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D.R.L. §§ 240, 252 Form SC -1 12/2013 ORI No: Order No: NYSID No: __________________ At a _______ Term (IAS Part) ______________ of the Supreme Court, State of New York, County of , at the Courthouse at PRESENT: Hon. TEMPORARY In the Matter of a Proceeding under ORDER OF PROTECTION Section (240) (252) of the Domestic Relations Law D.R.L. §§ 240, 252 Index No. Plaintiff/Petitioner Date of Birth: (Check one) v. “ ““ “ Ex parte “ ““ “ Both Parties Present In Court Defendant/Respondent Date of Birth: NOTICE: YOUR FAILURE TO OBEY THIS ORDER MAY SUBJE CT YOU TO MANDATORY ARREST AND CRIMINAL PROSECUTION, WHICH MAY RESULT I N YOUR INCARCERATION FOR UP TO SEVEN YEARS FOR CRIMINAL CONTEMPT, AND/O R MAY SUBJECT YOU TO SUPREME COURT PROSECUTION AND PENALTIES FOR CONTEMP T OF COURT. IF YOU FAIL TO APPEAR IN COURT WHEN YOU ARE REQUIRED TO DO SO, THIS ORDER MAY BE EXTENDED IN YOUR ABSENCE AND THEN CONTINUES IN EFFE CT UNTIL A NEW DATE SET BY THE COURT. 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 a determination has been made in accordance with section “ 240 “ 252 of the Domestic Relations Law, and the Respondent having been [check applicab le 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]: observe the following conditions of behavior: ( Check Applicable Paragraphs and Subparagraphs) [01] ‘Stay away from [A] “ [name(s) of protected persons] , and/or from the [B] “ home of , [C] “ school of , [D] “ business of , [E] “ place of employment of , [F] “ other [specify location] ; [14] ‘ Refrain from communication or any other contact by mail or by telephone, e-mail, voice-mail or other electronic or any other means with [specify protected person(s )]: Form SC-1 Page 2 ; [02] ‘Refrain from assault, stalking, harassment, aggrava ted harassment, menacing, reckless endangerment, strangulation, criminal obstruction of breathing or circulation, disorderly conduct, criminal mischief , sexual abuse, sexual misconduct, forcible touching, intim idation, threats, identity theft, grand larceny, coercion or any criminal offense against [specify protected person( s) and/ or members of protected person’s family or household, and/or person(s) with custody of child(ren)]: ; [15] ‘ Refrain from intentionally injuring or killing wit hout justification the following companion animal ( s) (pet(s)) [specify type(s) and, if available, name(s)] : ; [11] ‘Permit [specify individual] to enter the residence during [specify date/time] with [specify law enforcement agency, if any]: in order to remove personal belongings not in issue in litigation [spe cify items]: ; [04] ‘Refrain from (indicate acts) that create an unreasonable risk to the health, safety, or welfare of [specify child(ren), family or household members]: ; [05] ‘Permit [specify individual] , entitled by a court order or separation or other written agreement, to visit with [specify child(ren)]: during the following periods of time [specify]: ; under the following terms and conditions [specify] : ; [07] ‘ Temporary Custody of [specify child(ren)]: shall be awarded to [specify individual]: under the following terms and conditions [specify] : ; [12] ‘ Surrender any and all handguns, pistols, revolver s, rifles, shotguns and other firearms owned or pos sessed, including, but not limited to, the following: and do not obtain any further guns or other firear ms. Such surrender shall take place immediately, b ut not later than [specify date/time]: at [specify]: ; [ ] ‘ Promptly return or transfer the following identifi cation documents specify]: ___________________________________________________ _________________________________to the party protected by this Order NOT LATER THAN [specify dat e]: in the following manner [specify manner or mode of return or transfe r]: ____________________________________________ [Check box(es) if applicable]: ‘ Such documents shall be made available for use as evidence in this judicial pr oceeding. ‘ [Jointly owned documents or documents in both part ies’ names only]: The following document(s) may be used as necess ary for legitimate use by the Respondent [specify]: . ‘Pay counsel fees and/or any costs associated with t he order to [specify person and terms]: ; [99] ‘Observe such other conditions as are necessary to f urther the purposes of protection [specify conditions]: Form SC-1 Page 3 It is further ordered that the license of the person against whom this or der is issued to carry, possess, repair, sell or otherwise dispose of a firearm or firearms, if any, pursuant to Penal Law §400.00, is hereby ( Check all applicable boxes): [13A] ‘ suspended [13B] ‘ revoked, and/ or [13C] “ the person against whom this order is issued shal l remain ineligible to receive a firearm license duri ng the period of this order.. It is further ordered that this order of protection shall remain in forc e until and including [specify date]: , but if you fail to appear in court when you are r equired to do so, the order may be extended and continue in effect until a new date set by the Court. The Domestic Relations Law provides that the presentation of a copy of this or der of protection to a police officer or peace officer acting pursuant to his or her special duties shall authorize, and sometimes r equires, such officer to arrest a person who is alleged to have violated the terms of the order and to bring him or her before the Court to face penalties authorized by law. Federal law requires that this order must be honored and enforced by st ate and tribal courts, including courts of a state, the District of Columbia, a commonwealth, territory or possession of the United States, if the person against whom the order is sought is an intimate partner of the protected party and has or will be afforded reasonable notice and opportunity to be heard in accordance with state la w sufficient to protect that person's rights (18 U.S.C.§§ 2265, 2266). It is a federal crime to : • cross state lines to violate this order or to sta lk, harass or commit domestic violence against an i ntimate partner or family member; • buy, possess or transfer a handgun, rifle, shotg un or other firearm or ammunition while this Order remains in effect (Note: there is a limited exception for military or law enforcement officers but only while they ar e on duty) ; and • buy, possess or transfer a handgun, rifle, shotg un or other firearm or ammunition after a convictio n of a domestic violence-related crime involving the use or attemp ted use of physical force or a deadly weapon agains t an intimate partner or family member, even after this Order ha s expired.. (18 U.S.C. ''922(g)(8), 922(g)(9), 2261, 2261A, 2262). Dated : JUSTICE COURT (COURT SEAL) 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]: ‘ [Modifications 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]: ______ ___________________________________________________ _