Free RESTRAINING ORDER TO PREVENT ABUSE - Oregon

TO PETITIONER AND RESPONDENT: NOTICE OF "Exceptional Circumstances HEARING: The Court has scheduled an "exceptional circumstances" hearing about the temporary custody of your child/ren, on: Date:________ Time:____________ Courtroom: ________________________
(To Be Completed by Court Staff Only)

IN THE CIRCUIT COURT OF THE STATE OF OREGON COUNTY OF ___________________________ Petitioner (your full name) vs. (date of birth), ) ) ) ) ) ) ) Case No. ____________________ RESTRAINING ORDER TO PREVENT ABUSE (Family Abuse Prevention Act)

Respondent (full name of person to be restrained/date of birth).

NOTICETO RESPONDENT: You must obey all of the provisions of this Restraining Order, even if the Petitioner contacts you or gives you permission to contact him/ her. Violation of this Restraining Order may result in your arrest and in civil and/or criminal penalties. This order is enforceable throughout Oregon and in every other state. Review this order carefully. See the attached "NOTICE TO RESPONDENT/REQUEST FOR HEARING" for more information about your rights to a hearing. The Court, having reviewed the Petition, and having heard testimony, makes the following findings:
1. Judge's Initials 1. Petitioner and Respondent are RELATED as follows: A. Petitioner and Respondent are spouses/ registered domestic partners, or former spouses/ former registered domestic partners. B. Petitioner and Respondent are adults related by blood, marriage or adoption. C. Petitioner and Respondent have been cohabitating (living together in a sexually intimate relationship) since (date), or cohabitated from (date) to (date). D. Petitioner and Respondent have been involved in a sexually intimate relationship within the last two years. E. Petitioner and Respondent are the unmarried parents of a child/ren. F. Petitioner is a minor and has been involved in a sexually intimate relationship with Respondent who is 18 years of age or older. 2. Respondent has ABUSED Petitioner as defined by ORS 107.705; the abuse occurred WITHIN THE LAST 180 DAYS as provided in ORS 107.710; Respondent represents a CREDIBLE THREAT to the physical safety of Petitioner or Petitioner's child/ren; and the Petitioner is in IMMINENT DANGER OF FURTHER ABUSE. 2._________

RESTRAINING ORDER TO PREVENT ABUSE - Page 1 of 8
(FAPA 6/08)

Judge's Initials 3. This order involves minor CHILDREN. A. Oregon has JURISDICTION over the issues of the child/ren custody and parenting time under ORS 109.701 to 109.834 on the following grounds:

3A.

1. Oregon is the child/ren's home state OR No other state has home state jurisdiction OR All courts with jurisdiction on home state or significant connections grounds declined jurisdiction OR is the child/ren's home state but it has declined jurisdiction AND the children's parents or a person acting as a parent has significant connections with Oregon and substantial evidence is available here concerning the children's care, protection, and personal relationships. ORS 109.741 (1)(a)(b) and (c). 2. Oregon was the home state within six months before this proceeding was commenced and the child/ren are absent from the state but a parent or person acting as a parent continues to live in Oregon. ORS 109.741(1)(a) 3. Emergency grounds exist for the exercise of temporary jurisdiction because the child/ren are present in this state and have been abandoned or it is necessary to protect the child/ren because the child/ren, or a sibling or parent of the child/ren is subjected to or threatened with mistreatment or abuse. ORS 109.751 B. Existence of other orders concerning the minor children involved: 3B. PRIOR ORDER EXISTS ELSEWHERE: A previous child/ren custody, parenting time, guardianship or juvenile dependency determination has been made in _______________________________________________ (State/Tribe/Country). CUSTODY/PARENTING TIME MATTER PENDING: A child/ren custody, parenting time, guardianship, or juvenile dependency proceeding has been commenced in ____________________________________ (State/Tribe/Country). NO PRIOR ORDER EXISTS AND NONE IS PENDING: No child/ren custody, parenting time, guardianship or juvenile dependency determination has been issued or proceeding commenced in another state, tribe or country having jurisdiction under ORS 109.701-109.834. The custody and parenting time provisions in this Order shall become a final determination for purposes of the Uniform Child/ren Custody Jurisdiction and Enforcement Act if Oregon becomes the home state of the child/ren. INTERSTATE JUDICIAL COMMUNICATION is needed because: 3C. A custody/parenting time/child/ren placement matter is CURRENTLY PENDING in another state/tribe/country, or Oregon is exercising Temporary Emergency Jurisdiction under the UCCJEA in this protective order and ANOTHER STATE/TRIBE/COUNTRY HAS ALREADY ISSUED a custody/parenting time/child/ren placement order. EXCEPTIONAL CIRCUMSTANCES exist that affect the custody of the child/ren. 3D.

C.

D.

4.

4. EMERGENCY MONETARY ASSISTANCE: The Court finds that emergency monetary assistance is necessary to provide for the safety and welfare of the Petitioner and/or one or more child/ren in the custody of the Petitioner.

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(FAPA 6/08)

IT IS HEREBY ORDERED THAT: Judge's Initials Petitioner's Request (check all that apply): 1. 1. Respondent is restrained (prohibited) from intimidating, molesting, interfering with or menacing Petitioner, or attempting to intimidate, molest, interfere with or menace Petitioner directly or through third parties. 2. 2. Respondent is restrained (prohibited) from intimidating, molesting, interfering with or menacing, or attempting to intimidate, molest, interfere, or menace, the minor child/ren in Petitioner's custody directly or through third parties. 3. 3. Except as otherwise set out in this Order, Respondent is restrained (prohibited) from entering or attempting to enter, or remaining in, the area within 150 feet of the building and land at the following locations: (include names/addresses unless withheld for safety reasons) a. Petitioner's current or future residence. b. Petitioner's current or future business or place of employment c. Petitioner's current or future school. d. Other locations: 4. 4. Respondent shall not knowingly be or stay within 150 feet or _______ feet (other distance) of Petitioner unless otherwise ordered by the Court as follows:

Nothing in this restraining order prevents Respondent from appearing in a court hearing as a party or witness or attending other court-related processes in cases involving the Petitioner. At such times Respondent must stay at least feet away from the Petitioner and follow any additional protective terms ordered in that case. 5. 5. Except as otherwise set out in this Order, Respondent is restrained (prohibited) from: a. Contacting, or attempting to contact, Petitioner in person directly or through third parties. b. Contacting, or attempting to contact, Petitioner by mail or e-mail, or any other electronic transmission, except for mailing court-ordered emergency monetary assistance, checks or money orders directly or through third parties. c. Contacting, or attempting to contact, Petitioner by telephone, including cell phone or text messaging directly or through third parties. d. Exceptions to the restraint from third party contact is as follows (list purpose/s and person/s):

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(FAPA 6/08)

6. Respondent is restrained (prohibited) from entering, attempting to enter, or remaining at:

Judge's Initials 6.

a. The child/ren's current or future day care provider, or removing them from daycare. b. The child/ren's current or future school, or removing them from the school. 7. Respondent shall move from and not return to the residence located at 7.

except with a peace officer to remove essential personal effects of the Respondent, and if the Respondent is the custodial parent, essential personal effects of Respondent's child/ren, including, but not limited to: clothing, toiletries, diapers, medications, social security cards, birth certificates, identification and tools of the trade. 8. 8. A peace officer shall accompany the Petitioner to the parties' residence to remove essential personal effects of Petitioner, and if the Petitioner is the custodial parent, essential personal effects of the Petitioner's child/ren, including, but not limited to: clothing, toiletries, diapers, medications, social security cards, birth certificates, identification and tools of the trade. 9. 9. Emergency Monetary Assistance: The Respondent is ordered to pay Petitioner $ as th Emergency Monetary Assistance by the 45 day after Respondent is served with this Restraining Order by check or money order. Payment is to be made by mail to the following address: 10. Firearms. Respondent shall not purchase or possess any firearms or ammunition. Other orders regarding firearms (for court use only):

10. Event Code: FQOR

FIREARMS NOTIFICATION If the firearms prohibition in Paragraph 10 is initialed by the judge, it IS unlawful under OREGON state law for you to possess or purchase a FIREARM, including a rifle, pistol, or revolver, and AMMUNITION. You should consult an attorney if you have questions about this. EVENT CODE: NOGR

11. Other Relief:

11.

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(FAPA 6/08)

Judge's Initials 12. 12. TEMPORARY CUSTODY of the following child/ren is ordered as follows, subject to the parenting time terms set forth in Paragraphs 17 and 18 below. CHILD CUSTODY Party to Have Custody (Petitioner or Respondent) Child/ren's Name Date of Birth Age

Additional page attached labeled, "Paragraph 12 continued." 13. 13. A peace officer of the county or city where the child/ren are located shall assist in recovering the custody of the parties' child/ren that was awarded to Petitioner. The peace officer is authorized to use any reasonable force to that end, including forcible entry into the following specific premises (list the address(es) where the child/ren are most likely to be found and why):

14. (For court use only) Effect of Prior Custody Order (ORS 107.722) A CUSTODY ORDER ALREADY EXISTS in Case # County, Oregon, or

14. filed in (another state/tribe).

14A. NO new custody order is made because the terms in the existing order or judgment shall continue to apply. 14B. The child/ren custody provisions in paragraph 12 of this Restraining Order are necessary to protect the safety and welfare of the child/ren or Petitioner but they CONFLICT with the custody provisions in the already existing order or judgment. Therefore, the child/ren custody provisions in this Restraining Order shall remain in effect only until this Restraining Order expires or is cancelled, until a new order is issued in the other case, or until (date), whichever occurs first. 15. 15. Exceptional Circumstances Hearing: The Court has found that exceptional circumstances affecting custody exist, so NO custody order is entered at this time about the parties' child/ren. Both parties shall instead appear at a hearing as indicated in the box on the upper left-hand corner of page 1 of this Restraining Order. This hearing will be the respondent's only chance to contest this order. The purpose of the hearing will be to consider the temporary custody of the parties' child/ren and other issues that may be contested by the Respondent. At the hearing, the court may cancel or change this Order. 16. 16. Until the Exceptional Circumstances Hearing, the residence of the child/ren and the parental contact with the child/ren shall be as follows:

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(FAPA 6/08)

Judge's Initials 17. 17. The parent not awarded temporary custody shall have parenting time with the minor child/ren listed in paragraph 12 beginning on , as follows: PARENTING TIME a. NO PARENTING TIME because (explain why Respondent should not have parenting time): 17a.

b. SUPERVISED PARENTING TIME: 3 hours or _______ hours per week supervised by , as follows:

17b.

c. PARENTING TIME as follows (day/s of week, place, times) or as attached:

17c.

AND/OR Every weekend from

a.m./p.m. until (day) to a.m./p.m. FIRST AND THIRD or SECOND AND FOURTH weekends from (day) a.m./p.m. until (day) to Once per week on (day) a.m./p.m. until (day) to a.m./p.m.

(day)

a.m./p.m.

d. The parent without temporary custody will pick up and return the child/ren at: 17d. Petitioner's Respondent's residence. Petitioner Respondent may remain at the curb (or driveway if no curb), for a maximum of 5 minutes or minutes, for the sole purpose of picking up and/or returning the child/ren. Other location:

18. (For court use only) Effect of Prior Parenting Time Order (ORS 107.722) 18. A PARENTING TIME ORDER ALREADY EXISTS in Case # filed in County, Oregon, or (Another State/Tribe) NO new parenting time order is made because the terms in the existing order or judgment shall continue to apply. The parenting time provisions in this Restraining Order are necessary to protect the safety and welfare of the child/ren or Petitioner but they CONFLICT with the custody provisions in the already existing order or judgment. Therefore, the parenting time provisions in this Restraining Order shall remain in effect only until this Restraining Order expires or is cancelled, until a new order is issued in the other case, or until ______________ (date), whichever occurs first.
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(FAPA 6/08)

19.

Judge's Initials No further service is necessary because Respondent appeared in person before the court. 19.

IT IS FURTHER ORDERED that the SECURITY AMOUNT for violation of any provision of this Order is $5,000 unless otherwise specified here: Other Amount: $ The above provisions of this Restraining Order are in effect for a period of one (1) year from the date of the judge's signature (unless renewed before it expires) or until the Order is dismissed, modified, or replaced, whichever occurs first. CERTIFICATE OF COMPLIANCE WITH FULL FAITH AND CREDIT PROVISIONS OF VIOLENCE AGAINST WOMEN ACT (This is not a Brady Certificate) This Restraining Order meets all full faith and credit requirements of the Violence Against Women Act, 18 U.S.C. 2265 (2002). This Court has jurisdiction over the parties and the subject matter. The Respondent is being afforded notice and timely opportunity to be heard as provided by the law of this jurisdiction. This Order is valid and entitled to enforcement in this and all other jurisdictions. IT IS HEREBY ORDERED that: The Petition for Restraining Order to Prevent Abuse is GRANTED as set forth above. The Petition for Restraining Order is DENIED because: The Petitioner did not establish a claim for relief. The Petitioner did not appear at the time set for the ex parte hearing on his/her petition. Other: DATED: ______________________ JUDGE (Signature)

Print or Type Name of Judge Certificate of Document Preparation. You are required to truthfully complete this certificate regarding the document you are filing with the Court. Check all boxes and complete all blanks that apply: I selected this document for myself and I completed it without paid assistance. I paid or will pay money to Submitted by: for assistance in preparing this form.

Print Name, Petitioner Attorney for Petitioner

OSB No. (if applicable)

Address or Contact Address

City, State, Zip

Telephone or Contact Telephone Number

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(FAPA 6/08)

RELEVANT DATA PETITIONER (you)_______________________________________________ Female Male Name ***Residence/Contact Address ________________________________________________________________ Number, Street and Apt. Number (if applicable) City County State Zip Telephone/Contact Telephone Number __________________________________________________________ Birthdate____________________ Age _______ Race/Ethnicity Height _____________ Weight_____________ Eye Color_____________ Hair Color

***If you wish to have your residential address or telephone number withheld from Respondent, use a contact address or telephone number so the Court and the Sheriff can reach you if necessary.

RESPONDENT ___________________________________________________ Female Male Name Residence Address __________________________________________________________________________ Number, Street and Apt. Number (if applicable) City County State Telephone Number Birthdate_________________ Age ______ Race/Ethnicity Height_____________ Weight_____________ Eye Color _____________ Zip

Hair Color

-----------------------------------------------------------------------------------------------------------------------------PLEASE FILL OUT THIS INFORMATION TO AID IN SERVICE OF THE RESTRAINING ORDER Where is Respondent most likely to be located? Residence Hours _________________ Employment Hours _________________ Address: ___________________________________________ ___________________________________________________ Other Hours _________________ Address: __________________________________________ ___________________________________________________ Description of Vehicle ______________________________________________________________________ Is there anything about the Respondent's character, past behavior, or the present situation that indicates that the Respondent may be a danger to others? to him/herself? EXPLAIN: __________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Does the Respondent have any weapons, or access to weapons? EXPLAIN: __________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Has the Respondent ever been arrested for or convicted of a violent crime? EXPLAIN: __________________ __________________________________________________________________________________________

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(FAPA 6/08)