Fill and Sign the Nevada Order Protection Form

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Case No.___________________ Dept. No ________________ IN THE JUSTICE COURT OF _________________________TOWNSHIP COUNTY OF ___________________________, STATE OF NEVADA _________________________________, TEMPORARY ORDER Applicant , FOR PROTECTION AGAINST DOMESTIC VIOLENCE vs. Date Issued: _________________ _________________________________, Adverse Party. Date Expires: _________________ An Application and Affidavit having been filed in this Court by the above-named Applicant requesting that a Temporary Order for Protection against Domestic Violence be issued by this Court against YOU , the above-named Adverse Party, or the Court having received specific facts by telephone/facsimile pursuant to NRS 33.020(5), 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 specificVIOLATION OF THIS ORDER IS A CRIME YOU, THE ADVERSE PARTY , IS NOTIFIED THAT YOU CAN BE ARRESTED even if the person who obtained this Order invites or allows you to contact them. 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. 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 facts shown by a verified Application 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) and good cause appearing for issuing such Order without hearing, YOU ARE HEREBY ORDERED as follows: 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 Applicant has an interest; YOU ARE PROHIBITED from any contact whatsoever with the Applicant, including 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 Address) _______________________________, or any other place that Applicant may reside. YOU shall (City) (State) not interfere with Applicant’s possession and use of the residence, including utilities, phones, leases and other related residential services; 2. _____ A law enforcement officer, within whose jurisdiction __________________________ (Applicant’s or Adverse Party’s) residence is located, shall on ONE OCCASION ONLY accompany _____________________________ (Applicant or Adverse Party) to the residence of _____________________ located at _______________________________________, (Applicant/Adverse Party) (Street Address) _______________________, _________________and shall stand by while________________________ (City) (County) (Applicant/Adverse Party) obtains clothing, toiletries, and the following additional items: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ____________________________________________________________________________________ ____________________________________________________________________________________ ANY PROPERTY IN DISPUTE SHALL REMAIN IN THE RESIDENCE UNLESS IT IS SPECIFICALLY IDENTIFIED IN THIS ORDER. 3. _______ The Court, having jurisdiction under and meeting the requirements of Chapter 125A of the Nevada Revised Statutes (UCCJA), grants to Applicant temporary custody of the following minor child(ren) of the parties: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________. YOU ARE PROHIBITED from interfering with 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); 4. _______ 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 __________________________; 5 . _______ 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. 3 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (b) Name of School______________________________________________________________ Address_______________________________________________________________________ City______________________________County ______________________Nevada. (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. 7. ________ 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. 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (b) Name________________________________Address_______________________________ City_______________________________County ____________________ Nevada. (c) Name_________________________________Address_______________________________ City_______________________________County ____________________ Nevada. 8. (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). 9. ________ The following provisions and exceptions are made a part of this Order: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ THIS ORDER WILL REMAIN IN EFFECT UNTIL 11:59 P.M. ON THE DATE SET FORTH ON PAGE 1 UNLESS THIS COURT ORDERS OTHERWISE. If an Application for an Extended Order is filed, this Temporary Order will remain in effect until the hearing on an Extended Order is held. 5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 If you wish to dispute this Order or have it changed, you may request a hearing by filing a written request with this Court. Court staff will give you information about how to file your request. The Court will set a hearing on your request as quickly as possible. IT IS FURTHER ORDERED that a copy of this Order shall be transmitted forthwith together with the verified Application and supporting Affidavit, to the _________________ Sheriff’s Office, or the __________________Constable, who will promptly attempt to serve the same upon the Adverse Party, and upon service, file a Return of Service form with the Court by the end of the next business day after service is made. 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 that may be justified. (B) If such law enforcement officer cannot verify that the Adverse Party was served with a copy of the 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 a violation of this Order will result in the Adverse Party’s arrest; (4) the location of the Court that issued the original Order and the hours during which the Adverse Party can obtain a copy of this Order; and (5) the date and time set for a hearing on an Application for an Extended Order, if any. The law enforcement officer shall then provide written proof of notice to the officer’s agency and to the Court. ( C) It shall be the duty of the law enforcement officer serving this Order to remove the Adverse Party from Applicant’s residence as set forth in paragraph 1 of this Order. All fees are deferred . Dated : ___________________ ______________________________________________________________ Judge/Hearing Master 6