Approved, SCAO
Original -Court 1st copy - Respondent 2nd copy - Law Enforcement Agency Copies as needed JIS CODE: OAA
STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY
Court address
ORDER REMOVING ALLEGED ABUSER FROM CHILD'S HOME (CHILD PROTECTIVE PROCEEDINGS)
CASE NO. PETITION NO.
Court telephone no. name(s), alias(es), DOB
1. In the matter of
Regarding alleged abuser Height Weight Race
Last name
First name Sex
Middle initial
Relationship to child Hair color Eye color
Date of birth or age Other identifying information
Driver's license no.
2. Date of hearing: Judge/Referee: Bar no. 3. Notice of hearing was given as required by law. THE COURT FINDS: 4. A petition alleging abuse of the child(ren) has been authorized and there is probable cause to believe the parent, guardian, legal custodian, or other person committed the alleged abuse. 5. The alleged abuser's presence in the home presents a substantial risk of harm to the child(ren)'s life, physical health, or mental well-being. IT IS ORDERED that: 6. The alleged abuser named above shall a. leave the home at until further order of the court and have no contact with the child(ren) named above except as follows:
b. pay $
as appropriate support to maintain a suitable home environment for the child(ren).
Name of local law enforcement agency
c. surrender any firearms or potentially dangerous weapons to 7. Other:
.
8. This order is valid from until and is effective when the alleged abuser receives notice. A violation of the terms and conditions subjects the alleged abuser to criminal contempt of court. If found guilty of violating this order, the alleged abuser may be jailed for up to 90 days and fined up to $500.00.
Recommended by:
Referee signature
Date
Judge
Do not write below this line - For court use only
MCL 712A.13a JC 65 (9/07)
ORDER REMOVING ALLEGED ABUSER FROM CHILD'S HOME (CHILD PROTECTIVE PROCEEDINGS)