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Protection Notice To NCIC 10A - Ohio
| Protection Notice To NCIC Form. This is a Ohio form and can be used in General Tuscarawas County (Court Of Common Pleas) . |
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FORM 10-A: PROTECTION NOTICE TO NCIC New Form (Required fields appear in bold print) Modification of Previous Form SUBJECT NAME (LAST) (FIRST) (M.I.) ADDRESS (STREET) (CITY) (STATE) (ZIP) PHYSICAL HGT WGT HAIR EYES RACE SEX DESCRIPTION: NUMERICAL IDENTIFIER (NOTE: Only ONE of the 4 numerical identifiers is needed.) 1. SSN / / 2. DOB / / 3.* DRIVERS LIC. NO. STATE EXPIRATION YR. 4.* VEHICLE LIC. NO. STATE EXPIRATION YR. LIC. TYPE (* If #3 or #4 is used as a numerical identifier, entire line MUST be completed.) BRADY HANDGUN DISQUALIFIERS: (18 U.S.C. 922(d)(8) requires all yes to disqualify subject from purchasing a handgun) Does order protect an intimate partner or child(ren)? YES NO Did subject have opportunity to participate in hearing regarding order? YES NO Does order find subject a credible threat or explicitly prohibit physical force? YES NO IS THE SUBJECT BRADY DISQUALIFIED? YES NO CASE / ORDER NO. (15 DIGIT MAXIMUM) COURT ORIGINATING AGENCY IDENTIFIER (9 DIGIT ORI ASSIGNED BY NCIC) R.C. 2903.213 R.C. 2903.214 NAME OF JUDGE R.C. 2919.26 R.C. 3113.31 DATE OF ORDER / / EXPIRATION OF ORDER / / (IN R.C. 2919.26 CASES, NONEXP MAY BE USED) TERMS AND CONDITIONS OF ORDER (Mark all that are applicable) : 01 The subject is restrained from assaulting, threatening, abusing, harassing, following , interfering, or stalking the protected person and/or the child(ren) of the protected person. 02 The subject shall not threaten a member of the protected persons family or household. 03 The protected person is granted exclus ive possession of the residence or household. 04 The subject is required to stay away from the residence, property, school, or place of employment of the protected person or other family or household member. 05 The subject is restrained from making any communication with theprotected person, including but not limited to, personal, written, or telephone contact, or their employer, employees, or fellow workers, or others with whom the communication would be likely to cause annoyance or alarm the victim. 06 The subject has visitation or custody rights of the children named in this order. 07 The subject is prohibited from possessing and/or purchasing a firearm or other weapon. 08 See the Miscellaneous Field for comments regarding the specific terms and conditions of the order. Miscellaneous comments: OHP 09 The protected person is awarded tempor ary exclusive custody of the children named. DATA ONLY LIST ALL PROTECTED PERSONS (Total of 9 allowed, may attach additional forms; SSN is NOT necessary if DOB is given): #EPO PROTECTED PERSON (LAST) (FIRST) (M.I.) DOB / / SSN / / RACE SEX PROTECTED PERSON (LAST) (FIRST) (M.I.) DOB / / SSN / / RACE SEX MIS/ PROTECTED PERSON (LAST) (FIRST) (M.I.) DOB / / SSN / / RACE SEX Authorized by (signature): Date (circle one) Judge/Magistrate American LegalNet, Inc. www.USCourtForms.com Form 10-A May be reproduced locally 9/1/04 Discard all previous versions of this form
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