Fill and Sign the Unmade Template for Pinellas County Clerk Form

1 of 5 DR - - Ex Parte Order of Protection Amended Order Case No. Circuit Court, Div. County: Petitioner/Plaintiff , Arkansas This Order is Effective Until: First Middle Last Petitioner’s Date of Birth (mm/dd/yyyy) Race Sex Minor Children Protected under this Order Versus Respondent/Defendant Respondent Identifiers First Middle Last CAUTION: Respondent possesses a firearm Respondent has history of extreme violence d.o.b. d.o.b. d.o.b. d.o.b. Sex Race DOB mm/dd/yyyy Ht. Wt. Address: Work: Eyes Hair SS# Phone # DL # or other ID # Pursuant to Federal law, this Order shall be enforced by law enforcement officers in all states, territories, districts and tribal lands regardless of whether this Order of Protection is registered locally. 2 of 5 DR - - Relationship Identifiers: ☐ Current or former spouses ☐ Parents of child(ren) in common ☐ Live together ☐ Current or past dating relationship ☐ Other Relative (Explain)_______________ ________________________________________________________________________\ _________ THE COURT HEREBY FINDS AND ORDERS: ☒ That there is jurisdiction over the parties and subject matter, and Petitioner has presented sufficient evidence to show: (1) that the victim(s) is (are ) in immediate and present danger of domestic abuse, or (2) that the Respondent is scheduled to be released from incarceration within thirty (30) days, and upon the Respondent’s release there will be an immediate and present danger of domestic abuse. ☒ That the Petitioner has also presented sufficient evidence to show that the Respondent presents a credible threat to the physical safety of a person named in the order of protection as a family member or household member, a child of the family or household member, or a child of the respondent or enjoined party. ☒ That an Ex Parte Temporary Order of Protection is hereby granted pursuant to the terms herein. That the Respondent is ordered to appear before the Court on the ________ day of __________________________, 20 _________, at____________ __ .m. in the Courthouse located at_______________________________________________AR. If you fail to appear, the Court will likely make this Order permanent without further notice to you. The Respondent is hereby restrained from committing any criminal act against the victim(s) including, but not limited to: acts of violence or Domestic Abuse, A.C.A. §9-15-103(3); Harassment A.C.A. §5-71-208; Harassing Communica tions A.C.A. §5-71-209; Stalking A.C.A. §5-71-229; or Terroristic Threatening A.C.A. §5-13-301. ☒ The Respondent is prohibited from initiating any cont act with the victim(s) including but not limited to physical presence, telephonic, electronic, oral, written, visual, or video. Respondent also shall not use a third party to contact the victim(s) except by legal counsel or as authorized by law or court order. ☒ The Respondent is excluded from the Petitioner’s residence and the immediate vicinity thereof. Petitioner’s Address: (or) ☐ The Petitioner's address is excluded from notice to the Respondent. ☐ The Respondent is prohibited from the following places: Petitioner’s Workplace: __________________________________________________________________ School: ________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Other (Identify): ________________________________________________________________________ 3 of 5 DR - - (Childern's Names)________________________________________________________________________\ ___ ☐ ______________________________________________is awarded temporary custody of minor child(ren): (Children's Names)_______________________________________________________________________ _______________________________________________________________________________________ Any law enforcement officer with jurisdiction is ordered to assist the Petitioner in gaining possession of the dwelling and/or to otherwise assist in execution of the Order of Protection. A law enforcement officer with jurisdiction is ordered to serve the Order of Protection on the Respondent. A law enforcement officer with jurisdiction is orde red to assist the Petitioner in obtaining his or her personal effects from the dwelling upon proper and timely request of the Petitioner. A law enforcement officer with jurisdiction is orde red to assist the Respondent in obtaining his or her personal effects from the dwelling upon proper and timely request of the Respondent. Other Orders: ________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Respondent is temporarily prohibited from terminating the account(s) associated with the following telephone number(s): _______________________________________________________________________________________ ______________________________________________________________________________________ If the parties (or other persons named herein) are subject to the jurisdiction of another court (i.e. through a divorce or paternity action), upon proper notice and the opportunity to be heard, said court may amend the terms of this Order as appropriate. On this _____________________ day of ___________________________, 2__________, IT IS ORDERED. 4 of 5 DR - - ____ _______________________________________ C IRCUIT JUDGE/DISTRICT JUDGE Office of the Circuit Clerk, ___________________________________________________ Co unty, Arkansas WARNINGS TO RESPONDENT (1) A violation of the order of protection is a Class A misdemeanor carrying a maximum pena lty of one (1) year's imprisonment in the county jail or a fine of up to one thousand dollars ($1,000), or both; (2) A violation of an or der of protection under this section within five years of a previous conviction for a violation of an order of protection is a Class D felony; (3) It is unlawful for an intimate partner who is subject to an order of protection or an individual convicted of a misdemeanor of d omestic violen ce to ship, transport, o r possess a firearm or ammunition under 18 U.S.C. §9 22 (g)(8) and (9) as it existed on January 1, 20 19; (4) A conviction of violation of an order of p rotection under this section within five (5) years of a previous conviction for violation of an order of protection is a Class D felo ny; (5) A person wh o is a respondent o r an enjoined party is restrained from harassing, stalking , o r threatening a person named in an order of protection as a family or household member, a child , o f the family or household m ember, or a child of the resp ondent or enjoined party; (6) A person who is a resp ondent or an enjoined party is restrained from en gaging in other co nduct that would place a person named in an order of protection as a family or household member, a child of the family or h ou sehold member, or a child of the respondent or enjo ined party in reasonable fear of b odily injury; and (7) A person who is a respo ndent is prohibited from u sing, attempting to use, or threatening the use of p hysical force against the person named in the order o f protection as a family or h ouseh ol d member, a child of th e family o r household member, or a child o f the respondent o r enjoined party wh ich would reasonably be expected to cause bod ily injur y. -Crossing state, territorial, or tribal boundaries to violate this Order may result in federal imprisonment pursuant to 18 U.S.C. §2262. NOTICE TO LAW ENFORCEMENT -Th is Order of Protectio n is enforceable in every county of this state by any court or law enforcement officer. See A.C.A. §9-1 5-207(g). 5 of 5 DR - - PROOF OF SERVICE Case #: ___________________ ______________________ Court Date: ___________ _____________________________ SERVED: Date Time Place ___________________________ Attempts Made: List only date and time 1)___________________________ 2)____________________________ 3)___________________________ __________________________________________________________________________________________ Served On (Print Name) Manner of Service __________________________________________________________________________________________ Served By (Print Name) Title Badge # DECLARATION OF SERVER I declare, under penalty of perjury under the laws of the State of Arkansas, that the foregoing information contained in the proof of service is true and correct. Executed on __________________ ____ ___________________________________ DateSignature of Server ____ ___________________________________ Address of Server