Fill and Sign the Oregon Order Restraining 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 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF __________________ ) ) No. , ) Petitioner, ) MOTION, AFFIDAVIT AND ORDER RENEWING ELDER ABUSE ) PREVENTION ACT RESTRAINING ORDER vs. ) ) ) , ) Respondent. ) MOTION On the basis of ORS 124.035 and the following affidavit, Petitioner requests that the Court renew the Restraining Order signed ________________, _____ in this matter for a period of one year and continue the security amount in the amount set forth in the original order. Motion; Affidavit and Order Renewing Elder Abuse Prevention Act Restraining Order 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 STATE OF OREGON ) ) ss. AFFIDAVIT County of _______________ ) I ___________________________ swear/affirm that I am the Petitioner in this matter, and: (check one) _______ based on the conditions of abuse described in the original petition or previous Motion to renew, there is good cause to renew the Restraining Order. _______ based on the following additional facts, there is good cause to renew the Restraining Order: ______________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________ Petitioner (signature) ______________________________________ Petitioner (print name) ______________________________________ Petitioner’s address (you may use contact address) ______________________________________ ______________________________________ Telephone SUBSCRIBED AND SWORN to before me this ________ day of _________________, _____. Motion; Affidavit and Order Renewing Elder Abuse Prevention Act Restraining Order 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 ____________________________________________ NOTARY PUBLIC FOR OREGON/COURT CLERK My commission expires:__________________ TO THE RESPONDENT : THIS ORDER CONTINUES THE ORIGINAL OR MODIFIED RESTRAINING ORDER AND BECOMES EFFECTIVE IMMEDIATELY. VIOLATION OF THE CONTINUED RESTRAINING ORDER MAY RESULT IN YOUR ARREST OR IN CIVIL AND/OR CRIMINAL PENALTIES. IF YOU WISH TO CONTEST THE CONTINUATION OF THIS ORDER, SEE YOUR RIGHTS TO A HEARING IN THE ATTACHED FORM. This matter coming before the Court on petitioner’s motion, IT IS HEREBY ORDERED that: _____ The Restraining Order in this matter is renewed for a period of one year. _____ Other: ____________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _____ The security amount for violation of any provision of this order or the original restraining order is $5,000 unless otherwise specified; _____ other amount $_______________. Motion; Affidavit and Order Renewing Elder Abuse Prevention Act Restraining Order 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 _____ Petitioner’s motion is denied . Dated this _____ day of _____________________, _____. ______________________________________ Circuit Court Judge Submitted by: ______________________________________________ ___ Petitioner ___ Petitioner’s Attorney OSB #________ Motion; Affidavit and Order Renewing Elder Abuse Prevention Act Restraining Order 4