Fill and Sign the Petitioner Person Protected Form

Order for Protection - Stalking (ORPSTK) – Page 1 of 4 ST -04.0500 ( 07/2019 ) – RCW 7.92.100. RCW 9.41.800 Court of Washington For _____________________________ __________ Petitioner (person protected), (DOB) vs. _____________________________ __________ Respondent (person restrained). (DOB) No . Order for Protection - Stalking (ORPSTK) Cour t Address _________________________ _________________________________ _________________________________ Telephone Number: ( ) (Clerk’s action required) Respondent Identifiers Respondent’s Distinguishing Features : _____________________________________ _ ______________________________________ Caution : Access to weapons : [ ] yes [ ] no [ ] unknown Sex Race Hair Height W eight Eyes Notice of this hearing was served on the respondent by [ ] personal service [ ] service by publicati on per to court order [ ] service by mail per court order [ ] other . The protected person/s is/are the : [ ] Petitioner who is 16 years of age or older and filed on his or her own behalf. [ ] Petitioner/s who is/are the following minor child/ren on whose behalf the petition was filed: Name (First, Middle Initial, Last) Age [ ] The child/ren’s parent or guardian filed the petition; or [ ] A person who is not the parent or guardian, with whom the child/ren live/s, filed the petition; and the respondent is not the parent. [ ] Petitioner who is a vulnerable adult as defined in RCW 74.34.020 or 74.34.021, on whose behalf the petition was filed. [ ] An interested person filed the petition. No contact provisions begin on the next page. This Order for Protection – Stalking is effective until : Order for Protection - Stalking (ORPSTK) – Page 2 of 4 ST -04.0500 ( 07/2019 ) – RCW 7.92.100. RCW 9.41.800 Based upon the petition, testimony, and case record, the court finds that the respondent committed stalking conduct. It is ordered that : [ ] No -Contact : Respondent is restrained from having any contact, including nonphysical contact, with the protected person/s directly, indirectly, or through third parties regardless of whether those third parties know of the order, except for mailing or service of process of court documents by a 3rd party or c ontact by respondent’s lawyer/s. [ ] Surveillance : Respondent is prohibited from keeping the protected person/s under surveillance, including electronic surveillance . [ ] Excluded from places : Respondent is excluded from the protected person/s’ [ ] residence [ ] workplace [ ] school [ ] day care. [ ] Stay Away : Respondent is prohibited from knowingly coming within or knowingly remaining within _______________ (distance) of protected person/s’ [ ] residence [ ] workplace [ ] school [ ] day care. [ ] other: [ ] The address is confidential . [ ] Petitioner waives confidentiality of the protected person/s’ address which is: [ ] Evaluation: Respondent shall submit to a [ ] mental health [ ] chemical dependency ev aluation by ________________________________________________ ________ at respondent’s expense. [ ] Pay Fees and Costs: Judgment is granted against respondent in favor of ____________________ in the amount of $ _______ for costs incurred in bringing the action and $ _________ for attorneys’ fees. Notice : Petitioner, you must fill out and file a completed form ST 3.030, Judgment Summary . The court has granted judgment against the respondent in the amount of $ __________ for administrative court costs a nd service fees. A Judgment Summary, form WPF ST 3.030, must be completed and filed. [ ] Prohibit Weapons and Order Surrender The Respondent must:  not access, possess or obtain a firearm, other dangerous weapon, or concealed pistol license s; and  comp ly with the Order to Surrender Weapons filed separately. (Note: Also use form All Cases 02.050 .) Order for Protection - Stalking (ORPSTK) – Page 3 of 4 ST -04.0500 ( 07/2019 ) – RCW 7.92.100. RCW 9.41.800 Findings – The court (check all that apply): [ ] must issue the orders referred to above because the court finds by clear and convincing evidence that the respondent: [ ] has used, displayed, or threatened to use a firearm or other dangerous weapon in a felony; or [ ] is ineligible to possess a firearm under RCW 9.41.040. [ ] may issue the orders referred to above because the court finds by a preponde rance of evidence, the respondent: [ ] presents a serious and imminent threat to public health or safety, or the health or safety of any individual by possessing a firearm or other dangerous weapon; or [ ] has used, displayed, or threatened to use a f irearm or other dangerous weapon in a felony; or [ ] is ineligible to possess a firearm under RCW 9.41.040. Warning to the Respondent : A knowing violation of this stalking protection order is a criminal offense under chapter 26.50 RCW and will subject a violator to arrest. You can be arrested even if any person protected by the order invites or allows 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. A knowing violation of this order is punishable under RCW 26.50.110. Full Faith and Credit: The court has jurisdiction over the parties, the minors and the subject matter. This order is issued in accordance with the Full Faith and Cred it provisions of VAWA. 18 U.S.C. § 2265. Washington Crime Information Center (WACIC) Data Entry It is ordered that the clerk of court shall forward a copy of this order , and any order to surrender weapons, on or before the next judicial day t o __________ ___________________ [ ] County Sheriff’s Office [ ] Police Department, where Petitioner lives and shall enter it into WACIC. Service [ ] The clerk of the court shall also electronically forward a copy of this order , and any order to surrender weapons , 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. Or [ ] Respondent appeared and was informed of the order by the court; further service is not required. Or [ ] Petitioner shall serve this order by [ ] mail [ ] publication as previously ordered. Or [ ] (Only if surrender of weapons not ordered ) Petitioner has made private arrangements for service of this order. Order for Protection - Stalking (ORPSTK) – Page 4 of 4 ST -04.0500 ( 07/2019 ) – RCW 7.92.100. RCW 9.41.800 This order is in effect until the expiration date on page one . If the duration of this order exceeds one year, the court finds that Respon dent is likely to resume stalking of the petitioner when the order expires. Other: . Dated : ________________ at _____ a.m./p.m . Judge/Court Commissioner I acknowledge receipt of a copy of this Order: Signature of Respondent/ Lawyer WSBA No. Print Name Sign ature of Petitioner/ Lawyer WSBA No. Print Name Petitioner : The law allows you to register for certain notifications regarding this protection order and its status. Visit www.RegisterVPO.com or call 1 -877 -242 -4055 for more information, or to sign up. If you feel that you are in danger, call 9 -1-1 immediately. Petitioner or Petitioner’s Lawyer must complete a Law Enforcement Information Sheet (LEIS).