Fill and Sign the Order Protection Notice Form

Court of Washington For No . ___________________________ __________ Petitioner DOB vs. __________________________ __________ Respondent DOB Temporary Order for Protection and Notice of Hearing (TMORPRT) (Clerk's Action Required) Next Hearing Date/Time: __________________ At : ____________________________________ Names of minors: No minors Involved Respondent Identifiers First Middle Last Age _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ Caution : Sex Race Hair Height Weight Eyes Respondent’s Distinguishing Features: ______________________________________ ______________________________________ Access to weapons : yes no unknown The court finds : The court has jurisdiction over the parties, the minors, and the subject matter. The respondent will be served notice of his or her opportunity to be heard at the scheduled hearing. RCW 26.50.070. For good cause shown, the court finds that an emergency exists and that a Temporary Protection Order should be issued without notice to the respondent to avoid irreparable harm or injury. The court orders : 1. Respondent is restrained from causing petitioner physical harm, bodily injury, assault, including sexual assault, and from molesting, harassing, threatening, or stalking petitioner the minors named in the table above these minors only: 2. Respondent is restrained from harassing, following, keeping under physical or electronic surveillance, cyberstalking as defined in RCW 9.61.260, and using telephonic, audiovisual, or other electronic means to monitor the actions, locations, or wire or electronic communication of petitioner the minors named in the table above only the minors listed below members of the victim’s household listed below the victim’s adult children listed below: Additional no contact provisions are on the next page . The terms of this order shall be effective until: Temp Ord for Protection/Nt of Hrg (TMORPRT) - Page 1 of 4 WPF DV-2.015 Mandatory (08/2017) - RCW 26.50.070, RCW 9.41.800 the end of the hearing, noted above. 3. Respondent is restrained from coming near and from having any contact whatsoever, in person or through others, by phone, mail, or any means, directly or indirectly, except for mailing or service of process of court documents by a 3 rd party or contact by respondent’s lawyer(s) with petitioner the minors named in the table above these minors only: 4 . Respondent is restrained from going onto the grounds of or entering petitioner's residence workplace school the day care or school of the minors named in the table above these minors only: other: Petitioner's address is confidential. Petitioner waives confidentiality of the address which is : 5. Petitioner shall have exclusive right to the residence petitioner and respondent share. The respondent shall immediately vacate the residence. The respondent may take respondent's personal clothing and respondent's tools of trade from the residence while a law enforcement officer is present. This address is confidential. Petitioner waives confidentiality of this address which is: 6. Respondent is prohibited from knowingly coming within , or knowingly remaining within _______________________ (distance) of: petitioner's residence workplace school the day care or school of the minors named in the table above these minors only : other : 7. Petitioner shall have possession of essential personal belongings, including the following: 8. Petitioner is granted use of the following vehicle: Year, Make & Model_____________________________________ License No. 9. Other : Protection for minors: 10 . Petitioner is granted the temporary care, custody, and control of the minors named in the table above these minors only : 11. Respondent is restrained from interfering with petitioner's physical or legal custody of the minors named in the table above these minors only : 12. Respondent is restrained from removing from the state the minors named in the table above these minors only : Temp Ord for Protection/Nt of Hrg (TMORPRT) - Page 2 of 4 WPF DV-2.015 Mandatory (08/2017) - RCW 26.50.070, RCW 9.41.800 Surrender of Weapons Order filed separately The respondent must comply with the Order to Surrender Weapons Issued Without Notice filed separately, which requires the respondent to surrender any firearms and other dangerous weapons. The court finds that irreparable injury could result if the order to surrender weapons is not issued. The respondent is directed to appear and show cause why this temporary order should not be made effective for one year or more and why the court should not order the relief requested by the petitioner or other relief which may include electronic monitoring, payment of costs, and treatment. Failure to Appear at the Hearing May Result in the Court Granting Such Relief. The Next Hearing Date is Shown on Page One . Warnings to Respondent : A violation of provisions 1 through 6 of this order with actual notice of its terms is a criminal offense under chapter 26.50 RCW and will subject you to arrest . If the violation of the protection order involves travel across a state line or the boundary of a tribal jurisdiction, or involves conduct within the special maritime and territorial jurisdiction of the United States, which includes tribal lands, you may be subject to criminal prosecution in federal court under 18 U.S.C. § 2261, 2261A, or 2262. A violation of provisions 1 through 6 of this order is a gross misdemeanor unless one of the following conditions apply: Any assault that is a violation of this order and that does not amount to assault in the first degree or second degree under RCW 9A.36.011 or 9A.36.021 is a class C felony. Any conduct in violation of this order that is reckless and creates a substantial risk of death or serious physical injury to another person is a class C felony. Also, a violation of this order is a class C felony if you have at least two previous convictions for violating a protection order issued under Titles 7, 10, 26 or 74 RCW. If the court issues a final protection order, and your relationship to the petitioner is that of spouse or former spouse, parent of a common child, or former or current cohabitant as intimate partner, including a current or former registered domestic partner, you may not possess a firearm or ammunition for as long as that final protection order is in effect. 18 U.S.C. § 922(g)(8). A violation of this federal firearms law carries a maximum possible penalty of 10 years in prison and a $250,000 fine. An exception exists for law enforcement officers and military personnel when carrying department/government-issued firearms. 18 U.S.C. § 925(a)(1). If you are convicted of an offense of domestic violence, you will be forbidden for life from possessing a firearm or ammunition. 18 U.S.C. § 922(g)(9); RCW 9.41.040. You Can Be Arrested Even if the Person or Persons Who Obtained the Order Invite or Allow You to Violate the Order’s Prohibitions . You have the sole responsibility to avoid or refrain from violating the order’s provisions. Only the court can change the order upon written application. Pursuant to 18 U.S.C. § 2265, a court in any of the 50 states, the District of Columbia, Puerto Rico, any United States territory, and any tribal land within the United States shall accord full faith and credit to the order. Warning: A person may be guilty of custodial interference in the second degree if they violate provisions 10, 11, or 12. Temp Ord for Protection/Nt of Hrg (TMORPRT) - Page 3 of 4 WPF DV-2.015 Mandatory (08/2017) - RCW 26.50.070, RCW 9.41.800 Washington Crime Information Center (WACIC) Date Entry It is further ordered that the clerk of the court shall forward a copy of this order on or before the next judicial day to _______________________________________________________ County Sheriff's Office Police Department Where Petitioner Lives which shall enter it into WACIC. Service The clerk of the court shall also forward a copy of this order on or before the next judicial day to County Sheriff's Office Police Department Where Respondent Lives which shall personally serve the respondent with a copy of this order and shall promptly complete and return to this court proof of service. Petitioner has made private arrangements for service of this order. Law Enforcement Assistance Law enforcement shall assist petitioner in obtaining: Possession of petitioner's residence personal belongings located at: the shared residence respondent's residence other:_______________________________________ Custody of the above-named minors, including taking physical custody for delivery to petitioner (if applicable). Other: . Dated: at a.m./p.m. Judge/Commissioner Presented by:  Signature of Petitioner/Lawyer WSBA No. Print Name Temp Ord for Protection/Nt of Hrg (TMORPRT) - Page 4 of 4 WPF DV-2.015 Mandatory (08/2017) - RCW 26.50.070, RCW 9.41.800 The petitioner or petitioner’s lawyer must complete a Law Enforcement Information Sheet (LEIS).