Free Elder/Disabled Person Abuse Restraining Order - Sweepstakes Promotions - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN

_____________________________________
Petitioner (your nam e) Gua rdian Petitioner,
vs. _____________________________________ Respondent (person to be restrained)

) ) ) ) ) ) ) ) )

CASE NO :__________________________ RESTRAINING ORDER TO PREVENT AUBSE [Elderly Persons and Person s with Disabilities Abus e Prevention A ct]

TO THE RESPONDENT: VIOLATION OF THIS RESTRAINING ORDER MAY RESULT IN YOUR ARREST AND IN CIVIL AND/OR CRIMINAL PENALTIES. REVIEW THIS ORDER CAREFULLY. EACH PROVISION MUST BE OBEYED. SEE YOUR RIGHTS TO A HEARING. The court, having reviewed the petition, makes the following findings: JUDGE'S INITIALS [____]Petitioner or _________________________ has been abused by respondent as defined by ORS 124.005; [____]The abuse of petitioner or ______________________ by respondent occurred within the last 180 days as provided in ORS 124.010; [____]There is an immediate and present danger of further abuse to petitioner or _______________________________________________ . IT IS HEREBY ORDERED that: Petitioner's/Guardian Petitioner's Request JUDGE'S INITIALS

G 1. Respondent is restrained from mailing the petitioner or ____________________ (name of protected person) any sweepstakes promotions, effective on a date not less than 150 days from the date of this Order......................................................................................... [______] Petitioner's/Guardian Petitioner's Request JUDGE'S INITIALS

G 2. Respondent shall remove the petitioner or ______________________________ from the respondent's sweepstakes promotion mailing list or shall place the petitioner or
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_________________________, on the respondent's list of persons to whom sweepstakes promotions may not be mailed.................................................................................................................. [______] G3.Respondent shall refund promptly any payment received in any form from the petitioner or _____________________________ after the date this Order is entered by the court.......................................................................................................... [______] G 4. Other relief: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________...[______] G 5.No further service is necessary because respondent appeared in person before the court. IT IS FURTHER ORDERED that: SECURITY AMOUNT FOR VIOLATION OF ANY PROVISION OF THIS ORDER IS $5,000 unless otherwise specified. Other Amount ($ ) THE ABOVE PROVISIONS OF THIS RESTRAINING ORDER ARE IN EFFECT FOR A PERIOD OF ONE YEAR OR UNTIL THE ORDER IS AMENDED OR DISMISSED, WHICHEVER OCCURS FIRST. IT IS HEREBY ORDERED that: G The Petition for Restraining Order to Prevent Abuse of Elderly Person or Person With Disabilities is dismissed.

DATED this __________ day of ____________________, 20____. ________________________________ JUDGE (Signature) ________________________________ Print, Type or Stamp Name of Judge

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