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Order For Protection (Stalking Modification Of Permanent Order) UJS-121I - South Dakota
| Order For Protection (Stalking Modification Of Permanent Order) Form. This is a South Dakota form and can be used in Stalking Protection Orders Statewide . |
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STATE OF SOUTH DAKOTA COUNTY OF ______________ DOMESTIC ) ) ) STALKING PERMANENT IN CIRCUIT COURT _________ JUDICIAL CIRCUIT ORDER FOR PROTECTION TPO NO. _____________________ PETITIONER IDENTIFIERS: EX PARTE TEMPORARY PETITIONER First Middle Last Date of Birth of Petitioner And/or on behalf of minor family member(s): (list name and DOB):______________________________ _____________________________________________ _____________________________________________ Other Protected Persons/DOB:_________________ _____________________________________________ __________________________________________ __________________________________________________ V. RESPONDENT First Middle Last RESPONDENT IDENTIFIERS: SEX RACE HEIGHT WEIGHT EYES HAIR DATE OF BIRTH STATE EXPDATE Relationship to Petitioner: _____________________________________________ _____________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ DRIVERS LICENSE # Respondent's Address: CAUTION: Weapon Involved Distinguishing Features: _____________________________________________ _____________________________________________ That it has jurisdiction over the parties and subject matter, and the Respondent has been provided with reasonable notice and opportunity to be heard, and that in the case of an ex parte order, the Respondent will be provided with reasonable notice and opportunity to be heard sufficient to protect the Respondent's due process rights. That the Respondent is restrained from acts of abuse and physical harm, making threats of abuse, stalking or harassment. That the Respondent is restrained from contact with the Petitioner by any direct or indirect means except as authorized in this order. Additional findings and orders are on the following pages. This order shall be effective through , , or if a permanent protection order is Month/Day Year issued, until that order is served. Only this Court can change this order. VIOLATION OF THIS PROTECTION ORDER IS A CRIMINAL OFFENSE. WARNING TO RESPONDENT: This order shall be enforced, even without registration, by courts of any state, the District of Columbia, any U.S. Territory, and may be enforced by Tribal Lands (18 U.S.C.§2265). Crossing state, territorial, or tribal boundaries to violate this order may result in federal imprisonment (18 U.S.C. §2262). Form UJS-121I (Stalking Modification of Permanent Order) Rev. 11/07 THE COURT FINDS: THE COURT ORDERS: 1 American LegalNet, Inc. www.FormsWorkflow.com ADDITIONAL FINDINGS: This matter came before this Court on this day and the following parties appeared personally: Petitioner Petitioner's Attorney ______________________ Other ____________________ Respondent Respondent's Attorney ___________________ Other ____________________ 1) This Court FINDS that, without admitting to the allegations in the Petition, the Respondent waives further hearing, findings of fact, and conclusions of law, and stipulates to the entry of an Order of Protection on the terms specified below. 2) Having considered the evidence presented and any affidavits and pleadings on file, this Court FINDS: A. That jurisdiction and venue are properly before this Court; B. That the above-named Petitioner and Respondent are "family or household members" within the meaning of SDCL 25-10-1(2); C. By a preponderance of the evidence that "domestic abuse" as defined by SDCL 25-10-1(1) has occurred; and D. That the Petitioner has suffered physical injury resulting from an assault or a crime of violence, as defined by SDCL 22-1-2(9). E. That the Motion to Modify is granted and modified terms incorporated herein. ADDITIONAL ORDERS: 1) The Respondent shall not come within a distance of ________________________of the Petitioner or the children named above unless otherwise specified in this order and of the following: A. The Petitioner's residence including: (street/apt/box)_____________________________ (city) ____________________________ (state)______ (zip)___________B. The Petitioner's place of employment including (street/apt/box) _____________________ (city) ,(state) ______ (zip) C. Other places including: (street/apt/box)_________________________ _________ (city)____________________________, (state) ______ (zip)___________-_________ (street/apt/box) ________________________________ (city) ____________________________,(state) ______ (zip)___________-_________ (street/apt/box) ________________________________ (city) ____________________________,(state) ______ (zip)___________-_________ 2) Phone calls, emails, third party contact, and correspondence, direct or indirect, is not permitted except as follows: ________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 4) Respondent is ordered to immediately turn over all weapons and ammunition to local sheriff. 5) Other relief as follows:______________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Form UJS-121I (Stalking Modification of Permanent Order) Rev. 11/07 2 American LegalNet, Inc. www.FormsWorkflow.com AND IT IS FURTHER ORDERED THAT: the Petitioner shall, immediately upon the granting of this Order, deliver two copies of this Order to the sheriff of this county. One copy shall be personally served by the sheriff upon the Respondent, unless personal service has been acknowledged below. DATED / / . Service of this order is authorized on any day including Sunday. Judge Attest: By: , Clerk of Courts , Deputy NOTICE OF ENTRY OF ORDER AND ACKNOWLEDGMENT OF PERSONAL SERVICE I acknowledge receipt of a copy of this Order of Protection. _______________________________________ Petitioner ___________________________________________ Respondent UNDER A PERMANENT PROTECTION ORDER: You may be subject to the following federal laws: (1) Effective immediately, you may not possess, carry, ship or transport any firearm or ammunition
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