Standard Civil Protection Order Forms -- Domestic Relations Division

(A) Distribution of packet (1) A domestic relations division of a court of common pleas shall distribute, upon request, a forms packet for use in domestic violence civil protection order proceedings under R.C. 3113.31. The packet shall include, at a minimum, forms and instructions that are substantially similar to “Forms 10-C, 10.01-A, 10.01-C, 10.01-D, 10.01-F, and 10.01- H”. (2) A domestic relations division of a court of common pleas shall distribute, upon request, a forms packet for use in dating violence civil protection order proceedings pursuant to R.C. 3113.31. The packet shall include, at a minimum, forms that are substantially similar to “Forms 10-C, 10.01-C, 10.01-P, and 10.01-Q.” (B) Civil protection order or consent agreement forms and protection order warning (1) In every domestic violence case in which a domestic relations division of a court of common pleas issues an ex parte or full hearing civil protection order or approves a consent agreement pursuant to R.C. 3113.31, the court shall use, as applicable, forms that are substantially similar to “Forms 10.01-H through 10.01-J” and include a cover sheet that is substantially similar to “Form 10-C” and send a completed form that is substantially similar to “Form 10-A” and copy of the order to the local law enforcement agency for entry of the order into the “National Crime Information Center Protection Order File.” In every dating violence case in which a domestic relations division of a court of (2) common pleas issues an ex parte or full hearing civil protection order or approves a consent agreement pursuant to section R.C. 3113.31, the court shall use, as applicable, forms that are substantially similar to “Forms 10.01-Q through 10.01-S” and include a cover sheet that is substantially similar to “Form 10-C” and send a completed form that is substantially similar to “Form 10-A” and copy of the order to the local law enforcement agency for entry of the order into the “National Crime Information Center Protection Order File.” (C) Modification or termination of full hearing civil protection order or consent agreement In every case in which a domestic relations division of a court of common pleas (1) modifies the terms of a full hearing civil protection order or a consent agreement pursuant to R.C. 3113.31(E)(8), it shall use the applicable forms that are substantially similar to “Forms 10.01-L and 10.01-M or 10.01-T,” include a cover sheet that is substantially similar to “Form 10-C,” and send a completed form that is substantially similar to “Form 10-A” and copy of the order to the local law enforcement agency for entry of the order into the “National Crime Information Center Protection Order File.” (2) In every case in which a domestic relations division of a court of common pleas terminates a full hearing civil protection order or a consent agreement before its original expiration date pursuant to R.C. 3113.31(E)(8), it shall use a form that is substantially similar to “Form 10.01-L” and send a completed form that is substantially similar to “Form 10-A” and a copy of the order to the local law enforcement agency for entry of the order into the “National Crime Information Center Protection Order File.” (D) Wireless service transfer order In every case in which a domestic relations division of a court of common pleas orders the transfer of wireless service as a term of an ex parte or full hearing civil protection order, it shall complete a form that is substantially similar to “Form 10-E.” (E) Notice of deadly weapons surrender In every case in which a domestic relations division of a court of common pleas orders the respondent to surrender deadly weapons, including firearms and ammunition, into the protective custody of law enforcement, it shall enter into the docket a form that is substantially similar to “Form 10-F.” (F) Remote access exception A domestic relations division of a court of common pleas shall not make available through remote access pursuant to Sup.R. 44 through 47 any record of a civil protection order case that is likely to reveal the identity or location of a petitioner or another party to be protected or could be protected by a protection order. Commentary (January 1, 1998) On December 9, 1994, Am.Sub.H.B. No. 335 became effective, which made significant changes to Ohio’s domestic violence laws. Section 4 of Am.Sub.H.B. No. 335, states as follows: The General Assembly hereby requests the Supreme Court, in consultation with the Department of Human Services, to prescribe a form that is to be filed by a petitioner seeking a civil protection order under section 3113.31 of the Revised Code and that makes reference to all the forms of relief that a court is authorized to grant under division (E) of section 3113.31 of the Revised Code, as amended by this act, contains space for the petitioner to request any of those forms of relief, and includes instructions for completing the form so that a petitioner may file the form without the assistance of an attorney. The Supreme Court, in consultation with its Domestic Violence Task Force, developed forms in response to the General Assembly’s request in Am.Sub.H.B. No. 335. During its eighteen months of study, the Supreme Court’s Domestic Violence Task Force determined that pro se victims of domestic violence often do not have access to the forms necessary to obtain a civil protection order pursuant to R.C. 3113.31. The Task Force also found that due to the variety of protection order forms used by Ohio courts, it can be difficult for law enforcement officers to recognize valid protection orders and understand the pertinent provisions of such orders. Further, the Task Force discovered that misconceptions exist in regard to the penalties for violating protection orders. The Court developed this rule to address these concerns. FORM 10.01-A: GENERAL INFORMATION ABOUT DOMESTIC VIOLENCE PROTECTION ORDERS DEFINITIONS YOU NEED TO KNOW Domestic violence is when a family or household member uses physical violence, threats, intimidation, and/or emotional, sexual, and economic abuse to maintain power and control over the other person, usually within an intimate relationship. Domestic violence is most often a combination of psychological and physical actions; the physical results are just the most visible. Domestic violence is a pattern of conduct in which one intimate partner uses force or threats of force to control the other person. State law has determined that some forms of abuse do not constitute criminal behavior or behavior requiring the Court’s intervention. For example, psychological battering, economic abuse, or verbal harassment without evidence of threats or physical harm are not recognized by Ohio law as domestic violence that allows a petitioner to obtain a protection order or request that criminal charges be filed. When a family or household member tries to cause you bodily harm by hitting, pushing, beating, or physically hurting you, that is domestic violence. When a family or household member makes you afraid that you will be harmed, that is domestic violence. When a family or household member stalks, commits sexually oriented offenses against you, or forces sexual relations on you, that is domestic violence. When a family or household member abuses your children, that is domestic violence. IN A CIVIL DOMESTIC VIOLENCE CASE: Petition for Domestic Violence Civil Protection Order (“CPO”) is the document a domestic violence victim, the victim’s parent, or an adult household member of the victim must file with the domestic relations court to obtain a civil protection order against an alleged offender. Domestic Violence Civil Protection Order (“CPO”) Ex Parte is an emergency order the Court issues in response to the Petition for a Civil Protection Order after an ex parte hearing. The ex parte hearing is described in this form on page 3. Domestic Violence Civil Protection Order (“CPO”) Full Hearing is the final order the Court issues after a full hearing. The full hearing is described in this form on page 3. The full hearing CPO replaces the ex parte CPO. Sometimes the final order issued by the Court is a Consent Agreement and Domestic Violence Civil Protection Order, Form 10.01-J, upon terms agreed to by the parties. Petitioner is the person asking or “petitioning” the Court for protection. By filing the Petition for a CPO, YOU are the Petitioner. Respondent is the alleged domestic violence offender. Petitioner seeks protection from the Respondent by filing for a CPO. IN A CRIMINAL DOMESTIC VIOLENCE CASE: Motion for a Criminal Domestic Violence Temporary Protection Order (“DVTPO”) is the document that must be filed in a criminal case if a victim of domestic violence or victim of a sexually oriented offense wishes to obtain a protection order against an alleged offender, who is a family or household member. The criminal case must allege the offender committed negligent assault, criminal damaging or endangering, criminal mischief, burglary, aggravated trespass, endangering children, any offense of violence, or any sexually oriented offense against a family or household member. The prosecutor has a form for this purpose. Domestic Violence Temporary Protection Order (“DVTPO”) is the order the Court issues in response to the Motion for Temporary Protection Order. The DVTPO requires the offender to stop abusing and to stay away from the victims named in the Motion for Temporary Protection Order. A DVTPO expires when the alleged offender’s criminal case ends or when a new CPO is issued based on the same facts. Alleged Victim is the person asking the Court for protection in the Motion for a DVTPO. Defendant is the person the Motion for a DVTPO is filed against. The Defendant is the person accused of the crimes of negligent assault, criminal damaging or endangering, criminal mischief, burglary, aggravated trespass, endangering children, any sexually oriented offense, or any offense of violence against a family or household member. FORM 10.01-A: GENERAL INFORMATION ABOUT DOMESTIC VIOLENCE PROTECTION ORDERS Amended: April 15, 2021 Discard all previous versions of this form [Page 2 of 3 Form 10.01-A] FEES You cannot be charged any costs or fees for filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, or obtaining a protection order. DOMESTIC VIOLENCE CIVIL PROTECTION ORDERS (CPO) What is a Domestic Violence Civil Protection Order (“CPO”)? A CPO is issued by a domestic relations court to protect a victim of domestic violence. A CPO is intended to prevent further domestic violence. It orders someone who has been abusive to do or not do certain things in the future. You may want to consider getting a CPO even if you have a DVTPO from a criminal court because a CPO lasts longer and provides more benefits – such as child custody and support orders. Domestic violence includes the commission of sexually oriented offenses. Violating a CPO is a crime. If the Respondent violates the CPO, he or she may be arrested, jailed, and fined for disobeying the CPO. A CPO can remain in effect for up to 5 years. If the Respondent violates the CPO, you can call the police, go back to the domestic relations court to file a contempt charge, and go to the prosecutor's office to have the Respondent charged with the crime of violating the CPO. Why get a Domestic Violence Civil Protection Order? If you are a victim of domestic violence, a CPO may help you. Once domestic violence starts, the violence often happens more often and gets increasingly severe. A CPO may stop this cycle of violence because the Court orders the Respondent to stop hurting or threatening you and your family or household members. The Court can use a CPO to order the Respondent to stay away from you for up to five years. A CPO can give you time to "sort things out" and decide what you want to do next without having to be afraid all of the time. If your children have seen domestic violence, a CPO may give all of you a chance to get some help so that you and your children are safe. Domestic violence is a crime. A CPO tells the Respondent you and the Court are serious about requiring the Respondent to stop his or her abusive behavior and not to hurt or threaten you again. A CPO sets some "rules" that the Respondent must obey while the CPO is in effect. These rules may require the Respondent to pay child or spousal support; give up possession of a home or car; and/or obey the Court’s orders about visitation. A CPO issued by a domestic relations court may last longer than a DVTPO issued by a criminal court and can provide more kinds of help. You should know that if you get a CPO based upon the same facts as the DVTPO, the DVTPO from the criminal court will automatically end, even if the criminal case continues. Who can get a Domestic Violence Civil Protection Order? You can apply for a CPO if you are related to the Respondent by blood or marriage AND have lived with Respondent at any time; OR you are living with or have lived with the Respondent during the past five years; OR you used to be married to the Respondent; OR you have a child with the Respondent, whether or not you ever married or lived together. You can also get a CPO for any member of your household. You may be able to get a CPO if you have been dating the Respondent; if you share family or financial responsibilities with the Respondent; AND you have an intimate relationship with the Respondent. Remember that a CPO has limits. If you suspect that the Respondent will not obey the terms of a CPO, contact your local domestic violence program or the Ohio Domestic Violence Network at 800-934-9840. Do I need an attorney for me to obtain a Domestic Violence Civil Protection Order? No, but you are often better off having legal representation in your CPO proceeding. Neither the Clerk of Court nor other Court employees can give you legal advice. Having an attorney represent you is especially helpful when your case involves contested custody and visitation and/or when an attorney represents the Respondent. If you cannot afford an attorney, contact your local legal aid office at 866-LAWOHIO (toll free), bar association, or Ohio State Legal Services (800-589-5888) for information on low cost or free legal representation. FORM 10.01-A: GENERAL INFORMATION ABOUT DOMESTIC VIOLENCE PROTECTION ORDERS Amended: April 15, 2021 Discard all previous versions of this form [Page 3 of 3 Form 10.01-A] Must there be a court hearing for me to obtain a Domestic Violence Civil Protection Order? Yes. There are two hearings involved in a CPO case: the ex parte hearing and the full hearing. Ex Parte Hearing: At this hearing, only you are present. The Respondent is not present. An ex parte hearing is held on the same day a Petition for Civil Protection Order is filed. If a Petition for a CPO is filed early enough in the day, an ex parte hearing is held that same day. At the ex parte hearing, you take an oath to tell the truth and a judge or magistrate hears your statement of what happened. If the judge or magistrate finds that the events you described meet the requirements of the law, the Court will issue an Ex Parte CPO and schedule a full hearing. If the Respondent is asked to vacate the home in which you live, there will be a full hearing within 7 business days. Otherwise, a full hearing will be set within 10 business days. The Court can hold a full hearing only after the Respondent has been served with the Ex Parte CPO. You may need to fill out forms for the Clerk of Court to cause service. Full Hearing: The full hearing is the final hearing. At this hearing, both you and the Respondent can testify. You must be present at the full hearing. You should bring any witnesses and other evidence to support your case. If the Court issues a Full Hearing CPO, it remains in force until the date indicated in the CPO, with 5 years being the maximum. If the Respondent does not show up for the full hearing, you can still obtain a final CPO. However, if the Respondent is not served with the Ex Parte CPO before the full hearing, the Court postpones the full hearing until the Respondent is served. If the full hearing is postponed, the Ex Parte CPO remains in effect until the full hearing is held. You may bring an advocate with you to the ex parte and full hearings for support. Some domestic violence shelters and victim assistance programs can provide advocates to go with you to these hearings. Contact your local domestic violence program or the Ohio Domestic Violence Network, 800-934-9840, for program and shelter information. CRIMINAL DOMESTIC VIOLENCE TEMPORARY PROTECTION ORDERS (DVTPO) Your local criminal court grants a DVTPO. You ask the Court for a DVTPO when a criminal complaint is filed alleging someone has committed domestic violence or a sexually oriented offense against you. The DVTPO orders someone who has abused you to do or stop doing certain things in the future. Violating a DVTPO is a crime. If the Defendant violates the DVTPO, the Defendant may be arrested, jailed, and fined for disobeying the DVTPO. Violating a DVTPO is also a reason for the Court to revoke the Defendant’s bail. A DVTPO lasts only until the criminal case is ended or a CPO, based on the same facts, is issued by a domestic relations court. You can find information about Domestic Violence Civil Protection Orders in R.C. 3113.31 and information about Domestic Violence Temporary Protection Orders in R.C. 2919.26. RESOURCES You may be able to find additional information about domestic violence at the following web sites: Ohio Domestic Violence Network Ohio Legal Help National Resource Center on Domestic Violence www.nrcdv.org Supreme Court of Ohio – Domestic Violence Program www.odvn.org www.ohiolegalhelp.org www.supremecourt.ohio.gov/domviol PLEASE NOTE: Computer use can be monitored. It is impossible to completely clear all website footprints. If you are in danger, please use a safer computer that your abuser cannot access directly or remotely. For example, computers at a public library, internet café, domestic violence shelter, or community technology center, may be safer computers. FORM 10.01-A: GENERAL INFORMATION ABOUT DOMESTIC VIOLENCE PROTECTION ORDERS Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-C: INFORMATION ABOUT FILING A DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER PETITION • If you have any questions about completing the Petition for a Domestic Violence Civil Protection Order (Form 10.01-D) or the Dating Violence Civil Protection Order (Form 10.01-P), contact the local victim assistance program, domestic violence program, or Ohio Domestic Violence Network at 800-934-9840. • Neither the Clerk of Court’s Office nor the local domestic violence program can give legal advice. If you need legal advice, talk to a lawyer. Only a lawyer can give you legal advice. • There is NO FEE for filing the Petition. • Once completed, take the Petition and other necessary documents to the Clerk of Court’s Office. • If you want an emergency order, also known as an Ex Parte Protection Order, check “want” in paragraph 2 of the Petition. • The Court will consider your request for an Ex Parte Protection Order and may ask you questions. • Regardless if an Ex Parte Protection Order was requested, granted, or denied, a full hearing will be scheduled. • You must attend the full hearing. Your victim advocate may also be present at the hearing. • On the day of the full hearing, be prepared to (1) tell the Court what happened, (2) bring with you any witnesses, evidence, and documentation to prove your case, and (3) ask Respondent questions. • Respondent may be represented by a lawyer. You may represent yourself or ask for a continuance to obtain a lawyer. [R.C. 3113.31(D)(2)(a)(iii)] • Respondent or Respondent’s lawyer may present evidence and ask you questions. • The Court cannot issue a protection order against you unless Respondent has filed a Petition. Domestic Violence [R.C. 3113.31] Person with Whom Respondent Is or Was in a Dating Relationship [R.C. 3113.31(A)(9)] DEFINITIONS “Domestic violence” means the occurrence of one or more of the following acts against a family or household member or a person with whom Petitioner has a dating relationship: attempting to cause or recklessly causing bodily injury; placing another person by the threat of force in fear of imminent serious physical harm or committing menacing by stalking or aggravated trespass; committing any act with respect to a child that would result in the child being an abused child, as defined [by law]; or committing a sexually oriented offense. An adult who, at the time of the conduct in question, is in a dating relationship with Respondent who also is an adult or who, within the twelve months preceding the conduct in question, has had a dating relationship with Respondent who also is an adult. FORM 10.01-C: INFORMATION ABOUT FILING A DOMESTIC VIOLENCE OR A DATING VIOLENCE CIVIL PROTECTION ORDER PETITION Amended: April 15, 2021 Discard all previous versions of this form Dating Relationship [R.C. 3113.31(A)(8)] A relationship between adults who have, or have had, a relationship of a romantic or intimate nature. [Page 2 of 2 of Form 10.01-C] "Dating relationship" does not acquaintanceship or ordinary business or social context. include a casual in a fraternization Family or Household Member [R.C. 3113.31(A)(3)-(4)] "Family or household member” means either of the following: (1) Any of the following who is residing with or has resided with Respondent, such as a spouse, a person living as a spouse, or a former spouse of Respondent; a parent, a foster parent, or a child of Respondent, or another person related by consanguinity or affinity (blood or marriage) to Respondent; a parent or a child of a spouse, person living as a spouse, or former spouse of Respondent, or another person related by consanguinity or affinity (blood or marriage) to a spouse, person living as a spouse, or former spouse of Respondent. (2) The natural parent of any child of whom Respondent is the other natural parent or is the putative other natural parent. “Person living as a spouse” means a person who is living or has lived with Respondent in a common law marital relationship, who otherwise is cohabiting with Respondent, or who otherwise has cohabited with Respondent within five years prior to the date of the alleged occurrence of the act in question. FORM 10.01-C: INFORMATION ABOUT FILING A DOMESTIC VIOLENCE OR A DATING VIOLENCE CIVIL PROTECTION ORDER PETITION Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-D: PETITION FOR DOMESTIC VIOLENCE CIVIL PROTECTION ORDER IN THE COURT COUNTY, OHIO Petitioner : Case No. Address (Safe mailing address) City, State, Zip Code Date of Birth / / v. Respondent Address (If home address unknown, put work address) City, State, Zip Code : : : Judge/Magistrate : PETITION FOR DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (R.C. 3113.31) : : : : : Date of Birth / / Respondent is 18 years old or older IF YOU ARE ASKING FOR YOUR ADDRESS TO BE KEPT CONFIDENTIAL, PLEASE PUT A MAILING ADDRESS WHERE YOU CAN SAFELY RECEIVE MAIL. IF YOU ARE A PARTICIPANT IN THE SECRETARY OF STATE’S ADDRESS CONFIDENTIALITY PROGRAM, PLEASE USE THE P.O. BOX ADDRESS GIVEN TO YOU. THIS FORM IS A PUBLIC RECORD. 1. I need or witness needs a foreign language interpreter in _____________________________ or an American Sign Language interpreter per Sup.R. 88. 2. want do not want an ex parte (emergency) protection order per R.C. 3113.31. Petitioner I further requests a full hearing trial be scheduled, even if the ex parte protection order is granted, denied, or not requested. 3. Who needs protection? Me My minor children A family or household member who is not a minor child Other 4. What is the domestic violence victim’s relationship to Respondent? Spouse of Respondent Former spouse of Respondent Natural parent of Respondent’s child Child of Respondent Parent of Respondent Foster Parent FORM 10.01-D: PETITION FOR DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 2 of 6 Form 10.01-D] Other relative (by blood or marriage) of Respondent/ Petitioner who has lived with Respondent at any time Person “living as a spouse of Respondent” is defined as: • now cohabiting; • or cohabited within five years before the alleged act of domestic violence 5. I have listed below all family or household members who need protection, other than me or the person for whom I am filing the Petition. (Leave blank if you are not including other family or household members.) NAME DATE OF BIRTH RELATIONSHIP TO PETITIONER RELATIONSHIP TO RESPONDENT THIS PERSON LIVES WITH PETITIONER NO YES YES YES YES NO NO NO 6. Petitioner requests a Domestic Violence Civil Protection Order. You must describe Respondent’s threats or actions that made you request a protection order, including if children were present when the acts took place. When did it happen? (If you do not know exact dates, give approximate dates). Explain why you believe you or your family or household members are in danger. If you need more space, attach an additional page. FORM 10.01-D: PETITION FOR DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 3 of 6 Form 10.01-D] 7. (Optional) You may describe, if you want and know, about any of the following items. Not describing these items in the Petition does not mean domestic violence did not happen. If you need more space, attach an additional page: • Respondent’s history of domestic violence or other violent acts; • Respondent’s history of violating court orders; • Respondent’s mental health; • Respondent’s threats to other persons; • Respondent’s access to deadly weapons, firearms, and ammunition or use of deadly weapons and acts or threats of violence with deadly weapon; • Respondent’s abuse alcohol or controlled substances (drugs); • Respondent’s violence resulted in serious physical injury, forced sex, strangulation (or choking), abuse during pregnancy, abuse of the family’s pet, and/or forced entry to gain access to Petitioner or Petitioner’s family and household members; • Recent separation from Respondent or relationship was recently terminated; • Respondent’s obsessive and controlling behaviors, including stalking, spying, following, and/or isolating you (Petitioner); • Respondent’s threats to kill self or others. 8. Petitioner is in fear and in continuing danger. 9. Petitioner further requests that the Court grant relief under R.C. 3113.31 to protect Petitioner and/or the family or household members named in this Petition from domestic violence by granting a civil protection order that (check all boxes that apply): (a) Directs Respondent to not abuse Petitioner and the family or household members named in this Petition by harming, attempting to harm, threatening, following, stalking, harassing, forcing sexual relations upon them, or by committing sexually oriented offenses against them. (b) Directs Respondent to not enter, approach, or contact by any means the residence, school, business, and place of employment of Petitioner and the family or household members named in this Petition. (c) Directs Respondent to not approach or have contact by any means with Petitioner and the family or household members named in this Petition. (d) Directs Respondent to leave, not return to, or interfere with Petitioner’s right to occupy the residence, including but not limited to cancelling any utilities or insurance or interrupting phone service, mail delivery, or the delivery of any other documents or items, and grants Petitioner exclusive possession of the following residence: FORM 10.01-D: PETITION FOR DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 4 of 7 Form 10.01-D] (e) Allocates temporary parental rights and responsibilities for the care of the following minor children to Petitioner until further Order of the Court (include names and birth dates of the minor children): Petitioner has completed and attached the Information for Parenting Proceeding, Form 10.01- F and it is incorporated herein. (f) Establishes or modifies parenting time with the following minor children and requires parenting time to be suspended or supervised or to occur under such conditions that the Court determines will ensure the safety of Petitioner and the minor children (include names and birth dates of the minor children): Petitioner has completed and attached the Information for Parenting Proceeding, Form 10.01- F and it is incorporated herein. (g) Directs Respondent to provide financial support for Petitioner and the family or household members named in this Petition (Court may request additional information). (h) Directs Respondent to not remove, damage, hide, harm, or dispose of any property, companion animals, or pets owned or possessed by Petitioner. (i) Grants Petitioner permission to take Petitioner’s companion animals or pets, as described below, away from the possession of Respondent: (j) Divides household and family personal property as follows: (k) Directs Respondent to permit Petitioner to have exclusive use of the following motor vehicle: (l) Directs Respondent to complete batterer counseling, substance abuse counseling, or other treatment or intervention as determined necessary by the Court. (m) Directs the wireless service provider to separate Petitioner’s account from Respondent’s account, per R.C. 3113.45 through 3113.459. Petitioner will assume all financial responsibility for any costs associated with the wireless service number and any costs for the device associated with the wireless service number. Respondent’s billing telephone number is: Petitioner’s contract information is on page 1 of this Petition. The wireless service numbers to be transferred to Petitioner which are used by Petitioner or the minor children in the care of Petitioner are: FORM 10.01-D: PETITION FOR DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 5 of 6 Form 10.01-D] (n) Includes the following additional provisions: 10. Petitioner further requests that the Court issue no mutual protection orders or other orders against Petitioner unless all of the conditions of R.C. 3113.31(E)(4) are met. 11. Petitioner further requests that if Petitioner has a victim advocate, the Court permit the victim advocate to accompany Petitioner at all stages of these proceedings as required by R.C. 3113.31(M). 12. Petitioner further requests at the ex parte hearing or full hearing that the Court grant such other relief as the Court considers equitable and fair, including orders or directives to law enforcement. 13. Petitioner has listed court cases (including divorce, custody, visitation, paternity, child support, children service/CPS case, animal cruelty, sexually oriented offense, no contact order, and protection order) and other legal matters regarding Respondent that may relate to this case: (Attach additional pages, if necessary.) CASE NAME CASE NUMBER COURT/COUNTY TYPE OF CASE RESULT OF CASE The information above is true, complete, and accurate to the best of my knowledge. I understand that knowingly providing false information in this document may result in a contempt of court finding against me which could result in a jail sentence and fine, or criminal penalties under R.C. 2921.13. SIGNATURE OF PETITIONER DATE IF YOU DO NOT HAVE AN ATTORNEY, PLEASE LEAVE THE INFORMATION BELOW BLANK. Signature of Attorney Attorney’s Registration Number Name of Attorney Attorney’s Telephone Attorney’s Address Attorney’s Fax City, State, Zip Code Attorney’s Email FORM 10.01-D: PETITION FOR DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 6 of 6 Form 10.01-D] IN THE COURT OF COMMON PLEAS COUNTY, OHIO Petitioner v. Respondent Case No. Judge/Magistrate : : : TO THE CLERK OF COURT: Pursuant to Civ.R. 65.1(C)(2), please serve Respondent a copy of the Petition, ex parte protection order, if granted, and any other accompanying documents to the address below and as follows: REQUEST FOR SERVICE Personal service Other (specify) Other (address): Personal service Other (specify) SPECIAL INSTRUCTIONS TO SHERIFF: Certified Mail, Return Receipt Requested Certified Mail, Return Receipt Requested SIGNATURE OF ATTORNEY OR PETITIONER RETURN OF SERVICE Respondent was served on . Officer and Badge Number Law Enforcement Agency Date CLERK’S CERTIFICATE OF MAILING Service of Process was sent by this day of . Attest: Deputy Clerk FORM 10.01-D: PETITION FOR DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-F: INFORMATION FOR PARENTING PROCEEDING AFFIDAVIT IN THE v. Petitioner Respondent COURT COUNTY, OHIO Case No. Judge: INFORMATION FOR PARENTING PROCEEDING AFFIDAVIT (R.C. 3127.23) (Filed with Form 10.01-D: Petition for Domestic Violence Civil Protection Order) : : : : : Use this form if you are requesting a parenting (custody or visitation) order in your Domestic Violence Civil Protection Order Petition (Form 10.01-D). If another court is already addressing or has addressed custody issues involving the children, custody and visitation issues may be handled in that case. By law, this form must be filed and served with the first pleading filed by each party in every parenting (custody or visitation) proceeding in this Court including a Petition for a Domestic Violence Civil Protection Order. If you need more space, attach an additional page. I (full legal name) state under oath or affirmation that these cases involve the custody of a child or children and the following statements are true: , 1. Pursuant to R.C. 3127.23(D), I am requesting that the Court not disclose my current address or that of the children. My address is confidential and should be placed under seal because my health, safety, or liberty or that of the children would be jeopardized by the disclosure of the identifying information. 2. (number) Minor children are subject to this case as follows: (NOTE: Provide residence information for the last FIVE years.) a. Child’s Name: Date of Birth: Period of Residence Address (Do not list your address if confidential) Person with whom Child Lived and Relationship to Child FORM 10.01-F: INFORMATION FOR PARENTING PROCEEDING AFFIDAVIT Amended: April 15, 2021 Discard all previous versions of this form [Page 2 of 6 Form 10.01-F] Case No.________________________ to present to to to Address Confidential Secretary of State Address Confidentiality Program Address Confidential Secretary of State Address Confidentiality Program Address Confidential Secretary of State Address Confidentiality Program Address Confidential Secretary of State Address Confidentiality Program b. Child’s Name: Date of Birth: Check this box if the information requested below is the same as above. Address (Do not list your address if confidential) Person with whom Child Lived and Relationship to Child Period of Residence to present to Address Confidential Secretary of State Address Confidentiality Program Address Confidential Secretary of State Address Confidentiality Program FORM 10.01-F: INFORMATION FOR PARENTING PROCEEDING AFFIDAVIT Amended: April 15, 2021 Discard all previous versions of this form [Page 3 of 6 Form 10.01-F] Case No.________________________ to to Address Confidential Secretary of State Address Confidentiality Program Address Confidential Secretary of State Address Confidentiality Program c. Child’s Name: Date of Birth: Check this box if the information requested below is the same as above. Address (Do not list your address if confidential) Period of Residence Person with whom Child Lived and Relationship to Child to present to to to Address Confidential Address Confidential Secretary of State Address Confidentiality Program Address Confidential Secretary of State Address Confidentiality Program Address Confidential Secretary of State Address Confidentiality Program d. List additional children on a page titled Attachment 2(d). (Provide the following information for each additional child: name, date of birth, person with whom the child lived and child’s relationship to the person, address, unless confidential, and dates when the child lived in that place with that person.) FORM 10.01-F: INFORMATION FOR PARENTING PROCEEDING AFFIDAVIT Amended: April 15, 2021 Discard all previous versions of this form [Page 4 of 6 Form 10.01-F] Case No.________________________ 3. Participation in custody case(s): (check only one) I HAVE NOT participated as a party, witness, or in any capacity in any other case, in this or any other state, concerning the custody of or visitation (parenting time) with any child subject to this case. I HAVE participated as a party, witness, or in any capacity in any other case, in this or any other state, concerning the custody of or visitation (parenting time) with any child subject to this case. Explain: a. Name of each child b. Type of case c. Court and State d. Date of court order or judgment (if any): 4. Information about custody case(s): (check only one) I HAVE NO INFORMATION of any cases that could affect the current case, any cases relating to custody, domestic violence or protection orders, dependency, neglect or abuse allegations, or adoptions concerning any child subject to this case. I HAVE THE FOLLOWING INFORMATION concerning cases that could affect the current case, including any cases relating to custody, domestic violence or protection orders, dependency, neglect or abuse allegations, or adoptions concerning any child subject to this case, other than listed in Paragraph 3. Explain: a. Name of each child b. Type of case c. Court and State d. Date of court order or judgment (if any): 5. List all of the criminal convictions including guilty pleas for you and the members of your household for the following offenses: any criminal offense involving acts that resulted in a child being abused or neglected; any offense that is a violation of R.C. 2919.25; any sexually oriented offense as defined in R.C. 2950.01; and any offense involving a victim who was a family or household member at the time of the offense and caused physical harm to the victim during the commission of the offense. NAME CASE NUMBER COURT/STATE/ COUNTY TYPE OF CASE RESULT OF CASE 6. Persons not a party to this case: I DO NOT KNOW OF ANY PERSON who is not a party to this case and who has physical custody or claims to have custody or visitation rights with respect to any child subject to this case. FORM 10.01-F: INFORMATION FOR PARENTING PROCEEDING AFFIDAVIT Amended: April 15, 2021 Discard all previous versions of this form [Page 5 of 6 Form 10.01-F] Case No.________________________ I KNOW THAT THE FOLLOWING NAMED PERSON(S) not a party to this case has/have physical custody or claim(s) to have custody or visitation rights with respect to any child subject to this case: a. Name and address of person physical custody has Name of each child claims custody rights claims visitation rights. b. Name and address of person has physical custody claims custody rights claims visitation rights. Name of each child c. Name and address of person physical custody has Name of each child claims custody rights claims visitation rights. 7. I have a continuing duty to inform this Court of any child custody, visitation, parenting time, divorce, dissolution of marriage, separation, neglect, abuse, dependency, guardianship, parentage, termination of parental rights, or domestic violence case concerning the children in this state or in any other state that could affect the current case. OATH OR AFFIRMATION I swear or affirm that the answers above are true, complete, and accurate to the best of my knowledge. I understand that making false statements in this document may result in a contempt of court finding against me which could result in a jail sentence and fine, and may also subject me to criminal penalties for perjury under R.C. 2921.11. DO NOT SIGN THE FORM UNLESS YOU ARE IN FRONT OF THE PERSON WHO WILL NOTARIZE THE PARENTING PROCEEDING AFFIDAVIT FOR YOU. Signature of Petitioner Sworn to and subscribed before me on this day of NOTARY PUBLIC FORM 10.01-F: INFORMATION FOR PARENTING PROCEEDING AFFIDAVIT Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) EX PARTE IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Case No. Per R.C. 3113.31(F)(3), this Order is indexed at Judge/Magistrate LAW ENFORCEMENT AGENCY WHERE INDEXED State OHIO ( ) - DOMESTIC VIOLENCE CIVIL PROTECTION ORDER PHONE NUMBER (DVCPO) EX PARTE (R.C. 3113.31) PETITIONER: PERSON(S) PROTECTED BY THIS ORDER: First Middle Last v. RESPONDENT: Petitioner: Petitioner’s Family or Household Members: ( Additional forms attached.) DOB: DOB: DOB: DOB: DOB: SEX RESPONDENT IDENTIFIERS RACE HGT WGT First Middle Last DRIVER’S LIC. NO. EXP. DATE / / STATE EYES HAIR DOB Relationship to Petitioner: Address where Respondent can be found: Distinguishing Features: WARNING TO LAW ENFORCEMENT: RESPONDENT HAS FIREARMS ACCESS – PROCEED WITH CAUTION Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent will be provided with reasonable notice and opportunity to be heard within the time required by Ohio law. Additional findings of this Order are set forth below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until / / UNLESS EXTENDED BY SEPARATE ENTRY. WARNING TO RESPONDENT: See the warning page attached to the front of this Order. FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) EX PARTE Amended: April 15, 2021 Discard all previous versions of this form [Page 2 of 6 Form 10.01-H] Case No.___________________________ This proceeding came on for an ex parte hearing on being present), upon the filing of a Petition by Petitioner for a Domestic Violence Civil Protection Order (DVCPO) against Respondent, pursuant to R.C. 3113.31. In accordance with R.C. 3113.31(D)(1), the Court held an ex parte hearing on the same day that the Petition was filed. (Respondent not / / The Court finds that the protected persons herein are in immediate and present danger of domestic violence and for good cause shown, the following temporary orders are necessary to protect the persons named in this Order from domestic violence. The Court also finds _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Additional findings on a separate page are included and attached herein. RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02] ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO RESPONDENT 1. RESPONDENT SHALL IMMEDIATELY VACATE the following residence: FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) EX PARTE Amended: April 15, 2021 Discard all previous versions of this form 2. EXCLUSIVE POSSESSION OF THE RESIDENCE located at: [Page 3 of 6 Form 10.01-H] Case No.___________________________ is granted to: with the protected persons’ right to occupy the residence including, but not limited to cancelling utilities or insurance or interrupting telecommunication (e.g., telephone, internet, or cable) services, mail delivery, or the delivery of any other documents or items. [NCIC 03] . Respondent shall not interfere 3. RESPONDENT SHALL SURRENDER all keys and garage door openers to the above residence within 24 hours of service of this Order to the law enforcement agency that serves Respondent with this Order or as follows: 4. RESPONDENT SHALL NOT ENTER or interfere with the residence, school, business, place of employment, day care centers, or child care providers of the protected persons named in this Order, including the buildings, grounds, and parking lots at those locations. Respondent may not violate this Order even with the permission of a protected person. [NCIC 04] 5. RESPONDENT SHALL STAY AWAY FROM ALL protected persons named in this Order, and not be present within 500 feet or those protected persons may be found, or any place Respondent knows or should know the protected persons are likely to be, even with a protected person’s permission. If Respondent accidentally comes in contact with protected persons in any public or private place, Respondent must depart immediately. This Order includes encounters on public and private roads, highways, and thoroughfares. [NCIC 04] (distance) of any protected persons wherever 6. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named in this Order or their residences, businesses, places of employment, schools, day care centers, or child care providers. Contact includes, but is not limited to, landline, cordless, cellular or digital telephone; text; instant messaging; fax; e-mail; voicemail; delivery service; social media; blogging; writings; electronic communications; posting a message; or communications by any other means directly or through another person. Respondent may not violate this Order even with the permission of a protected person. [NCIC 05] 7. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. 8. RESPONDENT SHALL IMMEDIATELY SURRENDER POSSESSION OF ALL KEYS TO THE FOLLOWING MOTOR VEHICLE, that served Respondent with the Order or as follows: , to the law enforcement agency and Petitioner is granted exclusive use of this motor vehicle. 9. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY owned or possessed by the protected persons named in this Order. Personal property shall be apportioned as follows: 10. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY COMPANION ANIMALS OR PETS owned or possessed by the protected persons named in this Order. FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) EX PARTE Amended: April 15, 2021 Discard all previous versions of this form [Page 4 of 6 Form 10.01-H] Case No.___________________________ 11. PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS owned by Petitioner from the possession of Respondent: Exchange of the listed companion animals or pets shall take place as follows: 12. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this Order. 13. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON at any time while the Order remains in effect in order to bring about a cessation of violence. Furthermore, Respondent may be subject to firearms and ammunition restrictions pursuant to 18 U.S.C. 922(g)(1) through (9), 18 U.S.C. 922(n), or R.C. 2923.13. [NCIC 07] RESPONDENT IS EXCEPTED only for official use pursuant to 18 U.S.C. 925(a)(1), if no other firearms and ammunition prohibitions apply. 14. RESPONDENT SHALL TURN OVER ALL DEADLY WEAPONS owned by Respondent or in Respondent’s possession to the law enforcement agency that serves Respondent with this Order no later than or as follows: Any law enforcement agency is authorized to accept possession of deadly weapons pursuant to this paragraph and hold them in protective custody for the duration of this Order. [NCIC 07] Law enforcement shall immediately notify the Court upon receiving Respondent’s deadly weapons for protective custody as set forth in this Order. Upon the expiration or termination of this Order and if a full hearing order is not issued or consent agreement approved, Respondent may reclaim any deadly weapons held in protective custody by law enforcement pursuant to this Order unless Respondent is otherwise disqualified as verified by a check of the NCIC protection order file. 15. RESPONDENT’S CONCEALED CARRY WEAPON LICENSE, if any, is now subject to R.C. 2923.128. 16. PETITIONER IS AN UNMARRIED FEMALE who gave birth to (a child) born on residential parent or legal custodian of the child until a court of competent jurisdiction issues an order . As set forth in R.C. 3109.042, Petitioner is the sole designating another person as the residential parent or legal custodian. 17 PARENTAL RIGHTS AND RESPONSIBILITIES ARE TEMPORARILY ALLOCATED AS FOLLOWS: [NCIC 09] This Order applies to the following child children: 18. PARENTING TIME ORDERS DO NOT PERMIT RESPONDENT TO VIOLATE THE TERMS OF THIS ORDER. FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) EX PARTE Amended: April 15, 2021 Discard all previous versions of this form (A) Respondent’s parenting time rights are suspended; or (B) As a limited exception to paragraphs 5 and 6, temporary parenting time rights are established as [Page 5 of 6 Form 10.01-H] Case No.___________________________ follows: [NCIC 06] This Order applies to the following child children: 19. LAW ENFORCEMENT AGENCIES, including but not limited to, are ordered to assist Petitioner in gaining physical custody of the child children, if necessary. 20. RESPONDENT SHALL SUPPORT the protected persons named in this Order as follows: 21. RESPONDENT MAY PICK UP CLOTHING and personal effects from the above residence only in the days of the filing of this company of a uniformed law enforcement officer within seven or Order. Arrangements may be made by contacting: 22. RESPONDENT SHALL NOT USE OR POSSESS alcohol or illegal drugs. 23. RESPONDENT SHALL NOT INTERFERE with wireless service transfer, prevent the functionality of a device on the network, or incur further contractual or financial obligations related to the transferred numbers. Wireless service rights to and billing responsibility for the wireless service number or numbers in use by Petitioner or any minor children in the care of Petitioner shall be transferred to Petitioner by separate order, Wireless Service Transfer Order (Form 10-E). 24. IT IS FURTHER ORDERED: [NCIC 08] 25. ALL DISCOVERY SHALL STRICTLY COMPLY with Civ.R. 65.1(D). 26. THE CLERK OF COURT SHALL CAUSE A COPY OF THE PETITION, THIS ORDER, AND ANY OTHER ACCOMPANYING DOCUMENT to be served on Respondent as set forth in Civ.R. 65.1(C)(2). The Clerk of Court shall also provide copies of the Petition and certified copies of this Order to Petitioner upon request. 27. THIS ORDER DOES NOT EXPIRE because of a failure to serve notice of the full hearing upon Respondent before the date set for the full hearing or because the Court grants a continuance, as set forth in R.C. 3113.31(D)(2)(b). FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) EX PARTE Amended: April 15, 2021 Discard all previous versions of this form 28. THIS ORDER SURVIVES a divorce, dissolution of marriage, or legal separation. Any subsequent order from this Court, another domestic relations court, or juvenile court may modify paragraphs 16, 17, 18, and 19. [Page 6 of 6 Form 10.01-H] Case No.___________________________ 29. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER for filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. IT IS SO ORDERED. JUDGE/MAGISTRATE NOTICE TO RESPONDENT NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERM OF THIS ORDER EVEN WITH THE PROTECTED PERSON’S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. TO THE CLERK A COPY OF PETITION, THIS ORDER, AND ANY OTHER ACCOMPANYING DOCUMENTS SHALL BE SERVED ON RESPONDENT PURSUANT TO CIV.R. 65.1(C)(2). COPIES OF THIS ORDER AND OTHER ACCOMPANYING DOCUMENTS SHALL BE DELIVERED TO: Petitioner Petitioner’s Attorney Law Enforcement Agency Where Petitioner Resides: Sheriff’s Office: Law Enforcement Agency Where Petitioner Works: CSEA Other: A FULL HEARING on this Order, and on all other issues raised by the Petition, shall be held before Judge or Magistrate: on the day of , 20 at a.m. p.m. at the following location: On the day of the Full Hearing, come prepared to (1) tell the Court what happened, (2) bring with you any witnesses, evidence, and documentation to prove your case, and (3) be aware that the other party or the party’s attorney may ask you questions. If you do not have an attorney, you may ask for a brief continuance to obtain an attorney per R.C. 3113.31(D)(2)(a)(iii) or you may represent yourself. Parties do not have to give discovery, answer questions, or give information to the other party or the other party’s lawyer unless ordered by judge or magistrate (Civ.R. 65.1(D)(2)). FORM 10.01-H: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) EX PARTE Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-I: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) FULL HEARING IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Case No. Per R.C. 3113.31(F)(3), this Order is indexed at Judge State OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - DOMESTIC VIOLENCE CIVIL PROTECTION ORDER PHONE NUMBER (CPO) FULL HEARING (R.C. 3113.31) PETITIONER: WITH SUPPORT ORDER PERSON(S) PROTECTED BY THIS ORDER: Petitioner Petitioner’s Family or Household Members: ( Additional forms attached) DOB: First Middle Last v. DOB: DOB: DOB: DOB: RESPONDENT: RESPONDENT IDENTIFIERS SEX RACE HGT WGT First Middle Last Relationship to Petitioner: Address where Respondent can be found: EYES HAIR DOB DRIVER’S LIC. NO. / EXP. DATE / STATE Distinguishing Features: WARNING TO LAW ENFORCEMENT: RESPONDENT HAS FIREARMS ACCESS – PROCEED WITH CAUTION Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent was provided with reasonable notice and opportunity to be heard within the time required by Ohio law. Additional findings of this Order are set forth below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until / / (DATE CERTAIN – 5 YEARS MAXIMUM) WARNING TO RESPONDENT: See the warning page attached to the front of this Order. FORM 10.01-I: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form [Page 2 of 7 Form 10.01-I] Case No.___________________________ This proceeding came on for a hearing on Ex Parte Order issued on / / / / . The following individuals were present: before the Court and the The Court hereby makes the following findings of fact: The Court finds that the protected persons herein are in immediate and present danger of domestic violence and for good cause shown, the following temporary orders are necessary to protect the persons named in this Order from domestic violence. The Court also finds: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Additional findings on a separate page are included and attached herein. FORM 10.01-I: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form [Page 3 of 7 Form 10.01-I] Case No.___________________________ The Court further finds by a preponderance of the evidence that 1) Petitioner and Petitioner’s family or household members are in danger and have been a victim of domestic violence as defined in R.C. 3113.31(A) committed by Respondent and 2) the following orders are equitable, fair, and necessary to protect the persons named in this Order from domestic violence. RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02] ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO RESPONDENT 1. RESPONDENT SHALL IMMEDIATELY VACATE the following residence: 2. EXCLUSIVE POSSESSION OF THE RESIDENCE located at: is granted to: the protected persons’ right to occupy the residence including, but not limited to canceling utilities . Respondent shall not interfere with or insurance or interrupting telecommunication (e.g. telephone, internet, or cable) services, mail delivery, or the delivery of any other documents or items. [NCIC 03] 3. RESPONDENT SHALL SURRENDER all keys and garage door openers to the above residence within 24 hours of service of this Order to the law enforcement agency that serves Respondent with this Order or as follows: 4. RESPONDENT SHALL NOT ENTER or interfere with the residence, school, business, place of employment, day care centers, or child care providers of the protected persons named in this Order, including the buildings, grounds, and parking lots at those locations. Respondent may not violate this Order even with the permission of a protected person. [NCIC 04] 5. RESPONDENT SHALL STAY AWAY FROM ALL protected persons named in this Order, and not be present within 500 feet or may be found, or any place Respondent knows or should know the protected persons are likely to be, even (distance) of any protected persons wherever those protected persons with a protected person’s permission. If Respondent accidentally comes in contact with protected persons in any public or private place, Respondent must depart immediately. This Order includes encounters on public and private roads, highways, and thoroughfares. [NCIC 04] 6. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named in this Order or their residences, businesses, places of employment, schools, day care centers, or child care providers. Contact includes, but is not limited to, landline, cordless, cellular or digital telephone; text; instant messaging; fax; e-mail; voicemail; delivery service; social media; blogging; writings; electronic communications; posting a message; or communications by any other means directly or through another person. Respondent may not violate this Order even with the permission of a protected person. [NCIC 05] 7. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. FORM 10.01-I: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form [Page 4 of 7 Form 10.01-I] Case No.___________________________ 8. RESPONDENT SHALL IMMEDIATELY SURRENDER POSSESSION OF ALL KEYS TO THE FOLLOWING MOTOR VEHICLE: to the law enforcement agency that served Respondent with the Order or as follows: and Petitioner is granted exclusive use of this motor vehicle. 9. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY owned or possessed by the protected persons named in this Order. Personal property shall be apportioned as follows: 10. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY COMPANION ANIMALS OR PETS owned or possessed by the protected persons named in this Order. 11. PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS owned by Petitioner from the possession of Respondent: Exchange of the listed companion animals or pets shall take place as follows: 12. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this Order. 13. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON, INCLUDING FIREARMS, AND AMMUNITION at any time while this Order remains in effect in order to bring about a cessation of violence. Furthermore, Respondent may be subject to firearms and ammunition restrictions pursuant to 18 U.S.C. 922(g)(1) through (9), 18 U.S.C. 922(n), or R.C. 2923.13. [NCIC 07] RESPONDENT IS EXCEPTED only for official use pursuant to 18 U.S.C. 925(a)(1), if no other firearms and ammunition prohibitions apply. 14. RESPONDENT SHALL TURN OVER ALL DEADLY WEAPONS, INCLUDING FIREARMS, AND AMMUNITION owned by Respondent or in Respondent’s possession to the law enforcement agency that serves Respondent with this Order no later than or as follows: Any law enforcement agency is authorized to accept possession of deadly weapons, including firearms, and ammunition pursuant to this paragraph and hold them in protective custody for the duration of this Order. [NCIC 07] Law enforcement shall immediately notify the Court upon receiving Respondent’s deadly weapons, including firearms, and ammunition into protective custody as set forth in this Order. Upon the expiration or termination of this Order, Respondent may reclaim any deadly weapons, including firearms, and ammunition held in protective custody by law enforcement pursuant to this Order unless Respondent is otherwise disqualified as verified by a check of the NCIC protection order file. 15. RESPONDENT’S CONCEALED CARRY WEAPON LICENSE, if any, is now subject to R.C. 2923.128. FORM 10.01-I: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form [Page 5 of 7 Form 10.01-I] Case No.___________________________ 16. PETITIONER IS AN UNMARRIED FEMALE who gave birth to (a child) born on residential parent or legal custodian of the child until a court of competent jurisdiction issues an order . As set forth in R.C. 3109.042, Petitioner is the sole designating another person as the residential parent or legal custodian. 17. PARENTAL RIGHTS AND RESPONSIBILITIES ARE TEMPORARILY ALLOCATED AS FOLLOWS: [NCIC 09] This Order applies to the following child children: 18. PARENTING TIME ORDERS DO NOT PERMIT RESPONDENT TO VIOLATE THE TERMS OF THIS ORDER. (A) Respondent’s parenting time rights are suspended; or (B) As a limited exception to paragraphs 5 and 6, temporary parenting time rights are established as follows: [NCIC 06] This Order applies to the following child children: 19. LAW ENFORCEMENT AGENCIES, including but not limited to, are ordered to assist Petitioner in gaining physical custody of the child children, if necessary. 20. RESPONDENT SHALL SUPPORT the protected persons named in this Order as follows: 21. RESPONDENT MAY PICK UP CLOTHING and personal effects from the above residence only in the company of a uniformed law enforcement officer within seven or Order. Arrangements may be made by contacting: days of the filing of this 22. RESPONDENT SHALL NOT USE OR POSSESS alcohol or illegal drugs. 23. RESPONDENT SHALL COMPLETE THE FOLLOWING COUNSELING PROGRAM: Respondent shall contact this program within days after receiving FORM 10.01-I: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form [Page 6 of 7 Form 10.01-I] Case No.___________________________ this Order and immediately arrange for an initial appointment. The counseling program is requested to provide the Court a written notice when Respondent attends the initial appointment, if Respondent fails to attend or is discharged, and when Respondent completes the program. Respondent is required to sign all necessary waivers to allow the Court to receive information from the counseling program. 24. RESPONDENT IS ORDERED TO APPEAR before Judge or Magistrate ___________________ on compliance with the terms of this Order. RESPONDENT IS WARNED: If you fail to attend the p.m. to review Respondent’s a.m. at / / counseling program you may be held in contempt of court or the Court may issue a warrant for your arrest. 25. RESPONDENT SHALL NOT INTERFERE with wireless service transfer, prevent the functionality of a device on the network, or incur further contractual or financial obligations related to the transferred numbers. Wireless service rights to and billing responsibility for the wireless service number or numbers in use by Petitioner or any minor children in the care of Petitioner shall be transferred to Petitioner by separate order, Wireless Service Transfer Order (Form 10-E). 26. IT IS FURTHER ORDERED: [NCIC 08] 27. THE CLERK OF COURT SHALL CAUSE A COPY OF THIS ORDER to be served on Respondent as set forth in Civ.R. 5(B) and 65.1(C)(3). The Clerk of Court shall also provide certified copies of this Order to Petitioner upon request. 28. THIS ORDER SURVIVES a divorce, dissolution of marriage, or legal separation. Any subsequent order from this Court, another domestic relations court, or juvenile court may modify paragraphs 16, 17, 18, and 19. 29. IF THE FULL HEARING PROCEEDING WAS REFERRED TO A MAGISTRATE, the Court has reviewed the magistrate’s granting of this Order and finds no error of law or other defect evident on the face of the Order as set forth in Civ.R. 65.1. Accordingly, the Court adopts the magistrate’s granting of the Order. 30. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER for filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. 31. THE COSTS OF THIS ACTION ARE assessed against Respondent waived. IT IS SO ORDERED. MAGISTRATE JUDGE NOTICE TO RESPONDENT NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERM OF THIS ORDER EVEN WITH THE PROTECTED PERSON’S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. FORM 10.01-I: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form [Page 7 of 7 Form 10.01-I] Case No.___________________________ NOTICE OF FINAL APPEALABLE ORDER Copies of this Order, which is a final appealable order, were served on or delivered to the parties indicated pursuant to Civ. R. 5(B) and 65.1(C)(3), including ordinary mail, on day of , 20 By: CLERK OF COURT TO THE CLERK: A COPY OF THIS ORDER SHALL BE SERVED ON RESPONDENT PURSUANT TO CIV.R. 65.1(C)(3). COPIES OF THIS ORDER SHALL BE DELIVERED ON: Petitioner Petitioner’s Attorney Respondent’s Attorney Counseling Program: Sheriff’s Office: Law Enforcement Agency Where Petitioner Resides: Law Enforcement Agency Where Petitioner Works: CSEA Other: FORM 10.01-I: DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (DVCPO) FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Per R.C. 3113.31(F)(3), this Order is indexed at Case No. Judge State OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PHONE NUMBER PROTECTION ORDER (R.C. 3113.31) WITH SUPPORT ORDER PETITIONER: PERSON(S) PROTECTED BY THIS ORDER: First Middle Last v. RESPONDENT: Petitioner: Petitioner’s Family or Household Members: ( Additional forms attached.) DOB: DOB: DOB: DOB: DOB: SEX RESPONDENT IDENTIFIERS RACE HGT WGT First Middle Last DRIVER’S LIC. NO. EXP. DATE EYES HAIR DOB / / STATE Relationship to Petitioner: Address where Respondent can be found: Distinguishing Features: WARNING TO LAW ENFORCEMENT: RESPONDENT HAS FIREARMS ACCESS – PROCEED WITH CAUTION Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent was provided with reasonable notice and opportunity to be heard within the time required by Ohio law. Additional findings of this Order are set forth below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until / / (DATE CERTAIN – 5 YEARS MAXIMUM) WARNING TO RESPONDENT: See the warning page attached to the front of this Order. FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 2 of 7 Form 10.01-J] Case No.__________________________ This proceeding came on for a hearing on / / before the Court and the Ex Parte Order issued on / / The following individuals were present: The parties agree to waive their notice and hearing rights. RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02] The Court finds: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Additional findings on a separate page are included and attached herein. ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO RESPONDENT 1. RESPONDENT SHALL IMMEDIATELY VACATE the following residence: FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 3 of 7 Form 10.01-J] Case No.__________________________ 2. EXCLUSIVE POSSESSION OF THE RESIDENCE located at: is granted to: the protected persons’ right to occupy the residence including, but not limited to canceling utilities or insurance or interrupting telecommunication (e.g., telephone, internet, or cable) services, mail delivery, or the delivery of any other documents or items. [NCIC 03] . Respondent shall not interfere with 3. RESPONDENT SHALL SURRENDER all keys and garage door openers to the above residence within 24 hours of service of this Order to the law enforcement agency that serves Respondent with this Order or as follows: 4. RESPONDENT SHALL NOT ENTER or interfere with the residence, school, business, place of employment, day care centers, or child care providers of the protected persons named in this Order, including the buildings, grounds, and parking lots at those locations. Respondent may not violate this Order even with the permission of a protected person. [NCIC 04] 5. RESPONDENT SHALL STAY AWAY FROM PETITIONER and all other protected persons named in this Order, and not be present within 500 feet or wherever those protected persons may be found, or any place Respondent knows or should know the protected persons are likely to be, even with a protected person’s permission. If Respondent accidentally comes in contact with protected persons in any public or private place, Respondent must depart immediately. This Order includes encounters on public and private roads, highways, and thoroughfares. [NCIC 04] (distance) of any protected persons 6. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named in this Order or their residences, businesses, places of employment, schools, day care centers, or child care providers. Contact includes, but is not limited to, landline, cordless, cellular or digital telephone; text instant messaging; fax; e-mail; voicemail; delivery service; social media; blogging; writings; electronic communications; posting a message; or communications by any other means directly or through another person. Respondent may not violate this Order even with the permission of a protected person. [NCIC05] 7. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. 8. RESPONDENT SHALL IMMEDIATELY SURRENDER POSSESSION OF ALL KEYS TO THE FOLLOWING MOTOR VEHICLE: served Respondent with the Order or as follows: to the law enforcement agency that and Petitioner is granted exclusive use of this motor vehicle. 9. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY owned or possessed by the protected persons named in this Order. Personal property shall be apportioned as follows: FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 4 of 7 Form 10.01-J] Case No.__________________________ 10. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF COMPANION ANIMALS OR PETS owned or possessed by the protected persons named in this Order. 11. PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS owned by Petitioner, from the possession of Respondent: Exchange of listed companion animals or pets shall take place as follows: 12. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this Order. 13. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON, INCLUDING FIREARMS, AND AMMUNITION at any time while this Order remains in effect in order to bring about a cessation of violence. Furthermore, Respondent may be subject to firearms and ammunition restrictions pursuant to 18 U.S.C. 922(g)(1) through (9), 18 U.S.C. 922(n), or R.C. 2923.13. [NCIC 07] RESPONDENT IS EXCEPTED only for official use pursuant to 18 U.S.C. 925(a)(1), if no other firearms and ammunition prohibitions apply. 14. RESPONDENT SHALL TURN OVER ALL DEADLY WEAPONS, INCLUDING FIREARMS AMMUNITION owned by Respondent or in Respondent’s possession to the law enforcement agency that serves Respondent with this Order no later than or as follows: Any law enforcement agency is authorized to accept possession of deadly weapons, including firearms, and ammunition pursuant to this paragraph and hold them in protective custody for the duration of this Order. [NCIC 07] Law enforcement shall immediately notify the Court upon receiving Respondent’s deadly weapons, including firearms, and ammunition into protective custody as set forth in this Order. Upon the expiration or termination of this Order, Respondent may reclaim any deadly weapons, including firearms, and ammunition held in protective custody by law enforcement pursuant to this Order unless Respondent is otherwise disqualified as verified by a check of the NCIC protection order file. 15. RESPONDENT’S CONCEALED CARRY WEAPON LICENSE, if any, is now subject to R.C. 2923.128. 16. PETITIONER IS AN UNMARRIED FEMALE who gave birth to (a child) born on residential parent or legal custodian of the child until a court of competent jurisdiction issues an order designating another person as the residential parent or legal custodian. . As set forth in R.C. 3109.042, Petitioner is the sole 17. PARENTAL RIGHTS AND RESPONSIBILITIES ARE TEMPORARILY ALLOCATED AS FOLLOWS: [NCIC 09] FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 5 of 7 Form 10.01-J] Case No.__________________________ This Order applies to the following child children: 18. PARENTING TIME ORDERS DO NOT PERMIT RESPONDENT TO VIOLATE THE TERMS OF THIS ORDER. (A) Respondent’s parenting time rights are suspended; or (B) As a limited exception to paragraphs 5 and 6, temporary parenting time rights are established as follows: [NCIC 06] This Order applies to the following child children: 19. LAW ENFORCEMENT AGENCIES, including but not limited to, are ordered to assist Petitioner in gaining physical custody of the child children, if necessary. 20. RESPONDENT SHALL SUPPORT the protected persons named in this Order as follows: 21. RESPONDENT MAY PICK UP CLOTHING and personal effects from the above residence only in the company of a uniformed law enforcement officer within seven or Order. Arrangements may be made by contacting: days of the filing of this 22. RESPONDENT SHALL NOT USE OR POSSESS alcohol or illegal drugs. 23. RESPONDENT SHALL NOT INTERFERE with wireless service transfer, prevent the functionality of a device on the network, or incur further contractual or financial obligations related to the transferred numbers. Wireless service rights to and billing responsibility for the wireless service number or numbers in use by Petitioner or any minor children in the care of Petitioner shall be transferred to Petitioner by separate order Wireless Service Transfer Order (Form 10-E). 24. RESPONDENT SHALL COMPLETE THE FOLLOWING COUNSELING PROGRAM: FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 6 of 7 Form 10.01-J] Respondent shall contact this program within immediately arrange for an initial appointment. The counseling program is requested to provide the Court a written notice when Respondent attends the initial appointment, if Respondent fails to attend or is discharged, and when Respondent completes the program. Respondent is required to sign all necessary waivers to allow the Court to receive information from the counseling program. days after receiving this Order and Case No.__________________________ 25. RESPONDENT IS ORDERED TO APPEAR before Judge or Magistrate / on Respondent’s compliance with this counseling order. Respondent is warned: If you fail to attend the counseling program you may be held in contempt of court or the Court may issue a warrant for your arrest. a.m. p.m., to review at / 26. IT IS FURTHER ORDERED: [NCIC 08] 27. THE CLERK OF COURT SHALL CAUSE A COPY OF THIS ORDER to be served on Respondent as set forth in Civ.R. 5(B) and 65.1(C)(3). The Clerk of Court shall also provide certified copies of this Order to Petitioner upon request. 28. THIS ORDER SURVIVES a divorce, dissolution of marriage, or legal separation. Any subsequent order from this Court, another domestic relations court, or juvenile court may modify paragraphs 16, 17, 18, and 19. 29. IF THE FULL HEARING PROCEEDING WAS REFERRED TO A MAGISTRATE, the Court has reviewed the magistrate’s granting of this Order and finds no error of law or other defect evident on the face of the Order as set forth in Civ.R. 65.1. Accordingly, the Court adopts the magistrate’s granting of the Order. 30. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER for filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. 31. THE COSTS OF THIS ACTION ARE assessed against Respondent waived. IT IS SO ORDERED. MAGISTRATE JUDGE NOTICE TO RESPONDENT NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERMS OF THIS ORDER, EVEN WITH THE PROTECTED PERSON’S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 7 of 7 Form 10.01-J] Case No.__________________________ I have read this Consent Agreement and Civil Protection Order and agree to its terms. I have read this Consent Agreement and Civil Protection Order and agree to its terms. SIGNATURE OF PETITIONER SIGNATURE OF RESPONDENT Address of Petitioner (Safe Mailing Address) Address of Respondent Signature of Attorney for Petitioner Signature of Attorney for Respondent Address of Attorney for Petitioner Address of Attorney for Respondent NOTICE OF FINAL APPEALABLE ORDER Copies of this Order, which is a final appealable order, were served on or delivered to the parties indicated pursuant to Civ. R. 5(B) and 65.1(C)(3), including ordinary mail, on day of , 20 By: CLERK OF COURT TO THE CLERK: A COPY OF THIS ORDER SHALL BE SERVED ON RESPONDENT PURSUANT TO CIV.R. 65.1(C)(3). COPIES OF THIS ORDER SHALL BE DELIVERED ON: Petitioner Petitioner’s Attorney Respondent’s Attorney Counseling Program: Sheriff’s Office: Law Enforcement Agency Where Petitioner Resides: Law Enforcement Agency Where Petitioner Works: CSEA Other: FORM 10.01-J: CONSENT AGREEMENT AND DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-K: MOTION TO MODIFY OR TERMINATE DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT IN THE COURT OF COMMON PLEAS COUNTY, OHIO Petitioner Address (Safe mailing address) City, State, Zip Code v. Respondent Address City, State, Zip Code Case No. Judge/Magistrate MOTION TO MODIFY OR TERMINATE DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT (R.C. 3113.31) : : : : : : : IF YOU ARE ASKING FOR YOUR ADDRESS TO BE KEPT CONFIDENTIAL, PLEASE PUT A MAILING ADDRESS WHERE YOU CAN SAFELY RECEIVE MAIL. IF YOU ARE A PARTICIPANT IN THE SECRETARY OF STATE’S ADDRESS CONFIDENTIALITY PROGRAM, PLEASE USE THE P.O. BOX ADDRESS GIVEN TO YOU. THIS FORM IS A PUBLIC RECORD. Petitioner Respondent moves this Court to modify or terminate the following Order: Domestic Violence Civil Protection Order granted on Dating Violence Civil Protection Order granted on Consent Agreement Domestic Violence Civil Protection Order approved on Consent Agreement Dating Violence Civil Protection Order approved on In the original proceeding, I was the Petitioner Respondent. 1. The terms of the civil protection order or consent agreement to be modified or terminated are: 2. The reasons for the modification or termination are: FORM 10.01-K: MOTION TO MODIFY OR TERMINATE DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT Amended: April 15, 2021 Discard all previous versions of this form [Page 2 of 3 Form 10.01-K] Case No._____________________ 3. Court fees cannot be assessed against Petitioner for filing a Motion to Modify or Terminate Civil Protection Order or Consent Agreement, which is in connection with a previously issued or approved protection order or consent agreement, pursuant to R.C. 3113.31(J)(1). Respectfully submitted, SIGNATURE OF PETITIONER/RESPONDENT Safe mailing address where the Court may send the moving party (YOU) mail. If you are a participant in the Secretary of State’s address confidentiality program, please use the P.O. Box address given to you. Signature of Attorney for Petitioner/Respondent (if applicable) Name Address Attorney Registration Attorney’s Telephone Attorney’s Fax Attorney’s Email FORM 10.01-K: MOTION TO MODIFY OR TERMINATE DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT Amended: April 15, 2021 Discard all previous versions of this form [Page 3 of 3 Form 10.01-K] Case No._____________________ IN THE COURT OF COMMON PLEAS COUNTY, OHIO Petitioner v. Respondent Case No. Judge/Magistrate : : : REQUEST FOR SERVICE TO THE CLERK OF COURT: Pursuant to Civ.R. 65.1(C)(4), please serve accompanying documents to the address below and as follows: Petitioner Respondent a copy of the Motion and any other Personal service Other (specify) Other (address): Personal Service Other (specify) SPECIAL INSTRUCTIONS TO SHERIFF: Certified Mail, Return Receipt Requested Certified Mail, Return Receipt Requested SIGNATURE OF ATTORNEY OR PETITIONER / RESPONDENT RETURN OF SERVICE Respondent was served on . Officer and Badge Number Law Enforcement Agency Date CLERK’S CERTIFICATE OF MAILING Service of Process was sent by this day of . Attest: Deputy Clerk FORM 10.01-K: MOTION TO MODIFY OR TERMINATE DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-L: JUDGMENT ENTRY ON MOTION TO MODIFY/TERMINATE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT Petitioner DOB: v. Respondent IN THE COURT OF COMMON PLEAS COUNTY, OHIO : Case No. / / : Judge : JUDGMENT ENTRY ON MOTION TO MODIFY OR TERMINATE CIVIL PROTECTION ORDER OR : CONSENT AGREEMENT (R.C. 3113.31) : : DOB: / / Upon the motion of Petitioner Respondent, this proceeding came on for a hearing on before the Court to modify terminate the following Order: Domestic Violence Civil Protection Order granted on Dating Violence Civil Protection Order granted on Consent Agreement Domestic Violence Civil Protection Order approved on Consent Agreement Dating Violence Civil Protection Order approved on Petitioner was present not present, but had reasonable notice and opportunity to be heard. Respondent was present not present, but had reasonable notice and opportunity to be heard. The Court has considered the following factors: 1. Petitioner consents does not consent to the modification termination of the Civil Protection Order or Consent Agreement. 2. Petitioner continues to fear does not fear Respondent. 3. The current nature of the relationship between Petitioner and Respondent is as follows: 4. Relative proximity of Petitioner’s and Respondent’s workplaces and residences. 5. Petitioner and Respondent have do not have minor children together. 6. Respondent has complied order or consent agreement. failed to comply with the terms and conditions of the original civil protection 7. Respondent has does not have a continuing involvement with illegal drugs or alcohol. FORM 10.01-L: JUDGMENT ENTRY ON MOTION TO MODIFY/TERMINATE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT Amended: April 15, 2021 Discard all previous versions of this form [Page 2 of 3 Form 10.01-L] Case No._______________________ 8. Respondent has been has not been convicted of or pleaded guilty to an offense of violence since the protection order was issued or the consent agreement was approved. 9. Other protection orders, consent agreements, restraining orders, or no contact orders have been have not been issued against Respondent pursuant to R.C. 3113.31 or 2919.26, any other provision of state law, or the laws of any other state. 10. Respondent participated has not participated in treatment, intervention program, or other counseling as set forth in the Court’s order or approved agreement. 11. Respondent completed has not completed treatment, intervention program, or other counseling as set forth in the Court’s order or approved agreement. 12. (time) has elapsed since the protection order was issued or the consent agreement was approved. 13. The age and health of Respondent is as follows: 14. The last incident of abuse, threat of harm, or commission of a sexually oriented offense occurred on: 15. Other information considered concerning the safety and protection of Petitioner or other protected parties: Based on all relevant factors, including those set forth in R.C. 3113.31(E)(8), the Court finds: THE ORDER ISSUED ON SHALL BE MODIFIED per the Modified Domestic Violence Civil Protection Order (Form 10.01-M) Modified Dating Violence Civil Protection Order (Form 10.01-T). THE ORDER IS TERMINATED. The civil protection order or consent agreement is no longer needed. Respondent may reclaim any deadly weapons held in protective custody by law enforcement pursuant to this Order unless Respondent is otherwise disqualified as verified by a check of the NCIC protection order file. THE MOTION IS DENIED. The civil protection order or consent agreement remains in full force and effect. The Court has prepared a Protection Order Notice to NCIC (Form 10-A) to show the modification or early termination of the prior order or agreement. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER for filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. THE COSTS OF THIS ACTION ARE assessed against Respondent waived. FORM 10.01-L: JUDGMENT ENTRY ON MOTION TO MODIFY/TERMINATE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT Amended: April 15, 2021 Discard all previous versions of this form [Page 3 of 3 Form 10.01-L] Case No._______________________ IF THE FULL HEARING PROCEEDING WAS REFERRED TO A MAGISTRATE, the Court has reviewed the magistrate’s granting or denial of the modification or termination of the Order and finds no error of law or other defect evident on the face of the Order as set forth in Civ.R. 65.1. Accordingly, the Court adopts the magistrate’s granting or denial of the modification or termination of the Order. IT IS SO ORDERED. MAGISTRATE JUDGE NOTICE OF FINAL APPEALABLE ORDER Copies of this Order, which is a final appealable order, were served on or delivered to the parties indicated above pursuant to Civ. R. 5(B) and 65.1(C)(4), including ordinary mail, on day of , 20 By: CLERK OF COURT TO THE CLERK: A COPY OF THIS ORDER SHALL BE SERVED ON RESPONDENT PURSUANT TO CIV.R. 65.1(C)(3). COPIES OF THIS ORDER SHALL BE DELIVERED ON: Petitioner Petitioner’s Attorney Respondent’s Attorney Counseling Program: Law Enforcement Agency Where Petitioner Resides: Law Enforcement Agency Where Petitioner Works: CSEA Other: FORM 10.01-L: JUDGMENT ENTRY ON MOTION TO MODIFY/TERMINATE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-M: MODIFIED DOMESTIC VIOLENCE CIVIL PROTECTION ORDER IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Per R.C. 3113.31(F)(3), this Order is indexed at Case No. Judge State OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - PHONE NUMBER PETITIONER: MODIFIED DOMESTIC VIOLENCE CIVIL PROTECTION ORDER (R.C. 3113.31) PERSON(S) PROTECTED BY THIS ORDER: First Middle Last v. Petitioner Petitioner’s Family or Household Members: ( Additional forms attached) DOB: DOB: DOB: DOB: DOB: RESPONDENT: RESPONDENT IDENTIFIERS SEX RACE HGT WGT First Middle Last DRIVER’S LIC. NO. EXP. DATE EYES HAIR DOB / / STATE Relationship to Petitioner: Address where Respondent can be found: Distinguishing Features: WARNING TO LAW ENFORCEMENT: RESPONDENT HAS FIREARMS ACCESS – PROCEED WITH CAUTION Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent will be provided with reasonable notice and opportunity to be heard within the time required by Ohio law. Additional findings of this Order are set forth below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until / / (SHALL BE SAME EXPIRATION DATE AS IN CIVIL PROTECTION ORDER OR CONSENT AGREEMENT UNLESS EXTENDED BY SEPARATE ENTRY) WARNING TO RESPONDENT: See the warning page attached to the front of this Order. FORM 10.01-M: MODIFIED DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 2 of 7 Form 10.01-M] Case No.___________________________ This proceeding came on for a hearing on presented and consideration of factors set forth in R.C. 31131.31(E)(8), the Court finds that the motion to modify the prior Domestic Violence Civil Protection Order issued on is well taken. . Based on the evidence / / / / RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02] The Court also finds ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Additional findings on a separate page are included and attached herein. 1. RESPONDENT SHALL IMMEDIATELY VACATE the following residence: 2. EXCLUSIVE POSSESSION OF THE RESIDENCE located at: FORM 10.01-M: MODIFIED DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 3 of 7 Form 10.01-M] Case No.___________________________ is granted to: . Respondent shall not interfere with the protected persons’ right to occupy the residence including, but not limited to canceling utilities or insurance or interrupting telecommunication (e.g. telephone, internet, cable) services mail delivery, or the delivery of any other documents or items. [NCIC 03] 3. RESPONDENT SHALL SURRENDER all keys and garage door openers to the above residence within 24 hours of service of this Order to the law enforcement agency that serves Respondent with this Order or as follows: 4. RESPONDENT SHALL NOT ENTER or interfere with the residence, school, business, place of employment, day care centers, or child care providers of the protected persons named in this Order, including the buildings, grounds, and parking lots at those locations. Respondent may not violate this Order even with the permission of a protected person. [NCIC 04] 5. RESPONDENT SHALL STAY AWAY FROM PETITIONER and all other protected persons named in this Order, and not be present within 500 feet or (distance) of any protected person wherever those protected persons may be found, or any place Respondent knows or should know the protected persons are likely to be, even with a protected person’s permission. If Respondent accidentally comes in contact with protected persons in any public or private place, Respondent must depart immediately. This Order includes encounters on public and private roads, highways, and thoroughfares. [NCIC 04] 6. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named in this Order or their residences, businesses, places of employment, schools, day care centers, or child care providers. Contact includes, but is not limited to, landline, cordless, cellular, or digital telephone; text; instant messaging; fax; e-mail; voicemail; delivery service; social media; blogging; writings; electronic communications; posting a message; or communications by any other means directly or through another person. Respondent may not violate this Order even with the permission of a protected person. [NCIC 05] 7. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. 8. RESPONDENT SHALL IMMEDIATELY SURRENDER POSSESSION OF ALL KEYS TO THE FOLLOWING MOTOR VEHICLE: that served Respondent with this Order or as follows: to the law enforcement agency and Petitioner is granted exclusive use of this motor vehicle. 9. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY owned or possessed by the protected persons named in this Order. Personal property shall be apportioned as follows: 10. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY COMPANION ANIMALS OR PETS owned or possessed by the protected persons named in this Order. 11. PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS, owned by Petitioner, from the possession of Respondent: FORM 10.01-M: MODIFIED DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 4 of 7 Form 10.01-M] Case No.___________________________ Exchange of the listed companion animals or pets shall take place as follows: 12. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this Order. 13. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON, INCLUDING FIREARMS, AND AMMUNITION at any time while this Order remains in effect in order to bring about a cessation of violence. Furthermore, Respondent may be subject to firearms and ammunition restrictions pursuant to 18 U.S.C. 922(g)(1) through (9), 18 U.S.C. 922(n), or R.C. 2923.13. [NCIC 07] RESPONDENT IS EXCEPTED only for official use pursuant to 18 U.S.C. 925(a)(1), if no other firearms and ammunition prohibition apply. 14. RESPONDENT SHALL TURN OVER ALL DEADLY WEAPONS, INCLUDING FIREARMS AND AMMUNITION, owned by respondent or in Respondent’s possession to the law enforcement agency that serves Respondent with this Order no later than or as follows: Any law enforcement agency is authorized to accept possession of deadly weapons, including firearms, and ammunition pursuant to this paragraph and hold them in protective custody for the duration of this Order. [NCIC 07] Law enforcement shall immediately notify the Court upon receiving Respondent’s deadly weapons, including firearms, and ammunition into protective custody as set forth in this Order. Upon the expiration or termination of this Order, Respondent may reclaim any deadly weapons, including firearms, and ammunition held in protective custody by law enforcement pursuant to this Order, unless Respondent is otherwise disqualified as verified by a check of the NCIC protection order file. 15. RESPONDENT’S CONCEALED CARRY WEAPON LICENSE, if any, is now subject to R.C. 2923.128. 16. PETITIONER IS AN UNMARRIED FEMALE who gave birth to (a child) born on . As set forth in R.C. 3109.042, Petitioner is the sole residential parent or legal custodian of the child until a court of competent jurisdiction issues an order designating another person as the residential parent or legal custodian. 17. PARENTAL RIGHTS AND RESPONSIBILITIES ARE TEMPORARILY ALLOCATED AS FOLLOWS: [NCIC 09] This Order applies to the following child children: FORM 10.01-M: MODIFIED DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 5 of 7 Form 10.01-M] Case No.___________________________ 18. PARENTING TIME ORDERS DO NOT PERMIT RESPONDENT TO VIOLATE THE TERMS OF THIS ORDER. (A) Respondent’s parenting time rights are suspended; or (B) As a limited exception to paragraphs 5 and 6, temporary parenting time rights are established as follows: [NCIC 06] This Order applies to the following child children: 19. LAW ENFORCEMENT AGENCIES, including but not limited to, are ordered to assist Petitioner in gaining physical custody of the child children, if necessary. 20. RESPONDENT SHALL SUPPORT the protected persons named in this Order as follows: 21. RESPONDENT MAY PICK UP CLOTHING and personal effects from the above residence only in the company of a uniformed law enforcement officer within seven or of this Order. Arrangements may be made by contacting: days of the filing 22. RESPONDENT SHALL NOT USE OR POSSESS alcohol or illegal drugs. 23. RESPONDENT SHALL COMPLETE THE FOLLOWING COUNSELING PROGRAM: Respondent shall contact this program within Order and immediately arrange for an initial appointment. The counseling program is requested days after receiving this to provide the Court a written notice when Respondent attends the initial appointment, if the Respondent fails to attend or is discharged, and when Respondent completes the program. Respondent is required to sign all necessary waivers to allow the Court to receive information from the counseling program. 24. RESPONDENT IS ORDERED TO APPEAR before Judge or Magistrate on Respondent’s compliance with this counseling order. Respondent is warned: If you fail to a.m. p.m. to review at / / attend the counseling program you may be held in contempt of court, or the Court may issue a warrant for your arrest. 25. RESPONDENT SHALL NOT INTERFERE with wireless service transfer, prevent the functionality of a device on the network, or incur further contractual or financial obligations related to the transferred numbers. FORM 10.01-M: MODIFIED DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 6 of 7 Form 10.01-M] Case No.___________________________ Wireless service rights to and billing responsibility for the wireless service number or numbers in use by Petitioner or any minor children in the care of Petitioner shall be transferred to Petitioner by separate order, Wireless Service Transfer Order (Form 10-E). 26. IT IS FURTHER ORDERED: [NCIC 08] 27. THE CLERK OF COURT SHALL CAUSE A COPY of this Order to be served on Respondent as set forth in Civ.R. 5(B) and 65.1(C)(4)(b). The Clerk of Court shall also provide certified copies of the Petition and this Order to Petitioner upon request. 28. THIS ORDER SURVIVES a divorce, dissolution of marriage, or legal separation. Any subsequent order from this Court, another domestic relations court, or juvenile court may modify paragraphs 16, 17, 18, and 19. 29. IF THE FULL HEARING PROCEEDING WAS REFERRED TO A MAGISTRATE, the Court has reviewed the magistrate’s granting of this Order and finds no error of law or other defect evident on the face of the as set forth in Civ.R. 65.1. Accordingly, the Court adopts the magistrate’s granting of the Order. 30. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER for filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. 31. THE COSTS OF THIS ACTION ARE assessed against Respondent waived. IT IS SO ORDERED. MAGISTRATE JUDGE NOTICE TO RESPONDENT NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERMS OF THIS ORDER, EVEN WITH THE PROTECTED PERSON’S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. FORM 10.01-M: MODIFIED DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 7 of 7 Form 10.01-M] Case No.___________________________ NOTICE OF FINAL APPEALABLE ORDER Copies of this Order, which is a final appealable order, were served or delivered on the parties indicated pursuant to Civ.R. 65.1(C)(4)(b), including ordinary mail, on day of , 20 By: CLERK OF COURT TO THE CLERK: A COPY OF THIS ORDER SHALL BE SERVED ON RESPONDENT PURSUANT TO CIV.R. 65.1(C)(4). COPIES OF THIS ORDER SHALL BE DELIVERED ON: Petitioner Petitioner’s Attorney Respondent’s Attorney Counseling Program: Sheriff’s Office: Law Enforcement Agency Where Petitioner Resides: Law Enforcement Agency Where Petitioner Works: CSEA Other: FORM 10.01-M: MODIFIED DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-O: MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER IN THE COURT OF COMMON PLEAS COUNTY, OHIO Case No. Judge/Magistrate MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER (R.C. 3113.31) Petitioner Address (Safe mailing address) City, State, Zip Code v. Respondent Address City, State, Zip Code : : : : : : : : IF YOU ARE ASKING FOR YOUR ADDRESS TO BE KEPT CONFIDENTIAL, PLEASE GIVE ANOTHER MAILING ADDRESS WHERE YOU CAN SAFELY RECEIVE MAIL. IF YOU ARE A PARTICIPANT IN THE SECRETARY OF STATE’S ADDRESS CONFIDENTIALITY PROGRAM, PLEASE USE THE P.O. BOX ADDRESS GIVEN TO YOU. THIS FORM IS A PUBLIC RECORD. Petitioner Respondent moves this Court to find in contempt of court for violating one or more of the provisions of the Domestic Violence Civil Protection Order Dating Violence Civil Protection Order issued on for the reasons below. / / 1. Respondent violated the Civil Protection Order by (check all that apply): Abusing me or another protected person Harming me or attempting to harm me or another protected person Threatening me or another protected person Following me or another protected person Stalking me or another protected person Harassing me or another protected person Forcing sexual relations upon Committing a sexually oriented offense against me or another protected person me or another protected person 2. Respondent failed to vacate the residence at 3. Respondent interfered with my exclusive possession of the residence located at FORM 10.01-O: MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 2 of 4 Form 10.01-O] Case No.________________________ Furthermore, Respondent did the following (check all that apply): Cancelled utilities Cancelled insurance Interrupted telecommunication (telephone, internet, or cable) services Interrupted mail delivery Interrupted delivery of any other documents or items 4. Respondent failed to surrender keys or garage door openers to the residence for which the Civil Protection Order Grants Petitioner exclusive use. 5. Respondent entered or interfered with the residence, school, business, place of employment, day care center, or child care provider of the protected persons. 6. Respondent violated the stay away provision of the Civil Protection Order. 7. Respondent violated the no contact provision of the Civil Protection Order by (check all that apply): Posting photographs, videos, or other images of me or another protected person on social media Referring to me or another protected persons on social media Electronically surveilling me or another protected person 8. Respondent failed to surrender the keys to the motor vehicle for which the Civil Protection Order grants Petitioner exclusive use. 9. Respondent removed, damaged, hid, or disposed of personal property, companion animals, or pets in violation of the Civil Protection Order. 10. Respondent impeded Petitioner from removing Petitioner’s companion animal or pet in violation of the Civil Protection Order. 11. Respondent caused or encouraged another person to do acts prohibited by the Civil Protection Order. 12. Respondent violated the Civil Protection Order by possessing, using, carrying, obtaining, or failing to turn over a deadly weapon, including firearms, and ammunition. 13. Petitioner Respondent violated the temporary allocation of parental rights and responsibilities (custody). 14. Petitioner Respondent violated the visitation order. 15. Respondent violated the child or spousal support provision in the Civil Protection Order. 16. Respondent used or possessed alcohol or illegal drugs in violation of the Civil Protection Order. 17. Petitioner Respondent failed to attend the ordered counseling program in violation of the Civil Protection Order. 18. Respondent interfered with the wireless service transfer, prevented the functionality of a device on the network, or incurred further contractual or financial obligations related to the wireless service transferred in violation of the Civil Protection Order. 19. Other violations of the Civil Protection Order or additional explanation (if you need more space, attach an additional page): FORM 10.01-O: MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 3 of 4 Form 10.01-O] Case No.________________________ I swear or affirm that the answers above are true, complete, and accurate to the best of my knowledge. I understand that making false statements in this document may result in a contempt of court finding against me which could result in a jail sentence and fine, and may also subject me to criminal penalties for perjury under R.C. 2921.11. SIGNATURE OF PETITIONER/RESPONDENT DATE IF YOU DO NOT HAVE AN ATTORNEY FOR THIS CASE, PLEASE LEAVE THIS INFORMATION BELOW BLANK Signature of Attorney for Petitioner Name Address Attorney Registration Number Telephone FORM 10.01-O: MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form [Page 4 of 4 Form 10.01-O] Case No.________________________ IN THE COURT OF COMMON PLEAS COUNTY, OHIO Petitioner v. Respondent Case No. Judge/Magistrate : : : TO THE CLERK OF COURT: Pursuant to Civ.R. 65.1(C)(4), please serve Respondent a copy of the Motion and any other accompanying documents to the address below and as follows: REQUEST FOR SERVICE Personal service Other (specify) Other (address): Personal service Other (specify) SPECIAL INSTRUCTIONS TO SHERIFF: Certified Mail, Return Receipt Requested Certified Mail, Return Receipt Requested SIGNATURE OF ATTORNEY OR PETITIONER RETURN OF SERVICE Respondent was served on . Officer and Badge Number Law Enforcement Agency Date CLERK’S CERTIFICATE OF MAILING Service of Process was sent by this day of . Attest: Deputy Clerk FORM 10.01-O: MOTION FOR CONTEMPT OF A DOMESTIC VIOLENCE OR DATING VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form FORM 10.01-P: PETITION FOR DATING VIOLENCE CIVIL PROTECTION ORDER IN THE COURT OF COMMON PLEAS COUNTY, OHIO Petitioner : Case No. Address (Safe mailing address) City, State, Zip Code Date of Birth / / v. Respondent Address (If home address unknown, put work address) City, State, Zip Code Date of Birth / / Judge/Magistrate : : : PETITION FOR DATING VIOLENCE CIVIL PROTECTION ORDER (R.C. 3113.31) : : : : : : CHECK ALL BOXES THAT APPLY. IF YOU ARE ASKING FOR YOUR ADDRESS TO BE KEPT CONFIDENTIAL, PLEASE PUT A MAILING ADDRESS WHERE YOU CAN SAFELY RECEIVE MAIL. IF YOU ARE A PARTICIPANT IN THE SECRETARY OF STATE’S ADDRESS CONFIDENTIALITY PROGRAM, PLEASE USE THE P.O. BOX ADDRESS GIVEN TO YOU. THIS FORM IS A PUBLIC RECORD. I need or a witness needs a foreign language interpreter in or an American Sign Language interpreter per Sup.R. 88. 1. I want do not want an ex parte (emergency) protection order per R.C. 3113.31. Petitioner further requests a full hearing trial be scheduled, even if the ex parte protection order is granted, denied, or not requested. 2. I am filing the Petition because I am in fear of continuing danger. I was 18 years old or older when the violence took place, and I am or was in a dating relationship with Respondent within one year before the violence took place. 3. I have listed below all family or household members who need protection other than me (Leave blank if you are not seeking protection for other family or household members.) NAME DATE OF BIRTH RELATIONSHIP TO PETITIONER FORM 10.01-P: PETITION FOR DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 2 of 5 of Form 10.01-P] 4. Respondent committed an act of violence against me. 5. Respondent was 18 years old or older when the violence took place. 6. I have or had a romantic or intimate relationship with the Respondent. 7. My relationship with Respondent was neither a casual acquaintance nor an ordinary business or social relationship. 8. You must describe the relationship with Respondent. You may include: (If you need more space, attach an additional page.) • Whether you developed a special bond beyond a casual acquaintanceship or an ordinary business or social relationship • Length of the relationship with Respondent • Nature and frequency of contact with Respondent, including whether you had an intimate relationship with Respondent and communications that would show the relationship with Respondent was more than a casual acquaintanceship or an ordinary business or social relationship • Expectations about the relationship with Respondent • Statements or conduct by Respondent or you that could show to the Court the depth of or commitment to the relationship • Any other reason or explanation to prove the dating relationship 9. You must describe Respondent’s threats or actions that made you afraid. When did it happen (if you do not know exact dates, give approximate dates). Explain why you believe you are in danger? If you need more space, attach an additional page. FORM 10.01-P: PETITION FOR DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 3 of 5 of Form 10.01-P] 10. You may want to describe, if you want and know, about any of the following. Not describing these items in the Petition does not mean dating violence did not happen. If you need more space, attach an additional page. • Respondent’s history of domestic violence or other violent acts • Respondent’s history of violating court orders • Respondent’s mental health • Respondent’s threats to other persons • Respondent’s access to deadly weapons, firearms, and ammunition or use of deadly weapons and acts or threats of violence with deadly weapon • Respondent’s abuse alcohol or controlled substances (drugs) • Respondent’s violence resulted in serious physical injury, forced sex, strangulation (or choking), abuse during pregnancy, abuse of the family’s pet, and/or forced entry to gain access to Petitioner or Petitioner’s family and household members • Recent separation from Respondent or relationship was recently terminated • Respondent’s obsessive and controlling behaviors, including stalking, spying, following, and/or isolating you (Petitioner) • Respondent’s threats to kill self or others 11. Petitioner further requests that the Court grant relief under R.C. 3113.31 to protect Petitioner and/or the family or household members named in this Petition from domestic violence by granting a civil protection order that: (Check all boxes that apply.) a. Directs Respondent to not abuse Petitioner and the family or household members named in this Petition by harming, attempting to harm, threatening, following, stalking, harassing, forcing sexual relations upon them, or by committing sexually oriented offenses against them. b. Directs Respondent to not enter, approach, or contact by any means the residence, school, business, and place of employment of Petitioner and the family or household members named in this Petition. c. Directs Respondent to not approach or have contact by any means with Petitioner and the family or household members named in this Petition. d. Directs Respondent to not remove, damage, hide, harm, or dispose of any companion animals or pets owned or possessed by Petitioner. e. Grants Petitioner permission to take Petitioner’s pets or companion animals, as described below, away from the possession of Respondent: f. Directs Respondent to complete counseling, substance abuse counseling, or other treatment or intervention as determined necessary by the Court. FORM 10.01-P: PETITION FOR DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 4 of 5 of Form 10.01-P] g. Directs the wireless service provider to separate Petitioner’s account from Respondent’s account, per R.C. 3113.45 to 3113.459. Petitioner will assume all financial responsibility for any costs associated with the wireless service number and any costs for the device associated with the wireless service number. The Respondent’s billing telephone number is . Petitioner’s contact information is on page 1 of this Petition. The wireless service numbers to be transferred to Petitioner which are used by Petitioner or the minor children in the care of Petitioner is: h. Includes the following additional provisions: 12. Petitioner further requests that the Court issue no mutual protection orders or other orders against Petitioner unless all of the conditions of R.C. 3113.31(E)(4) are met. 13. Petitioner further requests that if Petitioner has a victim advocate, the Court permit the victim advocate to accompany Petitioner at all stages of these proceedings as required by R.C. 3113.31(M). 14. Petitioner further requests at the ex parte hearing or full hearing that the Court grant such other relief as the Court considers equitable and fair, including orders or directives to law enforcement. 15. Petitioner has listed court cases (including children service/CPS case, animal cruelty, sexually oriented offense, no contact order, and protection order) and other legal matters regarding Respondent which may relate to this case: (If you need more space, attach an additional page.) CASE NAME CASE NUMBER COURT/COUNTY TYPE OF CASE RESULT OF CASE I swear or affirm that the answers above are true, complete, and accurate to the best of my knowledge. I understand that making false statements in this document may result in a contempt of court finding against me, which could result in a jail sentence and fine, and may also subject me to criminal penalties for perjury under R.C. 2921.11. SIGNATURE OF PETITIONER DATE IF YOU DO NOT HAVE AN ATTORNEY, PLEASE LEAVE THE INFORMATION BELOW BLANK. Signature of Attorney Attorney’s Registration Number Name of Attorney Attorney’s Address City, State, Zip Code Attorney’s Telephone Attorney’s Fax Attorney’s Email FORM 10.01-P: PETITION FOR DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 5 of 5 of Form 10.01-P] IN THE COURT OF COMMON PLEAS COUNTY, OHIO Petitioner v. Respondent Case No. Judge/Magistrate : : : TO THE CLERK OF COURT: Pursuant to Civ.R. 65.1(C)(2), please serve Respondent a copy of the Petition, ex parte protection order, if granted, and any other accompanying documents to the address below and as follows: REQUEST FOR SERVICE Personal service Other (specify) Other (address): Personal Service Other (specify) SPECIAL INSTRUCTIONS TO SHERIFF: Certified Mail, Return Receipt Requested Certified Mail, Return Receipt Requested SIGNATURE OF ATTORNEY OR PETITIONER RETURN OF SERVICE Respondent was served on . Officer and Badge Number Law Enforcement Agency Date CLERK’S CERTIFICATE OF MAILING Service of Process was sent by this day of . Attest: Deputy Clerk FORM 10.01-P: PETITION FOR DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 FORM 10.01-Q: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) EX PARTE IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Case No. Per R.C. 3113.31(F)(3), this Order is indexed at LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - PHONE NUMBER PETITIONER: Judge/Magistrate State OHIO DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) EX PARTE (R.C. 3113.31) PERSON(S) PROTECTED BY THIS ORDER: DOB: Petitioner: Petitioner’s Family or Household Members: ( Additional forms attached.) First Middle Last v. RESPONDENT: DOB: DOB: DOB: DOB: RESPONDENT IDENTIFIERS SEX RACE HGT WGT First Middle Last EYES HAIR DRIVER’S LIC. NO. EXP. DATE DOB / / STATE Petitioner is or was in a dating relationship with Respondent within 12 months preceding the conduct resulting in this Order being requested. Address where Respondent can be found: Distinguishing features: WARNING TO LAW ENFORCEMENT: RESPONDENT HAS FIREARMS ACCESS – PROCEED WITH CAUTION Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent will be provided with reasonable notice and opportunity to be heard within the time required by Ohio law. Additional findings of this Order are set forth below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until / / UNLESS EXTENDED BY SEPARATE ENTRY. WARNING TO RESPONDENT: See the warning page attached to the front of this Order. FORM 10.01-Q: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) EX PARTE Adopted: April 15, 2021 [Page 2 of 5 Form 10.01-Q] Case No.___________________________ This proceeding came on for an ex parte hearing on being present), upon the filing of a Petition by Petitioner for a Dating Violence Civil Protection Order (DTVCPO) against the Respondent, pursuant to R.C. 3113.31. In accordance with R.C. 3113.31(D)(1), the Court held an ex parte hearing on the same day that the Petition was filed. (Respondent not / / The Court finds that the protected persons herein are in immediate and present danger of domestic violence and for good cause shown, the following temporary orders are necessary to protect the persons named in this Order from dating violence. RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02] The Court also finds: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Additional findings on a separate page are included and attached herein. 1. RESPONDENT SHALL NOT ENTER or interfere with the residence, school, business, place of employment, day care centers, or child care providers of the protected persons named in this Order, including the buildings, grounds, and parking lots at those locations. Respondent may not violate this Order even with the permission of a protected person. [NCIC 04] 2. RESPONDENT SHALL STAY AWAY FROM ALL protected persons named in this Order, and not be present within 500 feet or (distance) of any protected person wherever persons FORM 10.01-Q: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) EX PARTE Adopted: April 15, 2021 [Page 3 of 5 Form 10.01-Q] Case No.___________________________ are likely to be, even with a protected person’s permission. If Respondent accidentally comes in contact with protected persons in any public or private place, Respondent must depart immediately. This Order includes encounters on public and private roads, highways, and thoroughfares. [NCIC 04] 3. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named in this Order or their residences, businesses, places of employment, schools, day care centers, or child care providers. Contact includes, but is not limited to, landline, cordless, cellular or digital telephone; text; instant messaging; fax; e-mail; voicemail; delivery service; social media; blogging; writings; electronic communications; posting a message; or communications by any other means directly or through another person. Respondent may not violate this Order even with the permission of a protected person. [NCIC 05] 4. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. 5. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY, COMPANION ANIMALS, OR PETS owned or possessed by the protected persons named in this Order. 6. THE PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS owned by Petitioner, from the possession of Respondent: Exchange of the listed companion animals or pets shall take place as follows: 7. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this Order. 8. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON at any time while the Order remains in effect in order to bring about a cessation of violence. Furthermore, Respondent may be subject to firearms and ammunition restrictions pursuant to 18 U.S.C. 922(g)(1) through (9), 18 U.S.C. 922(n), or R.C. 2923.13. [NCIC 07] RESPONDENT IS EXCEPTED only for official use pursuant to 18 U.S.C. 925(a)(1), if no other firearms and ammunition prohibitions apply. 9. RESPONDENT SHALL TURN OVER ALL DEADLY WEAPONS owned by Respondent or in Respondent’s possession to the law enforcement agency that serves Respondent with this Order no later than or as follows: Any law enforcement agency is authorized to accept possession of deadly weapons pursuant to this paragraph and hold them in protective custody for the duration of this Order. [NCIC 07] Law enforcement shall immediately notify the Court upon receiving Respondent’s deadly weapons for protective custody as set forth in this Order. Upon the expiration or termination of this Order and if a full hearing order is not issued or consent agreement approved, Respondent may reclaim any deadly weapons held in protective custody by law enforcement pursuant to this Order unless Respondent is otherwise disqualified as verified by a check of the NCIC protection order file. 10. RESPONDENT’S CONCEALED CARRY WEAPON LICENSE, if any, is not subject to R.C. 2923.128. 11. RESPONDENT SHALL NOT USE OR POSSESS alcohol or illegal drugs. FORM 10.01-Q: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) EX PARTE Adopted: April 15, 2021 [Page 4 of 5 Form 10.01-Q] Case No.___________________________ 12. RESPONDENT SHALL NOT INTERFERE with wireless service transfer, prevent the functionality of a device on the network, or incur further contractual or financial obligations related to the transferred numbers. Wireless service rights to and billing responsibility for the wireless service number or numbers in use by the Petitioner or any minor children in the care of the Petitioner shall be transferred to Petitioner by separate order, Wireless Service Transfer Order (Form 10-E). 13. IT IS FURTHER ORDERED: [NCIC 08] 14. ALL DISCOVERY SHALL STRICTLY COMPLY with Civ.R. 65.1(D). 15. THE CLERK OF COURT SHALL CAUSE A COPY OF THE PETITION, THIS ORDER, AND ANY OTHER ACCOMPANYING DOCUMENT to be served on the Respondent as set forth in Civ.R. 65.1(C)(2). The Clerk of Court shall also provide copies of the Petition and certified copies of this Order to Petitioner upon request. 16. THIS ORDER DOES NOT EXPIRE because of a failure to serve notice of the full hearing upon the Respondent before the date set for the full hearing or because the Court grants a continuance, as set forth in R.C. 3113.31(D)(2)(b). 17. IT IS FURTHER ORDERED THAT NO COSTS OR FEES SHALL BE ASSESSED AGAINST THE PETITIONER for filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving this protection order, or subpoenaing witnesses or obtaining a certified copy of this protection order. This Order is granted without bond. IT IS SO ORDERED. JUDGE/MAGISTRATE NOTICE TO RESPONDENT NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERM OF THIS ORDER EVEN WITH THE PROTECTED PERSON’S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. FORM 10.01-Q: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) EX PARTE Adopted: April 15, 2021 [Page 5 of 5 Form 10.01-Q] Case No.___________________________ TO THE CLERK: A COPY OF PETITION, THIS ORDER, AND ANY OTHER ACCOMPANYING DOCUMENTS SHALL BE SERVED ON RESPONDENT PURSUANT TO CIV.R. 65.1(C)(2): COPIES OF THIS ORDER AND ANY OTHER ACCOMPANYING DOCUMENTS SHALL BE DELIVERED TO: Petitioner Petitioner’s Attorney Law Enforcement Agency Where Petitioner Resides: Sheriff’s Office: Law Enforcement Agency Where Petitioner Works: Other: A FULL HEARING on this Order, and on all other issues raised by the Petition, shall be held before Judge or Magistrate: on the day of , 20 at a.m./p.m. at the following location: On the day of the Full Hearing, come prepared to (1) tell the Court what happened, (2) bring with you any witnesses, evidence, and documentation to prove your case, and (3) be aware that the other party or party’s attorney may ask you questions. If you do not have an attorney, you may ask for a brief continuance to obtain an attorney per R.C. 3113.31(D)(2)(a)(iii) or you may represent yourself. Parties do not have to give discovery, answer questions, or give information to the other party or the other party’s lawyer unless ordered by judge or magistrate (Civ.R. 65.1(D)(2)). FORM 10.01-Q: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) EX PARTE Adopted: April 15, 2021 FORM 10.01-R: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) FULL HEARING IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Case No. Per R.C. 3113.31(F)(3), this Order is indexed at Judge State OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - DATING VIOLENCE CIVIL PROTECTION ORDER PHONE NUMBER (DTCPO) FULL HEARING (R.C. 3113.31) PETITIONER: PERSON(S) PROTECTED BY THIS ORDER: Petitioner Petitioner’s Family or Household Members: ( Additional forms attached) DOB: First Middle Last v. RESPONDENT: First Middle Last Petitioner is or was in a dating relationship with Respondent within 12 months preceding the conduct resulting in this Order being requested. Address where Respondent can be found: DOB: DOB: DOB: DOB: RESPONDENT IDENTIFIERS SEX RACE HGT WGT EYES HAIR DOB DRIVER’S LIC. NO. / EXP. DATE / STATE Distinguishing Features: WARNING TO LAW ENFORCEMENT: RESPONDENT HAS FIREARMS ACCESS – PROCEED WITH CAUTION Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent was provided with reasonable notice and opportunity to be heard within the time required by Ohio law. Additional findings of this Order are set forth below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until WARNING TO RESPONDENT: See the warning page attached to the front of this Order. / / (DATE CERTAIN – 5 YEARS MAXIMUM) FORM 10.01-R: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) FULL HEARING Adopted: April 15, 2021 This proceeding came on for a hearing on Ex Parte Order issued on [Page 2 of 5 Form 10.01-R] Case No.___________________________ before the Court and the . The following individuals were present: The Court hereby makes the following findings of fact regarding the granting of the Order, including the facts upon which the Court concluded the existence of the dating relationship: Additional findings on a separate page are included and attached herein. The Court further finds by a preponderance of the evidence that 1) Petitioner is or was in a dating relationship with Respondent, 2) Petitioner or Petitioner’s family or household members are in danger and have been a victim as defined in R.C. 3113.31(A) committed by Respondent, and 3) the following orders are equitable, fair, and necessary to protect the persons named in this Order from dating violence. RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02] ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO RESPONDENT 1. RESPONDENT SHALL NOT ENTER or interfere with the residence, school, business, place of employment, day care centers, or child care providers of the protected persons named in this Order, including the buildings, grounds, and parking lots at those locations. Respondent may not violate this Order even with the permission of a protected person. [NCIC 04] 2. RESPONDENT SHALL STAY AWAY FROM ALL protected persons named in this Order, and not be present within 500 feet or (distance) of any protected persons wherever those protected persons may be found, or any place Respondent knows or should know the protected persons are likely to be, even with a protected person’s permission. If Respondent accidentally comes in contact with protected persons in any public or private place, Respondent must depart immediately. This Order includes encounters on public and private roads, highways, and thoroughfares. [NCIC 04] FORM 10.01-R: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) FULL HEARING Adopted: April 15, 2021 Case No.___________________________ 3. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named [Page 3 of 5 Form 10.01-R] in this Order or their residences, businesses, places of employment, schools, day care centers, or child care providers. Contact includes, but is not limited to, landline, cordless, cellular or digital telephone; text; instant messaging; fax; e-mail; voicemail; delivery service; social media; blogging; writings; electronic communications; posting a message; or communications by any other means directly or through another person. Respondent may not violate this Order even with the permission of a protected person. [NCIC 05] 4. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. 5. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY, COMPANION ANIMALS, OR PETS owned or possessed by the protected persons named in this Order. 6. PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS owned by Petitioner from the possession of Respondent: Exchange of the listed companion animals or pets shall take place as follows: 7. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this Order. 8. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON, at any time while this Order remains in effect in order to bring about a cessation of violence. Furthermore, Respondent may be subject to firearms and ammunition restrictions pursuant to 18 U.S.C. 922(g)(1) through (9), 18 U.S.C. 922(n), or R.C. 2923.13. [NCIC 07] RESPONDENT IS EXCEPTED only for official use pursuant to 18 U.S.C. 925(a)(1), if no other firearms and ammunition prohibitions apply. 9. RESPONDENT SHALL TURN OVER ALL DEADLY WEAPONS owned by Respondent or in Respondent’s possession to the law enforcement agency that serves Respondent with this Order no later than _ _____ or as follows: Any law enforcement agency is authorized to accept possession of deadly weapons pursuant to this paragraph and hold them in protective custody for the duration of this Order. [NCIC 07] Law enforcement shall immediately notify the Court upon receiving Respondent’s deadly weapons for protective custody as set forth in this Order. Upon the expiration or termination of this Order, Respondent may reclaim any deadly weapons held in protective custody by law enforcement pursuant to this Order unless Respondent is otherwise disqualified as verified by a check of the NCIC protection order file. 10. RESPONDENT’S CONCEALED CARRY WEAPON LICENSE, if any, is now subject to R.C. 2923.128. 11. RESPONDENT SHALL NOT USE OR POSSESS alcohol or illegal drugs. FORM 10.01-R: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) FULL HEARING Adopted: April 15, 2021 12. RESPONDENT SHALL COMPLETE THE FOLLOWING COUNSELING PROGRAM: [Page 4 of 5 Form 10.01-R] Case No.___________________________ Respondent shall contact this program within this Order and immediately arrange for an initial appointment. The counseling program is requested to provide the Court a written notice when Respondent attends the initial appointment, if Respondent fails to attend or is discharged, and when Respondent completes the program. Respondent is required to sign all necessary waivers to allow the Court to receive information from the counseling program. days after receiving 13. RESPONDENT IS ORDERED TO APPEAR before Judge or Magistrate on compliance with the terms of this Order. RESPONDENT IS WARNED: If you fail to attend the p.m. to review Respondent’s at a.m. / / counseling program, you may be held in contempt of court or the Court may issue a warrant for your arrest. 14. RESPONDENT SHALL NOT INTERFERE with wireless service transfer, prevent the functionality of a device on the network, or incur further contractual or financial obligations related to the transferred numbers. Wireless service rights to and billing responsibility for the wireless service number or numbers in use by Petitioner or any minor children in the care of Petitioner shall be transferred to Petitioner by separate order, Wireless Service Transfer Order (Form 10-E). 15. IT IS FURTHER ORDERED: [NCIC 08] 16. THE CLERK OF COURT SHALL CAUSE A COPY OF THIS ORDER to be served on Respondent as set forth in Civ.R. 5(B) and 65.1(C)(3). The Clerk of Court shall also provide certified copies of this Order to Petitioner upon request. 17. IF THE FULL HEARING PROCEEDING WAS REFERRED TO A MAGISTRATE, the Court has reviewed the magistrate’s granting of this Order and finds no error of law or other defect evident on the face of the Order as set forth in Civ.R. 65.1. Accordingly, the Court adopts the magistrate’s granting of the Order. 18. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER for filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. 19. THE COSTS OF THIS ACTION ARE assessed against Respondent waived. IT IS SO ORDERED. MAGISTRATE JUDGE FORM 10.01-R: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) FULL HEARING Adopted: April 15, 2021 [Page 5 of 5 Form 10.01-R] Case No.___________________________ NOTICE TO RESPONDENT NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERM OF THIS ORDER EVEN WITH THE PROTECTED PERSON’S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. NOTICE OF FINAL APPEALABLE ORDER Copies of this Order, which is a final appealable order, were served on or delivered to the parties indicated above pursuant to Civ.R. 5(B) and 65.1(C)(3), including ordinary mail, on day of , 20 By: CLERK OF COURT TO THE CLERK: A COPY OF THIS ORDER SHALL BE SERVED ON RESPONDENT PURSUANT TO CIV.R. 65.1(C)(3). COPIES OF THIS ORDER SHALL BE DELIVERED ON: Petitioner Petitioner’s Attorney Respondent’s Attorney Counseling Program: Sheriff’s Office Law Enforcement Agency Where Petitioner Resides: Law Enforcement Agency Where Petitioner Works: Other: FORM 10.01-R: DATING VIOLENCE CIVIL PROTECTION ORDER (DTCPO) FULL HEARING Adopted: April 15, 2021 FORM 10.01-S: CONSENT AGREEMENT AND DATING VIOLENCE CIVIL PROTECTION ORDER IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Case No. Per R.C. 3113.31(F)(3), this Order is indexed at Judge State OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - PHONE NUMBER PETITIONER: CONSENT AGREEMENT AND DATING VIOLENCE CIVIL PROTECTION ORDER (R.C. 3113.31) PERSON(S) PROTECTED BY THIS ORDER: Petitioner Petitioner’s Family or Household Members: ( Additional forms attached) DOB: First Middle Last v. RESPONDENT: First Middle Last Petitioner is or was in a dating relationship with Respondent within 12 months preceding the conduct resulting in this Order being requested. Address where Respondent can be found: DOB: DOB: DOB: DOB: RESPONDENT IDENTIFIERS SEX RACE HGT WGT EYES HAIR DOB DRIVER’S LIC. NO. / EXP. DATE / STATE Distinguishing Features: WARNING TO LAW ENFORCEMENT: RESPONDENT HAS FIREARMS ACCESS – PROCEED WITH CAUTION Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent was provided with reasonable notice and opportunity to be heard within the time required by Ohio law. Additional findings of this Order are set forth below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until / / (DATE CERTAIN – 5 YEARS MAXIMUM) WARNING TO RESPONDENT: See the warning page attached to the front of this Order. FORM 10.01-S: CONSENT AGREEMENT AND DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 2 of 5 Form 10.01-S] Case No.___________________________ This proceeding came on for a hearing on Ex Parte Order issued on / / / / before the Court and the . The following individuals were present: The parties agree to waive their notice and hearing rights. Petitioner is or was in a dating relationship with Respondent within 12 months preceding the conduct resulting in this Order being requested. The Court also finds: Additional findings on a separate page are included and attached herein. RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02] ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO RESPONDENT 1. RESPONDENT SHALL NOT ENTER or interfere with the residence, school, business, place of employment, day care centers, or child care providers of the protected persons named in this Order, including the buildings, grounds, and parking lots at those locations. Respondent may not violate this Order even with the permission of a protected person. [NCIC 04] 2. RESPONDENT SHALL STAY AWAY FROM ALL protected persons named in this Order, and not be present within 500 feet or (distance) of any protected persons wherever those protected persons may be found, or any place Respondent knows or should know the protected persons are likely to be, even with a protected person’s permission. If Respondent accidentally comes in contact with protected persons in any public or private place, Respondent must depart immediately. This Order includes encounters on public and private roads, highways, and thoroughfares. [NCIC 04] 3. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named FORM 10.01-S: CONSENT AGREEMENT AND DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 3 of 5 Form 10.01-S] Case No.___________________________ in this Order or their residences, businesses, places of employment, schools, day care centers, or child care providers. Contact includes, but is not limited to, landline, cordless, cellular or digital telephone; text; instant messaging; fax; e-mail; voicemail; delivery service; social media; blogging; writings; electronic communications; posting a message; or communications by any other means directly or through another person. Respondent may not violate this Order even with the permission of a protected person. [NCIC 05] 4. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. 5. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY, COMPANION ANIMALS, OR PETS owned or possessed by the protected persons named in this Order. 6. PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS owned by Petitioner from the possession of Respondent: Exchange of the listed companion animals or pets shall take place as follows: 7. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this Order. 8. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON at any time while this Order remains in effect in order to bring about a cessation of violence. Furthermore, Respondent may be subject to firearms and ammunition restrictions pursuant to 18 U.S.C. 922(g)(1) through (9), 18 U.S.C. 922(n), or R.C. 2923.13. [NCIC 07] RESPONDENT IS EXCEPTED only for official use pursuant to 18 U.S.C. 925(a)(1), if no other firearms and ammunition prohibitions apply. 9. RESPONDENT SHALL TURN OVER ALL DEADLY WEAPONS owned by Respondent or in Respondent’s possession to the law enforcement agency that serves Respondent with this Order no later than or as follows: Any law enforcement agency is authorized to accept possession of deadly weapons pursuant to this paragraph and hold them in protective custody for the duration of this Order. [NCIC 07] Law enforcement shall immediately notify the Court upon receiving Respondent’s deadly weapons for protective custody as set forth in this Order. Upon the expiration or termination of this Order, Respondent may reclaim any deadly weapons held in protective custody by law enforcement pursuant to this Order unless Respondent is otherwise disqualified as verified by a check of the NCIC protection order file. 10. RESPONDENT’S CONCEALED CARRY WEAPON LICENSE, if any, is now subject to R.C 2923.128. 11. RESPONDENT SHALL NOT USE OR POSSESS alcohol or illegal drugs. 12. RESPONDENT SHALL COMPLETE THE FOLLOWING COUNSELING PROGRAM: Respondent shall contact this program within this Order and immediately arrange for an initial appointment. The counseling program is requested to days after receiving FORM 10.01-S: CONSENT AGREEMENT AND DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 4 of 5 Form 10.01-S] Case No.___________________________ provide the Court a written notice when Respondent attends the initial appointment, if Respondent fails to attend or is discharged, and when Respondent completes the program. Respondent is required to sign all necessary waivers to allow the Court to receive information from the counseling program. 13. RESPONDENT IS ORDERED TO APPEAR before Judge or Magistrate on / / at a.m. p.m. to review Respondent’s compliance with the terms of this Order. RESPONDENT IS WARNED: If you fail to attend the counseling program, you may be held in contempt of court or the Court may issue a warrant for your arrest. 14. RESPONDENT SHALL NOT INTERFERE with wireless service transfer, prevent the functionality of a device on the network, or incur further contractual or financial obligations related to the transferred numbers. Wireless service rights to and billing responsibility for the wireless service number or numbers in use by Petitioner or any minor children in the care of Petitioner shall be transferred to Petitioner by separate order, Wireless Service Transfer Order (Form 10-E). 15. IT IS FURTHER ORDERED: [NCIC 08] 16. THE CLERK OF COURT SHALL CAUSE A COPY OF THIS ORDER to be served on Respondent as set forth in Civ.R. 5(B) and 65.1(C)(3). The Clerk of Court shall also provide certified copies of this Order to Petitioner upon request. 17. IF THE FULL HEARING PROCEEDING WAS REFERRED TO A MAGISTRATE, the Court has reviewed the magistrate’s granting of this Order and finds no error of law or other defect evident on the face of the Order as set forth in Civ.R. 65.1. Accordingly, the Court adopts the magistrate’s granting of the Order. 18. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER for filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. 19. THE COSTS OF THIS ACTION ARE assessed against Respondent waived. IT IS SO ORDERED. MAGISTRATE JUDGE NOTICE TO RESPONDENT NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERM OF THIS ORDER EVEN WITH THE PROTECTED PERSON’S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. FORM 10.01-S: CONSENT AGREEMENT AND DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 I have read this Consent Agreement and Civil Protection Order and agree to its terms. I have read this Consent Agreement and Civil Protection Order and agree to its terms. [Page 5 of 5 Form 10.01-S] Case No.___________________________ SIGNATURE OF PETITIONER SIGNATURE OF RESPONDENT Address of Petitioner (Safe Mailing Address) Address of Respondent Signature of Attorney for Petitioner Signature of Attorney for Respondent Address of Attorney for Petitioner Address of Attorney for Respondent NOTICE OF FINAL APPEALABLE ORDER Copies of this Order, which is a final appealable order, were served on or delivered to the parties indicated above pursuant to Civ.R. 5(B) and 65.1(C)(3), including ordinary mail, on day of , 20 By: CLERK OF COURT TO THE CLERK: A COPY OF THIS ORDER SHALL BE SERVED ON RESPONDENT PURSUANT TO CIV.R. 65.1(C)(3). COPIES OF THIS ORDER SHALL BE DELIVERED ON: Petitioner Petitioner’s Attorney Respondent’s Attorney Counseling Program: Sheriff’s Office Law Enforcement Agency Where Petitioner Resides: Law Enforcement Agency Where Petitioner Works: Other: FORM 10.01-S: CONSENT AGREEMENT AND DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 FORM 10.01-T: MODIFIED DATING VIOLENCE CIVIL PROTECTION ORDER IN THE COURT OF COMMON PLEAS COUNTY, OHIO Order of Protection Per R.C. 3113.31(F)(3), this Order is indexed at Case No. Judge State OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - PHONE NUMBER PETITIONER: MODIFIED DATING VIOLENCE CIVIL PROTECTION ORDER (R.C. 3113.31) PERSON(S) PROTECTED BY THIS ORDER: First Middle Last v. Petitioner: Petitioner’s Family or Household Members: ( Additional forms attached) DOB: DOB: DOB: DOB: DOB: RESPONDENT: RESPONDENT IDENTIFIERS SEX RACE HGT WGT EYES HAIR DRIVER’S LIC. NO. EXP. DATE DOB / / STATE First Middle Last Petitioner is or was in a dating relationship with Respondent within 12 months preceding the conduct resulting in this Order being requested. Address where Respondent can be found: Distinguishing Features: WARNING TO LAW ENFORCEMENT: RESPONDENT HAS FIREARMS ACCESS – PROCEED WITH CAUTION Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent will be provided with reasonable notice and opportunity to be heard within the time required by Ohio law. Additional findings of this Order are set forth below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until WARNING TO RESPONDENT: See the warning page attached to the front of this Order. / / (SHALL BE SAME EXPIRATION DATE AS IN CIVIL PROTECTION ORDER OR CONSENT AGREEMENT UNLESS EXTENDED BY SEPARATE ENTRY) FORM 10.01-T: MODIFIED DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 2 of 5 Form 10.01-T] Case No.___________________________ This proceeding came on for a hearing on presented and consideration of factors set forth in R.C. 31131.31(E)(8), the Court finds that the motion to modify the prior Dating Violence Civil Protection Order issued on is well taken. / / / / . Based on the evidence The Court also finds: Additional findings on a separate page are included and attached herein. RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02] ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO RESPONDENT 1. RESPONDENT SHALL NOT ENTER or interfere with the residence, school, business, place of employment, day care centers, or child care providers of the protected persons named in this Order, including the buildings, grounds, and parking lots at those locations. Respondent may not violate this Order even with the permission of a protected person. [NCIC 04] 2. RESPONDENT SHALL STAY AWAY FROM PETITIONER and all other protected persons named in this Order, and not be present within 500 feet or (distance) of any protected person wherever those protected persons may be found, or any place Respondent knows or should know the protected persons are likely to be, even with a protected person’s permission. If Respondent accidentally comes in contact with protected persons in any public or private place, Respondent must depart immediately. This Order includes encounters on public and private roads, highways, and thoroughfares. [NCIC 04] FORM 10.01-T: MODIFIED DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 3 of 5 Form 10.01-T] Case No.___________________________ 3. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named in this Order or their residences, businesses, places of employment, schools, day care centers, or child care providers. Contact includes, but is not limited to, landline, cordless, cellular, or digital telephone; text; instant messaging; fax; e-mail; voicemail; delivery service; social media; blogging; writings; electronic communications; posting a message; or communications by any other means directly or through another person. Respondent may not violate this Order even with the permission of a protected person. [NCIC 05] 4. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. 5. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY, COMPANION ANIMALS, OR PETS owned or possessed by the protected persons named in this Order. 6. PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS, owned by Petitioner, from the possession of Respondent: Exchange of the listed companion animals or pets shall take place as follows: 7. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this Order. 8. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON, at any time while this Order remains in effect in order to bring about a cessation of violence. Furthermore, Respondent may be subject to firearms and ammunition restrictions pursuant to 18 U.S.C. 922(g)(1) through (9), 18 U.S.C. 922(n), or R.C. 2923.13. [NCIC 07] RESPONDENT IS EXCEPTED only for official use pursuant to 18 U.S.C. 925(a)(1), if no other firearms and ammunition prohibitions apply. 9. RESPONDENT SHALL TURN OVER ALL DEADLY WEAPONS owned by Respondent or in Respondent’s possession to the law enforcement agency that serves Respondent with this Order no later than or as follows: Any law enforcement agency is authorized to accept possession of deadly weapons pursuant to this paragraph and hold them in protective custody for the duration of this Order. [NCIC 07] Law enforcement shall immediately notify the Court upon receiving Respondent’s deadly weapons for protective custody as set forth in this Order. Upon the expiration or termination of this Order, Respondent may reclaim any deadly weapons held in protective custody by law enforcement pursuant to this Order unless Respondent is otherwise disqualified as verified by a check of the NCIC protection order file. 10. RESPONDENT’S CONCEALED CARRY WEAPON LICENSE, if any, is now subject to R.C. 2923.128. 11. RESPONDENT SHALL NOT USE OR POSSESS alcohol or illegal drugs. FORM 10.01-T: MODIFIED DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 4 of 5 Form 10.01-T] Case No.___________________________ 12. RESPONDENT SHALL COMPLETE THE FOLLOWING COUNSELING PROGRAM: Respondent shall contact this program within immediately arrange for an initial appointment. The counseling program is requested to provide the Court a written notice when Respondent attends the initial appointment, if the Respondent fails to attend or is discharged, and when Respondent completes the program. Respondent is required to sign all necessary waivers to allow the Court to receive information from the counseling program. days after receiving this Order and 13. Respondent is ordered to appear before Judge or Magistrate on Respondent’s compliance with this counseling order. Respondent is warned: If you fail to a.m. p.m. to review at / / attend the counseling program you may be held in contempt or the Court may issue a warrant for your arrest. 14. RESPONDENT SHALL NOT INTERFERE with wireless service transfer, prevent the functionality of a device on the network, or incur further contractual or financial obligations related to the transferred numbers. Wireless service rights to and billing responsibility for the wireless service number or numbers in use by Petitioner or any minor children in the care of Petitioner shall be transferred to Petitioner by separate order, Wireless Service Transfer Order (Form 10-E). 15. IT IS FURTHER ORDERED: [NCIC 08] 16. THE CLERK OF COURT SHALL CAUSE A COPY of this Order to be served on Respondent as set forth in Civ.R. 5(B) and 65.1(C)(4)(b). The Clerk of Court shall also provide certified copies of the Petition and this Order to Petitioner upon request. 17. IF THE FULL HEARING PROCEEDING WAS REFERRED TO A MAGISTRATE, the Court has reviewed the magistrate’s granting of this Order and finds no error of law or other defect evident on the face of the as set forth in Civ.R. 65.1 Order. Accordingly, the Court adopts the magistrate’s granting of the Order. 18. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER for filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. 19. THE COSTS OF THIS ACTION ARE assessed against Respondent waived. IT IS SO ORDERED. MAGISTRATE JUDGE FORM 10.01-T: MODIFIED DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021 [Page 5 of 5 Form 10.01-T] Case No.___________________________ NOTICE TO RESPONDENT NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERMS OF THIS ORDER, EVEN WITH THE PROTECTED PERSON’S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. NOTICE OF FINAL APPEALABLE ORDER Copies of this Order, which is a final appealable order, were served on or delivered to the parties indicated above pursuant to Civ.R. 65.1(C)(4)(b), including ordinary mail, on day of , 20 By: CLERK OF COURT TO THE CLERK: A COPY OF THIS ORDER SHALL BE SERVED ON RESPONDENT PURSUANT TO CIV.R. 65.1(C)(4). COPIES OF THIS ORDER SHALL BE DELIVERED ON: Petitioner Petitioner’s Attorney Respondent’s Attorney Counseling Program: Sheriff’s Office Law Enforcement Agency Where Petitioner Resides: Law Enforcement Agency Where Petitioner Works: Other: FORM 10.01-T: MODIFIED DATING VIOLENCE CIVIL PROTECTION ORDER Adopted: April 15, 2021