU ARE EXCLUDED AND ORDERED to stay at least 100 yards away from the following places frequented regularly by Applicant and/or the minor child(ren): (a) Name_________________________________Address_______________________________City_______________________________County ____________________ Nevada.(b) Name_________________________________Address______________________________City_______________________________County ____________________ Nevada. 5 1 23 4 56789 1011 12 13141516171819202122232425262728 (c) Name_________________________________Address_______________________________City_______________________________County ____________________ Nevada.(d) Name_________________________________Address______________________________City_______________________________County ____________________ Nevada. 10. (a) ______ YOU ARE PROHIBITED , either directly or through an agent, from physically injuring or threatening to injure any animal that is owned or kept by the Applicant, the minor child(ren), or YOU. (b)______ YOU ARE PROHIBITED, either directly or through an agent, from taking possession of any animal owned or kept by the Applicant or the minor child(ren). (c) ______The arrangements for the possession and care of any animal(s) referenced above are as follows: ____________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________. 11. ______ YOU ARE ORDERED to comply with the attached Firearms Addendum.12. ______The following provisions and exceptions are made a part of this Order:________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. 6 1 23 4 56789 1011 12 13141516171819202122232425262728THIS ORDER WILL REMAIN IN EFFECT UNTIL 11:59 P.M. ON THE DATE SET FORTH ON PAGE 1 UNLESS THIS COURT ORDERS OTHERWISE.The Adverse Party is ordered to pay all previously deferred court costs and fees of $ _______________ payable to ______________________________ by ________________________. (date) Pursuant to NRS 33.030(2) the Adverse Party is ordered to pay $_______________ to Applicant by _________________________. (date) ORDER TO LAW ENFORCEMENT A. Any law enforcement officer who has probable cause to believe a violation of any provision of this Order has occurred is ordered to arrest the Adverse Party. Such party is to be charged with a criminal violation of this Order in addition to any other criminal charges which may be justified. B. If such law enforcement officer cannot verify that the Adverse Party was served with a copy of this Application and Order, the officer shall inform the Adverse Party of the following: (1) the specific terms of this Order; (2) that the Adverse Party now has notice of the provisions of this Order; (3) that aviolation of this Order will result in the Adverse Party’s arrest; and (4) the location of the Court that issued the original Order and the hours during which the Adverse Party can obtain a copy of the Order. The law enforcement officer shall then provide written proof of notice to the officer’s agency and to the Court.Dated: _______________ ____________________________________ Judge/Hearing Master 7 1 23 4 56789 1011 12 13141516171819202122232425262728 CHILD SUPPORT ADDENDUM ______YOU ARE ORDERED to pay the amount of $ ____________ for the support and maintenance of the minor child(ren): __________________________________________________________________________. Payments shall commence on _____________________________ and be paid on the ____________day of each month while this Order remains in effect. Arrears have not been addressed in this Order. If the Applicant wishes to have the payments made through the District Attorney’s office, the Applicant may seek relief from the local District Attorney’s office. NOTICE: PAYMENT OF SUPPORT IS TO BE AS PROVIDED HEREIN, AND THE GIVING OF GIFTS, OR THE PURCHASES OF FOOD, CLOTHING, AND THE LIKE WILL NOT FULFILL THE OBLIGATION.A.Adverse Party’s (Obligor’s) gross monthly income $ ___________: formula amount: __________ % equals $__________ per  month,  other ________________________. The basis for deviation from the State formula is as follows: ___________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________. B.  Withholding of income for the payment of the support must be carried out immediately, or The Court finding good cause: _____________________________________________________ withholding of income shall be postponed until such time as the Adverse Party (Obligor) becomes 30 days delinquent under this Order. Payments shall be made directly to the Applicant by mail, at the following address: ___________________________________________________________________________________________________________________________________________________,unless a court order states otherwise.C. The Adverse Party (Obligor) shall provide health insurance coverage for the minor child(ren), if available, through an employer at a reasonable cost, and shall provide all necessary assistance to enable Applicant to obtain the medical benefits for the minor child(ren). The Adverse Party (Obligor) shall pay $_____________________ per month for a medicalinsurance premium, payable to _______________________________________________________. The Adverse Party shall provide proof of medical insurance coverage including a medical identification card and FIVE claim forms, if necessary, to the Applicant by mail, at the following address: _________________________________________________________________, within ______________ days of today’s date, ___________________________________________. Both the Applicant and the Adverse Party shall split equally all medical expenses not covered by medical insurance. 8 1 23 4 56789 1011 12 13141516171819202122232425262728 FIREARMS ADDENDUM Any violation of the following is a gross misdemeanor under Nevada law (NRS 33.031). The Court has considered, among other factors: (1) whether you have a documented history of domestic violence; (2) whether you have used or threatened to use a firearm to injure or harass the Applicant, a minor child, or any other person; (3) whether you have used a firearm in the commission or attempted commission of any crime, and: _______________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Pursuant to Nevada Revised Statutes Chapter 33, THIS COURT ORDERS the following: 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 of this Order you shall: surrender  sell  transfer all firearms in your possession or under your custody or control to:____________________________________________________________________________________ (transferee) You must contact law enforcement before approaching a law enforcement officer or law enforcement facility with firearm(s).Not later than 72 hours or 1 business day, whichever is later, after the surrender, sale, or transfer of such firearm(s), you shall provide a receipt to the Court from the transferee. The receipt shall include the name and address of the transferee and a written description of each such firearm. Other ____________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________.Firearms Addendum No. 1 9 1 23 4 56789 1011 12 13141516171819202122232425262728 FIREARMS ADDENDUM Any violation of the following is a gross misdemeanor under Nevada law (NRS 33.031). This Court has considered, among other factors: (1) whether you have a documented history of domestic violence; (2) whether you have used or threatened to use a firearm to injure or harass the Applicant, a minor child(ren), or any other person; (3) whether you have used a firearm in the commission or attempted commission of any crime, and: ________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________.Pursuant to Nevada Revised Statutes Chapter 33, THIS COURT ORDERS the following: 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 of this Order you shall: surrender  sell  transfer all firearms in your possession or under your custody or control to ________________________________________________________________________________ (transferee)You must contact law enforcement before approaching a law enforcement officer or law enforcement facility with firearm(s). Not later than 72 hours or 1 business day, whichever is later, after the surrender, sale, or transfer of such firearm(s), you shall provide a receipt to the Court from the transferee. The receipt shall include the name and address of the transferee and a written description of each such firearm. YOU ARE GRANTED a limited employment exception from the prohibition noted above because you have established that:(1) the possession or use of a firearm(s) is an integral part of your employment with:Name of Employer_________________________________________________________Firearms Addendum No. 2 10 1 23 4 56789 1011 12 13141516171819202122232425262728 Employer’s Representative__________________________________________________Employer’s Address_______________________________________________________Employer’s County, City, State______________________________________________Employer’s Telephone Number______________________________________________AND (2) your employer agrees to store/safeguard your firearm(s) when you are not working, and sufficient proof to that effect has been provided to the Court. The firearm(s) that you may possess while you are working is/are: (for example: make, model, caliber, serial number, etc.) ____________________________________________________________________________________________ ____________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. Other:____________________________________________________________________________________ ____________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________.Firearms Addendum No. 2