Fill and Sign the Oregon 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 __________________ PLEASE PRINT LEGIBLY _________________________________ ) Petitioner (your name), ) RESTRAINING ORDER TO PREVENT ABUSE ) vs. ) ) Case No.: _________________________________ ) Respondent (person to be restrained). ) TO THE RESPONDENT: VIOLATION OF THIS RESTRAINING ORDER MAY RESULT IN YOUR ARREST AND IN CIVIL AND/OR CRIMINAL PENALTIES. REVIEW THIS ORDER CAREFULLY. EACH PROVISION MUST BE OBEYED. SEE YOUR RIGHTS TO A HEARING. The court, having reviewed the petition, makes the following findings: JUDGE’S INITIALS ____ Petitioner has been abused by respondent as defined by ORS 124.005; Restraining Order to Prevent Abuse 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 ____ The abuse of petitioner by respondent occurred within the last 180 days as provided in ORS 124.010; ____ There is an immediate and present danger of further abuse to petitioner. IT IS HEREBY ORDERED that: Petitioner’s Request JUDGE’S INITIALS ____ I. Respondent is restrained (prohibited) from _____ intimidating, molesting, interfering with or menacing petitioner, or attempting to intimidate, molest interfere with or menace petitioner. ____ II. Respondent is restrained (prohibited) from _____ entering, or attempting to enter: (Include names and addresses unless withheld for safety reasons.) ____ Petitioner’s residence: ______________________________ _____ ____ Petitioner’s business or place of employment: _______________ _____ ____________________________________________________ Restraining Order to Prevent Abuse 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 ____ Petitioner’s school: ____________________________________ _____ ____________________________________________________ ____ Other locations: _______________________________________ _____ ____________________________________________________ ____ III. Respondent is restrained (prohibited) from: ____ Contacting, or attempting to contact, petitioner by telephone. _____ ____ Contacting, or attempting to contact, petitioner by mail. _____ ____ IV. Respondent shall move from and not return to the residence located at ________________________ _____ ________________________________ except with a peace officer in order to remove essential personal effects of the respondent, including, but not limited to: clothing, toiletries, diapers, medications, social security cards, birth certificates, identification, and tools of the trade. ____ V. A peace officer shall accompany the petitioner to the _____ parties’ residence in order to remove essential personal effects of petitioner, including, but not limited to: clothing, toiletries, diapers, medications, Restraining Order to Prevent Abuse 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 social security cards, birth certificates, identification, and tools of the trade. ____ VI. Other relief: ___________________________________ _____ _______________________________________________ ________________________________________________ ____ VII. No further service is necessary because respondent appeared in person before the Court. _____ IT IS FURTHER ORDERED that: SECURITY AMOUNT FOR VIOLATION OF ANY PROVISION OF THIS ORDER IS $5,000 unless otherwise specified. Other Amount: $ _______________________ THE ABOVE PROVISIONS OF THIS RESTRAINING ORDER ARE IN EFFECT FOR A PERIOD OF ONE YEAR OR UNTIL THE ORDER IS VACATED, MODIFIED, OR SUPERSEDED, WHICHEVER OCCURS FIRST. DATED this ___________ day of ________________________, _________. _______________________________________ Circuit Court Judge Restraining Order to Prevent Abuse 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 Submitted by : __________________________________________________________ Print Name ___ Petitioner ___ Attorney for Petitioner; OSB No. __________ ____________________________________________________________ Address or contact address ____________________________________________________________ City State Zip ____________________________________________________________ Telephone or Contact Telephone Number (s) Restraining Order to Prevent Abuse 5