Fill and Sign the Respondent Restrained Person Dob Form

Sexual Assault Protection Order (ORSXP) - Page 1 of 4 WPF SA 3.015 Mandatory (07/2017) - RCW 7.90.090, .120, .130, RCW 9.41.800 Court of Washington For __________________________ __________ Petitioner (Protected Person) DOB vs. __________________________ __________ Respondent (Restrained Person) DOB Sexual Assault Protection Order No. Court Address Telephone Number : ( ) (ORSXP) (JIS Order Code: SXP) Clerk's Action Required Court Administrator’s Action Required Respondent Identifiers Sex Race Hair Height Weight Eyes Respondent’s Distinguishing Features : ______________________________________ ______________________________________ Caution : Access to weapons : yes no unknown The court finds : The court has jurisdiction over the parties and the subject matter, and Chapter 26.50 RCW does not apply. Respondent has been provided reasonable notice and an opportunity to be heard. Notice of this hearing was served on the respondent by personal service service by mail per court order service by publication per court order. Additional findings of this order are set forth below. The court orders : This order is effective immediately and for one year from today’s date, unless stated otherwise here (date) : Warnings to the Respondent : A knowing violation of this sexual assault 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 fro m violating the order’s provisions. Only the court can change the order . The court finds: Sexual Assault Protection Order (ORSXP) - Page 2 of 4 WPF SA 3.015 Mandatory (07/2017) - RCW 7.90.090, .120, .130, RCW 9.41.800 The respondent petitioner is under the age of 16 years of age and his or her parent(s) or guardian(s) had notice of this proceeding. appeared at this hearing and is a responsible and proper person and is appointed guardian ad litem for solely for purposes of this proceeding. is appointed attorney for solely for purposes of this proceeding. The court further finds by a preponderance of the evidence that the petitioner has been a victim of nonconsensual sexual conduct or nonconsensual sexual penetration by the respondent. It is ordered : 1. No Contact: Respondent is restrained from having any contact with Petitioner, including but not limited to telephone calls, mail, written notes, e-mail, texting, and social media (such as Facebook and Twitter), directly, indirectly, or through third parties regardless of whether those third parties know of the order. 2. Exclude from places: Respondent is excluded from the following places: Petitioner’s residence Petitioner’s workplace Petitioner’s school Petitioner’s day care Other: 3. Stay Away: Respondent is prohibited from knowingly coming within, or knowingly remaining within __________________ (distance) of: Petitioner’s residence Petitioner’s workplace Petitioner’s school Petitioner’s day care Other: 4. Other : 5. School Transfer: Respondent is restrained from attending _________________________________ school at ___________________________________________________ (address) attended by Petitioner and the respondent is Ordered to transfer to a different school. Respondent or Respondent’s parents or legal guardians are responsible for transportation and all other costs associated with change of school. See Appendix A which is attached and incorporated by reference. Sexual Assault Protection Order (ORSXP) - Page 3 of 4 WPF SA 3.015 Mandatory (07/2017) - RCW 7.90.090, .120, .130, RCW 9.41.800 Prohibit Weapons and Order Surrender The respondent must:  not possess or obtain any firearms, other dangerous weapons, or con cealed pistol license; and  comply with the Order to Surrender Weapons filed separately. 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 previously committed an offense making him or her ineligible to possess a firearm under RCW 9.41.040. may issue the orders referred to above because the court finds by a p reponderance 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 firearm or other dangerous weapon in a felony; or previously committed an offense making him or her ineligible to possess a firearm under RCW 9.41.040. Washington Crime Information Center (WACIC) Data 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 a Return of 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 for service upon ______________________________________ (Respondent’s Parent(s) or Legal Guardian(s)) at: _____________________________________________________________________ _______________________________________________________and law enforcement shall promptly complete and return to this court a Return of Service. Petitioner shall make private arrangements for service of this order. Respondent appeared and was served a copy of the order by the court; further service is not required. Petitioner may serve this order by mail publication as previously ordered. Sexual Assault Protection Order (ORSXP) - Page 4 of 4 WPF SA 3.015 Mandatory (07/2017) - RCW 7.90.090, .120, .130, RCW 9.41.800 This order is in effect until the expiration date on page one. Other: . Dated: __________________________________ at ______________________ a.m./p.m. __________________________________ Judge/Commissioner I acknowledge receipt of a copy of this Order: Signature of Respondent/Lawyer WSBA No. Print Name Date Signature of Respondent’s Guardian ad Litem, if any Print Name Date Signature of Petitioner/ Lawyer WSBA No. Print Name Date Signature of Person Filing Petition on Behalf of Petitioner Print Name Date The petitioner, the petitioner’s lawyer, or the person filing the petition on behal f of the petitioner must complete a Law Enforcement Information Sheet (LEIS).