Fill and Sign the Circuit Court District Division New Hampshire Judicial Branch Form

PETITIONER/PLAINTIFF THE COURT HEREBY ORDERS THAT: RESPONDENT/DEFENDANT IDENTIFIERS And/or on behalf of minor family member(s): (List Name And DOB) Relationship to Petitioner: RESPONDENT/DEFENDANT Other Protected Persons/DOB: CAUTION: The above named Respondent/Defendant shall not commit any further acts of abuse or make any threats of abuse. The terms of this order shall be effective untilThe above named Respondent/Defendant shall have no contact with the Petitioner/Plaintiff. No contact includes any defendant-initiated contact, direct or indirect, by means such as teleph one, personal contact, email, pager, gift-giving or telefacsimile machine. [05] unmarried, of opposite sex, currently or formerly living together Distinguishing Features (Over) AOC-CV-304, Page 1 of 5, Rev. 2/06 © 2006 Administrative Office of the Courts General Court of Justice District Court Division NORTH CAROLINA EX PARTE DOMESTIC VIOLENCE ORDER OF PROTECTION G.S. 50B-2, -3, -3.1 First Middle Last PETITIONER/PLAINTIFF IDENTIFIERS Date Of Birth Of Petitioner VERSUS First Middle Last parent spouse former spouse of opposite sex, currently or formerly in dating relationship current or former household member grandparent child grandchild Respondent's/Defendant's Address Weapon Involved unmarried, have a child in common This matter was heard by the undersigned district court judg e. magistrate. The court has jurisdiction over the subject matter. THE COURT HEREBY FINDS THAT: Additional terms of this order are as set forth on Pages 3 and 4. Additional findings of this order are set forth on Page 2. , WARNINGS TO THE RESPONDENT/DEFENDANT: This order shall be enforced, even without registration, by the courts of any state, the District of Columbia, and any U.S. Territory, and may be enforced by Tribal Lands (18 U.S.C. Section 2265). Cr ossing state, territorial, or tribal boundaries to violate this order may result in federal imprisonment (18 U.S.C. Section 2262). See additional warnings on Page 4. Only the Court can change this order. The plaintiff cannot give you permission to violate this order. State This order will be enforced anywhere in North Carolina. Drivers License No. Sex Race DOB HT WT Eyes Hair Expiration Date Social Security Number Case No. Court County The defendant is in possession of, owns or has access to firearms, ammunition, and gun permits described below. (Describe all firearms, ammunition, gun permits and give identifying number(s) if known, and indicate where defendant keeps firearms) 9.(Check block only if plaintiff is entitled to physical care of child.) It is in the best interest of the minor child(ren) that defendant h ave contact with the minor child(ren) in that: 8. It is in the best interest of and necessary for the safety of the minor child(ren) that defendant stay away from the minor child(ren) that the defendant return the minor child(ren) to plaintiff and that the defendant not remove the minor child(ren) from plaintiff in that: The minor child(ren) is exposed to a substantial risk of physical or emotional inju ry or sexual abuse in that: 7. 6. 5. The parties are the parents of the following child(ren) under the age of eighteen (18). The child(ren) are presently in the physical custody of the NOTE TO JUDGE: A copy of AOC-CV-609 for each child must be attached to the order. plaintiff is presently in possession of the parties' residence at a member of plaintiff's family 2. committed an act defined in G.S. 14-placed in fear of imminent serious bodily injury attempted to cause placed in fear of continued harassment that rises to such a level as t o inflict substantial emotional distress a. b. d. c. the child(ren) living with the plaintiff intentionally caused bodily injury to or in the custody of the plaintiff That on (date of most recent conduct) , the defendant a member of the plaintiff's household the plaintiff a member of the plaintiff's family a member of plaintiff's household the plaintiff 27.3 (2nd deg. rape) 27.4 (1st deg. sexual off.) 27.2 (1st deg. rape) 27.5 (2nd deg. sexual off.) 27.5A ( sexual battery) 27.7 (sexual activity by substitute parent) against the plaintiff a child(ren) living with or in the custody of the plaintiff by (describe defendant's conduct) 1. 3. 4. the custody of the plaintiff a. b. c. ADDITIONAL FINDINGS (Over) As indicated by the check block under Respondent/Defendant's name on Page 1, the parties are or have been in a personal relationship. AOC-CV-304, Page 2 of 5, Rev. 2/06 © 2006 Administrative Office of the Courts The defendant used threatened to use a deadly weapon against the minor child(ren) residing with or in plaintiff has a pattern of prior conduct involving the use threatened use of violence with a firearm against persons plaintiff minor child(ren) residing with or in the custody of the plaintiff made threats to seriously injure or kill the made threats to commit suicide d. defendant The plaintiff. defendant. The plaintiff has submitted an "Affidavit A s To The Status Of The Minor Child." Name Sex Date Of Birth Name Sex Date Of Birth in that (state facts):inflicted serious injuries upon the e. plaintiff minor child(ren) residing with or in the custody of the plaintiff File No. Other: (specify) (Over) AOC-CV-304, Page 3 of 5, Rev. 2/06 © 2006 Administrative Office of the Courts a. b. c. 9. 10. 11. the plaintiff is granted possession and use of the vehicle described in Block No. 10 of the Findings on Page 3. [08] The plaintiff is awarded temporary custody of the minor child(ren) (Check any of a, b, or c that apply.) and the defendant is ordered to stay away from the minor child(ren). and the defendant is ordered to immediately return the minor child(ren) to the care of the plaintiff. and the defendant is ordered not to remove the minor child(ren) fro m the care of the plaintiff. (If No. 10 is checked and you are allowing visitation to defendant) The defendant is allowed the following contact with the minor child(ren): 7. 6. It is ORDERED that: 1. 2. 3. 4. 5. 8. the defendant shall not assault, threaten, abuse, follow, harass (by telephone, visiting the home or workplace or other means), or interfere with the plaintiff. A law enforcement officer shall arrest the defendant if the officer has probable cause to believe the defendant has violated this provision. [01] the defendant shall not assault, threaten, abuse, follow, harass (by telephone, visiting the home or workplace or other means), or interfere with the minor child(ren) residing with or in the custody of the p laintiff. A law enforcement officer shall arrest the defendant if the officer has probable cause to believe the def endant has violated this provision. [01] the defendant shall not threaten a member of the plaintiff's f amily or household. [02] the plaintiff is granted possession of, and the defendant is exclu ded from, the parties' residence described above and all personal property located in the residence except for the defendant's perso nal clothing, toiletries and tools of trade. [03] any law enforcement agency with jurisdiction shall evict the defendant fro m the residence and shall assist the plaintiff in returning to the residence. [08] r esidence. A law enforcement officer shall assist the these items. defendant in returning to the residence to get plaintiff [08] defendant [08] is entitled to get personal clothing, toiletries, and tools of trade from the parties' plaintiff the (b) any school(s) the child(ren) attend. [04] (d) the plaintiff's school. [04] the defendant shall stay away from the following places: (a) the place where the plaintiff works. [04]. (c) the place where the child(ren) receives day care. [04] (e) Other: (name other places) [04] the defendant shall stay away from the plaintiff's residence or any pla ce where the plaintiff receives temporary shelter. A law enforcement officer shall arrest the defendant if the officer has pro bable cause to believe the defendant has violated this provision. [04] plaintiff is presently in possession of the parties' vehicle. (describe vehicle) The 10. defendant 11. 12. The Court has jurisdiction under the Uniform Child Custody Jurisdiction And Enfo rcement Act. 8. The plaintiff has failed to prove grounds for ex parte relief. 7. The defendant's conduct requires that he/she surrender all firearms, ammunition and gun permits. [G.S. 50B-3.1] ORDER 5. 3.It clearly appears that there is a danger of acts of domestic violence against the [G.S. 50B-2(c)] 4. The minor child(ren) is exposed to a substantial risk of [G.S. 50B-2(c)] 6. It is in the best interest of and necessary for the safety of the minor child(ren) that the defendant stay away from the minor child(ren). from the physical care of the plaintiff. physical injury. emotional injury. (and) not remove the minorminor child(ren). plaintiff. sexual abuse. (and) return the minor child(ren) to the physical care of the plaintiff. 1. The defendant has committed acts of domestic violence against the plaintiff. Based on these facts, the Court makes the following conclusions of law: 2.The defendant has committed acts of domestic violence against the mino r child(ren) residing with or in the custody of the plaintiff. Name Of Defendant (for magistrate only) This matter was heard at a time when the district court was not in session a nd a district court judge was not available and would not be available for a period of four or more hours. CONCLUSIONS The sheriff must deliver a copy of this order to the principal or the prin cipal's designee at the following school(s): (name schools) Deputy CSC Clerk of Superior Court 15.Other : (specify) [08] the request for Ex Parte Order is denied. 14. District Court Judge Designated Magistrate Signature Date the defendant is prohibited from this Order [07] The defendant is a law enforcement officer/member of the armed services and a firearm for official use. may may not possess or use the weapons cannot be surrendered at that time, you must surrender them to the sheriff within 24 hours at the time and place specified by the sheriff. Failure to surrender the weapons and permits as ordered or possessing, owning, purchasing, or receiving a firearm, ammunition or permits to purchase or carry concealed firearms after bein g ordered not to possess firearms, ammunition or permits is a crime. See "Notice To Parties: To The Defendant" on page 4 of this Ord er for information regarding the penalty for these crimes and instructions on how to request return of surrendered weapons. the defendant surrender to the Sheriff serving this order the fire arms, ammunition, and gun permits described in Number 3 of the Findings on Page 2 of this Order and any other firearms and ammunition in the defendant's care, custody, possession, ownership or control. NOTE TO DEFENDANT: You must surrender these items to the serving officer at the time thi s Order is served on you. If 13. AOC-CV-304, Page 4 of 5, Rev. 2/06 © 2006 Administrative Office of the Courtspossessing, owning or receiving [07] and the defendant's concealed handgun permit is suspended for t he effective period of this Order. [08] 12. purchasing a firearm for the effective period of TO THE PLAINTIFF: The court or judge is the only one that can make changes to this ord er. If you wish to change any of the terms of this order, you must come back into court to have the judge modify the order. You should keep a copy of this order on you at all times and should make copies to give to your friends and family. If you move to another county or state, you may wish to give a copy to the law enf orcement agency where you move, but you are not required to do so. If the defendant violates any provision of this order, you may call a law enforcement officer or go to a magistrate to charge the defendant with the crime of violating a protective order. You also may go to the Clerk of Court's office in the county where the protective order was issued and ask to fill out form AOC-CV-307, Motion For Order To Show Cause Domestic Violence Protective Order, to have an order issued for the defendant to appear b efore a district court judge to be held in contempt for violating th e order. 1. 2. 3. I certify this order is a true copy. CERTIFICATION Assistant CSC Signature Of Clerk Date 2.If you have been ordered to surrender firearms, ammunition, and gun permits and you fail to surrender them as required by this Order, or if you failed to disclose to the Court all information requested about possession of these items or provide false information about any of these items you may be charged with a Class H fe lony and may be imprisoned for up to 30 months. If you surrendered your firearms, ammunition, and permits, you may file a mot ion for the return of weapons with the clerk of court in the county in which this Order was entered when the prote ctive order is no longer in effect, except if at the time this Order expires criminal charges, in either state or federal court, are pending ag ainst you alleged to have been committed against the person who is protected by this order, you may not file for return of the fire arms until final disposition of the criminal charges. The form motion, "Motion For Return Of Weapons Surrendered Under Domestic Violence O rder" AOC-CV-319, is available from the clerk of court's office. The motion must be filed not later than 90 days after the expiration of the Order that requires you to surr ender the firearms or if you have pending criminal charges alleged to have been committed against the person who is protected by the domestic violence protection order, the motion must be filed not later than 90 days after final disposition of the criminal charges. At the time you file the motion, the clerk will schedule a hearing befo re the district court for a judge to determine whether to return the weapons to you. The sheriff cannot return yo ur weapons unless the Court orders the sheriff to do so. You must pay the sheriff's storage fee before the sheriff returns your weapon s. If you fail to file a motion for return of the weapons within 90 days after the expiration of this Order, or the final disposition of criminal charges pending at the time this Order expired, or if you fail to pay the storage fees within 30 days after the Court enters an order to return your weapons , the sheriff may seek an order from the Court to dispose of your weapons. NOTE TO PLAINTIFF: If the judge signs this Order and gives it to you, take it to the Clerk's office immediately. If the magistrate signs this Order and gives it to you, follow the magistrate's directions. NOTE TO CLERK: Give or mail a copy of this Order to the plaintiff and to the appropriate local law enforcement agency. Send copies to sheriff with Notice Of Hearing, Complaint and Summons for service on defendant. Send extra copies to the sheriff i f required to deliver copy(ies) to the child(ren)'s school. TO THE DEFENDANT: 1. NOTICE TO PARTIES If this Order prohibits you from possessing, owning, receiving or purchasing a fi rearm and you violate or attempt to violate that provision, you may be charged with a Class H felony pursuant to North Carolina G .S. 14-269.8 and may be imprisoned for up to 30 months. File No. Name Of Defendant Other manner of service on the defendant (specify) Defendant WAS NOT served for the following reason. By delivering to the defendant named above a copy of the order. By leaving a copy of the order at the dwelling house or usual place of abode of the defendant named above wit h a person of suitable age and discretion then residing ther ein. I certify that this Ex Parte Domestic Violence Order of Protection was rece ived and served as follows: Date Served Name Of Defendant Time Served PM AM Name And Address Of Person With Whom Copies Left Date Received Date Of Return Name Of Sheriff (Type Or Print) AOC-CV-304, Page 5 of 5, Rev. 2/06 © 2006 Administrative Office of the Courts RETURN OF SERVICE NOTE:To be used when Magistrate issues ex parte protective order and order will b e served on defendant separate from the complaint and civil summons. If complaint and summons are served with ord er, return on summons covers order. County Of Sheriff Signature Of Deputy Sheriff Making Return