Fill and Sign the Order of Protection Pins Juvenile Delinquency Form

F.C.A. §§ 352.3, 759 General Form 6a (Order of Protection: PINS; Juvenile Delin quency) 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 ORDER OF PROTECTION Article G3 G7 of the Family Court Act [Articles 3 and 7] Docket No. Family Unit No. (check one): G Upon default G Respondent present in court Respondent NOTICE: YOUR WILLFUL FAILURE TO OBEY THIS ORDER MAY SUBJECT YOU TO FAMILY COURT PROSECUTION AND DETENTION. THIS ORDER OF PRO TECTION WILL REMAIN IN EFFECT EVEN IF THE PROTECTED PARTY HAS, OR CONSENTS TO HAVE, CONTACT OR COMMUNICATION WITH THE PARTY AGAINST WHOM THE ORDER IS ISSUED. THIS ORDER OF PROTECTION CAN ONLY BE MODIFIED OR TERMINATED BY THE COURT. THE PROTECTED PARTY CANNOT BE HELD TO VIOLATE THIS ORDE R 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 c ontents of this Order “ not present in Court, and good cause having been s hown, [Applicable to Article 3 only]: G and good cause having been shown, NOW, THEREFORE, IT IS HEREBY ORDERED THAT [specify first name, middle initial and last name] , the above-named Respondent, observe the followin g conditions of behavior: Check 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 o rders of protection; check applicable 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 offense against [specify p rotected person(s) and/or other parent or any person to whom General Form 6a Page 2 custody of the Respondent child is awarded]: _______________________; G Refrain from (indicate acts) 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 referred [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 litigation; 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]: . 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 part y and has been or will be afforded reasonable notic e and opportunity to be heard 'in accordance with state law sufficient to p rotect that person's rights (18 U.S.C. §§ 2265, 226 6). 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 ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY TH E CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE C HILD 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]: _______ ________________________________