Order For Protection (Issued After Hearing) (Short Form) {PO-0112} | Pdf Fpdf Doc Docx | Indiana

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Order For Protection (Issued After Hearing) (Short Form) {PO-0112} | Pdf Fpdf Doc Docx | Indiana

Order For Protection (Issued After Hearing) (Short Form) {PO-0112}

This is a Indiana form that can be used for Protection Order within Statewide, Protective Order.

Alternate TextLast updated: 5/11/2006

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So that the Order of Protection is valid, after you print, YOU MUST REPLACE THIS PAGE with the Cover Sheet: Order of Protection (available for download in PDF form)at <<<<<<<<<********>>>>>>>>>>>>> 2PO-0112 Approved 07-01-02 Revised 07-23-04 STATE OF INDIANA ) IN THE ________________C OURT____ ) SS: (______ _________ DIVISION, ROOM __) COUNTY OF ________ ) CASE NO._________________________ _______________________, ) Petitioner ) vs. ) _______________________, ) Respondent ) ORDER FOR PROTECTION FINDINGS This matter having been heard by the Court on ____________________ pursuant to Indiana Code 34-26-5-10, the Court now makes the following Findings (strike through those which do not apply): a. _______________________ filed a timely Request for Hearing pursuant to Indiana Code 34-26-5-10(a); and/or, b. The Court is required to hold a hearing pursuant to Indiana Code 34- 26-5-10(b). c. The Petitioner was present at the hearing and the Respondent was/was not present. d. The Respondent had notice and an opportunity to be heard. e. The Petitioner has shown, by a preponderance of the evidence, that d omestic or family violence has occurred sufficient to justify the issuance of this Ord er. f. The Respondent has failed to show good cause why this Order for Prot ection should not be issued. g. The Respondent does/does not agree to the issuance of the Order for Protection. h. The Respondent represents a credible threat to the safety of the Pet itioner or a member of the Petitioners household. i. The following relief is necessary to bring about a cessation of the violence or the threat of violence. ORDER (strike through those which do not apply) Section 1General Provisions 1. The Respondent is hereby enjoined from threatening to commit or committing acts 01 - of domestic or family violence against the Petitioner and the following designated Petitioner family or household members, if any: __________________________________________________________________ 02- Others __________________________________________________________________ __________________________________________________________________. Page 2 of ____ pages <<<<<<<<<********>>>>>>>>>>>>> 3PO-0112 Approved 07-01-02 Revised 07-23-04 2. The Respondent is prohibited from harassing, annoying, telephoning, contacting, 05 or directly or indirectly communicating with the Petitioner. 3. The Respondent shall be removed and excluded from the Petitioners residence. 03 4. The Respondent is ordered to stay away from the residence, school, and/or place 04 of employment of the Petitioner. The Respondent is further ordered to stay away fr om the following place(s) that is/are frequented by the Petitioner a nd/or the Petitioners family or household members: _____________________________________________________. 5. The Petitioner shall have the possession and use of the residence/motor vehicle/other 03 essential personal effects as follows: Residence _________________________________________________________________ 08 - Other ________________________________________________________________________ _____. 6. The Court orders the following additional relief to provide for the safe ty and welfare 08 of the Petitioner and each family or household member designated in Paragraph 1 of this Order: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________. 7. To law enforcement officers: You are hereby directed to accompany the 08 Petitioner to the residence of the parties to ensure that the Petitioner is safely restored to the possession of the residence/motor vehicle/other essential personal effects listed above; or, you are to supervise the Petitioners or Re spondents removal of personal belongings. 8. The Respondent is prohibited from using or possessing a firearm, ammunition, or deadly weapon. The Respondent is ordered to surrender the following fire arm[ s], 08 ammunition, and/or deadly weapon[s] which the Court finds are in the contro l, ownership, or possession of the Respondent or in the control or possessi on of another person on behalf of the Respondent: a. ___________________________________________________; b. ___________________________________________________; c. ___________________________________________________; (attach a separate sheet if necessary). 9. The Respondent shall surrender the items listed above between the hours of __:__ and 08 __:___ on the date of ________________ to the following law enforcement agency ____________________________ at the following location: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________. Page 3 of ____ pages <<<<<<<<<********>>>>>>>>>>>>> 4PO-0112 Approved 07-01-02 Revised 07-23-04 10.The law enforcement agency listed above shall provide the Respondent with a receipt for the items the Court has ordered the Respondent to surrender. The law enforcement 08 agency shall also provide the Court with written verification of the Res pondents compliance with this Order no later than one (1) business day after such compliance. If the Respondent does not appear at the specified date and time, or app ears but does not have all of the items listed above, the law enforcement agency is ordered to contact the Court immediately by the following means: ________________________________________________________________. 11.The items listed above shall be kept by the law enforcement agency for the duration of 08 this Order or until the following date: _________________________. (if the parties do not have children, proceed to Section 3) Section 2Visitation Provisions 12. The Court, having found that domestic or family violence has occurred, now orders, 08 pursuant to IC 34-26-5-9(c)(2): a. Respondents visitation shall be supervised by a third party and/or limited as follows: ___________________________________ __________________________________________________ __________________________________________________; or, b. The Court finds that it is necessary to deny visitation at this time in order to protect the safety of the Petitioner and/or the minor

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