Fill and Sign the Get the at a Term of the Family Court County of State of New York Form

F.C.A. §§ 304.2, 740General Form 6 (Temporary Order of Protection: PINS; Juvenile Deli nquency) 12/2013 At a Term of the Family Court County of , State of New York (address) PRESENT: Hon In the Matter of a Proceeding under Article of the Family Court Act TEMPORARY ORDER OF PROTECTION [Articles 3 and 7] Docket No. Family Unit No. (check one) GEx Parte Respondent G Respondent present in court NOTICE: YOUR WILLFUL FAILURE TO OBEY THIS ORDER MAY SUBJECT YOU TO FAMILY COURT PROSECUTION AND DETENTION. IF YOU FAIL TO AP PEAR IN COURT WHEN YOU ARE REQUIRED TO DO SO, THIS ORDER MAY BE EXTENDED I N YOUR ABSENCE AND THEN CONTINUES IN EFFECT UNTIL A NEW DATE SET BY THE COU RT. THIS ORDER OF PROTECTION WILL REMAIN IN EFFECT EVE N IF THE PROTECTED PARTY HAS, OR CONSENTS TO HAVE, CONTACT OR COMMUNICATION WITH THE PARTY AGAINST WHOM THE ORDER IS ISSUED. THIS ORDER OF P ROTECTION CAN ONLY BE MODIFIED OR TERMINATED BY THE COURT. THE PROTECTED PARTY CANNOT BE HELD TO VIOLATE THIS ORDER NOR BE ARRESTED FOR VIOLATING THIS ORDER . Whereas the Family Court has made a determination i n accordance with [check applicable box]: G Article 3 (juvenile delinquency) G Article 7 (Person in Need of Supervision) of the Family Court Act, and the Respondent having been [check applicable box]: “ present in Court and advised of the issuance and contents of this Order “ not present in Court, and good cause having been s hown, Now, therefore, it is hereby ordered that [specify first name, middle initial and last name] , the above-named Respondent, observe the following conditions of behavior: Chec k Applicable Box(es): G Stay away from G [name(s) of protected person(s)] and/or from the G home of G school of G business of G place of employment of G other [specify]: ; G Refrain from harassing, intimidating, threatening or otherwise interfering with [specify victim(s) or members of victim's family or household] ; “ Refrain from intentionally injuring or killing wit hout justification the following companion animal (s) (pet(s)) [specify type(s) and, if available, name (s)]: ______________________________ ___________________________________________________ _____________________________ [The following paragraphs apply only to Article 7 orders of protection; check applicabl e box(es)]: G Refrain from assault, stalking, harassment, aggrav ated harassment, menacing, reckless endangerment, strangulation, criminal obstruction o f breathing or circulation, disorderly conduct, criminal mischief, sexual abuse, sexual misconduct, forcible touching, intimidation, threats, identity theft, grand larceny, coercion or any criminal offe nse against [specify protected person(s) and/or General Form GF-6 Page 2 members of protected person's family or household, and/or person(s) with custody of child(ren)]: ; G Refrain from (indicate acts of omission or commiss ion): that create an unreasonable risk to the health, saf ety or welfare of the Respondent; G Permit [specify individual]: , entitled by court order or separation agreement, to visit with the Respondent child during the following periods of time [specify] ; under the following terms and conditions [specify]: ; G Participate in family counseling or other professi onal counseling activities, or other services, including alternative dispute resolution services, deemed necessary for the rehabilitation of the Respondent and not contrary to Respondent’s religio us beliefs, conducted by an authorized person or agency to which the Respondent has been referre d [specify program or services]: ; G Permit [specify individual] to enter the residence during [specify date/time] to remove personal belongings not in issue in this or any other litig ation; G Pay or provide access to health or medical insuran ce for necessary medical care and treatment arising from the incident or incidents forming the basis of the order [specify beneficiary of treatment and coverage] ; G Custody of respondent during the term of this orde r is awarded to [specify individual] under the following terms and conditions [specify] : [The following paragraphs apply to ALL orders]: G Observe other condition(s) as are necessary to fur ther the purposes of protection [specify conditions]: It is further ordered that this order of protection shall remain in force until and including [specify]: , but if you fail to appear in court when you are required to do so, the order may be extended and continue in effect until a new date se t by the Court. PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, A N APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDE R BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPEL LANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNE Y FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. ENTER Date: __________________________________ Judge of the Family Court. Check Applicable Box(es): ‘ Party against whom order was issued was advised in Court of issuance and contents of Order ‘ Order personally served in Court upon party agai nst whom order was issued ‘ Service directed by other means [specify]: ‘ [M odifications or extensions only]: Order mailed on [ specify date and to whom mailed]: ‘ Warrant issued for party against whom order was issued [specify date]: ‘ ADDITIONAL SERVICE INFORMATION [specify]:_______ ________________________________