Judge Hours Minutes CIRCUIT COURT Loced DISTRICT COURT OF MARYLAND FOR Court Address Telephone No Case No TEMPORARY PROTECTIVE ORDER PETITIONER City/County MD First Middle Last and any minor(s) or vulnerable adult(s) on whose behalf the Petition was filed (List names and de(s) of birth) of Birth OTHER(S) TO BE PROTECTED: VS RESPONDENT RESPONDENT IDENTIFIERS Relionship to Petitioner Spouse Former Spouse Cohabitant Children in Common Other relionship Parent SEX RACE HT WT EYES HAIR DISTINGUISHING FEATURES Address City, Ste, Zip CAUTION: Weapon Involved Type: Access to Firearm(s) Telephone THE COURT FINDS th under the laws of Maryland the issuing Court has jurisdiction over the parties and the subject mter THE COURT ORDERS: Th the above named Respondent SHALL NOT abuse, threen to abuse, and/or harass the Petitioner and Others to be Protected Th the above named Respondent SHALL NOT contact the Protected Parties by any means Additional terms of the Order are as set forth in this document The terms of this Order shall be effective through Month/Day/Year VEHICLE DESCRIPTION EMPLOYER TAG NO If the Court is closed unexpectedly on the expirion de, this Order will remain in effect until the second day the Court is open The Final Protective Order hearing will be held Only the Court can change this Order NOTICE TO PETITIONER If a protective order has been issued, you can register to receive notificion of when the order has been served by registering with VINE Protective Order (VPO), a free automed service To register with VPO and access protective order informion, call 1-877-846-3420 or visit wwwregistervpocom NOTICE TO RESPONDENT: PENALTIES A violion of a Temporary Protective Order is a crime and law enforcement shall arrest the Respondent, with or without a warrant, and take the Respondent into custody if the officer has probable cause to believe th the Respondent has violed any provision of the Interim, Temporary, or Final Protective Order Violion of this Order may result in criminal prosecution, imprisonment or fine or both, or a finding of contempt This Protective Order shall be recognized and enforced by the courts of any ste, the District of Columbia, any US Territory, tribal lands (18 USC 2265) or Department of Defense installions (10 USC 1561a) Crossing ste, territorial or tribal boundaries to viole this Order may result in federal imprisonment (18 USC 2262) Federal law provides penalties of up to $250,000 fine and 10 years in prison for possessing, transporting, shipping, or receiving any firearm or ammunition while subject to a protective order or after being convicted of a misdemeanor crime of domestic violence (18 USC 922(g)(8) and (9)) or knowingly transferring a firearm after a conviction of a misdemeanor crime of domestic violence (18 USC 922(d)(9)) Questions regarding this notice should be directed to your torney, law enforcement agency, or the Maryland Ste Police Licensing Division 410-653-4500 CC-DC-DV-002 (Rev 10/2017) Page 1 of 5
After the appearance of the Petitioner Petitioner's Counsel Respondent Respondent's Counsel, and in considerion of the Petition and evidence, the Court makes the following findings: A, who is a person(s) eligible for relief, is: The current spouse of the Respondent A former spouse of the Respondent A cohabitant with the Respondent An individual reled to the Respondent by blood, marriage, or adoption Relionship A parent, stepparent, child or stepchild of the Respondent or a person eligible for relief who resides or resided with the Respondent or person(s) eligible for relief for least 90 days within one (1) year before the filing of the Petition A vulnerable adult An individual who has a child(ren) in common with the Respondent No of Children: Ages: An individual who has had a sexual relionship with the Respondent within one (1) year before the filing of the Petition B The Petitioner is: The person eligible for relief In the case of a vulnerable adult or minor child: A Ste's Attorney A local department of social services A relive An adult residing in the home C The Respondent consents to the entry of a Temporary Protective Order without admitting the allegions in the Petition or a judicial finding of abuse OR There are reasonable grounds to believe th the Respondent committed the following act(s) of abuse: Caused serious bodily harm Placed person(s) eligible for relief in fear of imminent serious bodily harm Assault in any degree Rape or a stutory sexual offense (or tempt) in any degree False Imprisonment Stalking Stutory abuse of a child ( Physical Sexual Mental) forward to DSS for investigion Stutory abuse of a vulnerable adult on Description of Harm: Case No D E AND There are reasonable grounds to believe th the above abuse(s) consisted of Respondent's use of a firearm against, thre to use a firearm against, causing serious bodily harm to, or threening to cause serious bodily harm to, a person or persons eligible for relief Weapon(s) involved, type: The Respondent has access to firearm(s) The Court lawfully can order Respondent to vace the home immediely, and award temporary use and possession of the home to the person eligible for relief (or, in the case of alleged abuse of a child or vulnerable adult, award temporary use and possession of the home to an adult living in the home), because the person eligible for relief and the Respondent resided together the time of the abuse and: Are married, or Are not married, but the name of the person eligible for relief appears on the lease or deed to the home, or Are not married, but the person eligible for relief has shared the home with the Respondent for a period of least 90 days within one (1) year before the filing of the Petition CC-DC-DV-002 (Rev 10/2017) Page 2 of 5
Case No Based on the foregoing, the Court hereby ORDERS: 1 The Respondent SHALL NOT abuse or threen to abuse 2 The Respondent SHALL NOT contact, tempt to contact, or harass (in person, by telephone, in writing, or by any other means) 3 The Respondent SHALL NOT enter the residence of (Residence includes yard, grounds, outbuildings, and common areas surrounding the dwelling) An undisclosed locion for reasons of safety 4 Respondent SHALL STAY AWAY from: (1) School: (2) School: (3) School: An undisclosed school of for reasons of safety (1) Childcare provider: while is in the care of the childcare provider (2) Childcare provider: while is in the care of the childcare provider An undisclosed childcare provider for reasons of safety while is in the care of the child care provider (1) Place of employment: (2) Place of employment: An undisclosed place of employment of (1) Temporary residence of (2) Temporary residence of An undisclosed temporary residence of The home of another family member, for reasons of safety for reasons of safety An undisclosed home of another family member, Locion is withheld for reasons of safety 5 The Respondent SHALL VACATE the home immediely (home includes yard, grounds, outbuildings, and common areas surrounding the dwelling) and remain away until the hearing provided for below (In Paragraph 9 and in any new hearing de set on extension of order) Temporary use and possession of the home is granted to The Respondent, accompanied by a law enforcement officer, may return to collect clothing and personal necessities, only between the hours of and on or as directed by local law enforcement 6 Custody of is awarded to until the Final Protective Order hearing Custody shall remain joint Law enforcement officers are ordered to use all reasonable and necessary force to return the minor child(ren) to the custodial parent after service of this Order CC-DC-DV-002 (Rev 10/2017) Page 3 of 5
Case No 7 The Respondent SHALL immediely surrender all firearm(s) to law enforcement agency and refrain from possession of any firearm, for the durion of this Order 8 Temporary possession of the pet(s) and Description is awarded to 9 A FINAL PROTECTIVE ORDER HEARING SHALL BE HELD ON, AM/PM AT Court Address NOTICE TO ALL PARTIES: Please bring all photos, documents and other evidence th you may have with you to court on your hearing de This Order supersedes and overrides any previously entered Interim Protective Order issued by a Commissioner, Judge ID Number This Order is extended for not more than 6 months until: Print New Hearing Judge ID Number New Hearing Judge ID Number New Hearing Judge ID Number NOTICE TO RESPONDENT A Petition for Protection alleges th you have committed abuse Based on the Petition and on any testimony provided the initial hearing, the Court has issued this Temporary Protective Order Violion of this Order may be a ste and/or federal crime or contempt of court, or both, and result in imprisonment or fine or both This Order may be enforced by another ste or jurisdiction, which may impose additional or different penalties for the violion In order to respond to the allegion th abuse occurred, you must appear in court the Final Protective Order hearing provided for in this Order If the hearing the Court finds by a preponderance of the evidence th you committed the alleged abuse, the Court will issue a Final Protective Order against you, even if you fail to appear The Court may Order any or all of the following: th you not abuse, threen to abuse, contact, tempt to contact, harass, and/or enter the residence of someone; th you stay away from someone's workplace, school, temporary residence, home, or child care provider; use and possession of your home, and/or jointly owned vehicle; awarding an award of temporary custody and/or visition of a child; an award of Emergency Family Maintenance; th you surrender all firearm(s) to a law enforcement agency and refrain from possession of any firearm for the durion of the Order; th you pay filing fees and costs; an award of temporary possession of a pet; th you and/or the person(s) eligible for relief participe in counseling and/or a domestic violence program; any other relief th the judge determines is necessary to protect a person eligible for relief from abuse Durion of the final protective order: Generally, a Final Protective Order may be in effect for as long as one (1) year Additionally: The Court for good cause may extend the term of the Final Protective Order for an additional six (6) months after a further hearing A Final Protective Order may be granted for a period not to exceed two (2) years, if a judge finds the Respondent has committed a subsequent act of abuse against a person eligible for relief within one (1) year after the de th a prior Final Protective Order issued against the same Respondent on behalf of the same person eligible for relief expires or by consent of the Respondent within one (1) year after the de th a prior Final Protective Order issued against the same Respondent on behalf of the same person eligible for relief expires, and the prior Final Protective Order was issued for a period of least six (6) months The Court shall issue a permanent Final Protective Order if requested by the person eligible for relief in the original protective order against an individual who was a Respondent in a previously issued Final Protective Order and th Respondent, for the same act of abuse th led to the issuance of the original final protective order, was convicted and sentenced to serve a term of imprisonment of least five (5) years for specified violions of the Criminal Law Article for the act of abuse th led to the issuance of the Final Protective Order and the Respondent has served least 12 months of the sentence The Court shall issue a permanent Final Protective Order if requested by the person eligible for relief in the original protective order against an individual who was a Respondent in a previously issued Final Protective Order and th Respondent, was convicted and sentenced for conspiracy or solicition to commit murder and the Respondent has served least 12 months of the sentence If you fail to appear in Court and a Final Protective Order is issued, you may be served by first-class mail your last known address with the Final Protective Order and all other notices concerning the Final Protective Order The Final Protective Order will be valid and enforceable upon mailing You must notify the Court in writing of any change of address Ste law requires the Respondent to surrender all firearms to a law enforcement agency if a Final Protective Order is issued CC-DC-DV-002 (Rev 10/2017) Page 4 of 5
NOTICE TO ALL PARTIES Hearing des and places are subject to change, and you should call the Court Clerk's Office to be sure you know when your hearing(s) will occur You are responsible for knowing Telephone Number Case No when and where hearings will occur Each party may be represented by an torney You are not required to have an torney At the Final Protective Order hearing, the Petitioner will be required to prove the alleged facts by a preponderance of the evidence, whether or not you are represented by an torney The Rules of Evidence apply to your hearing, whether or not you are represented by an torney If you are a party and cannot afford a prive torney, there are agencies th may be able to help you At the Final Protective Order hearing, the Court may order the Respondent to pay Emergency Family Maintenance and may enter an immedie and continuing withholding order for th purpose If Emergency Family Maintenance is requested, both parties should complete a Financial Stement (CC-DC-DV-004) before the Protective Order hearing and bring it to court You should also bring documents (such as pay stubs, copy of your lease, bills, etc) to support the figures you supply To request a foreign language interpreter or a reasonable accommodion under the Americans with Disabilities Act, please contact the Court immediely Possession and use of cell phones and other electronic devices may be limited or prohibited in designed areas of the court facility If the Court is closed unexpectedly on the expirion de, this Order will remain in effect until the second day the Court is open The Final Protective Order hearing will be held TRUE COPY CERTIFICATION OF TEMPORARY PROTECTIVE ORDER Attestion of Clerk I,, Clerk of the Court in City/County, Ste of Maryland, do hereby certify th this Order is a true and correct copy of the original In testimony whereof, I have hereunto set my hand and affixed the Seal of said Court Maryland, this day of Clerk Attestion of Judge I,, Judge of the Court in City/County, Ste of Maryland, do hereby certify th, whose name is subscribed to the foregoing certifice of testion, now is, and/or was the time of signing and sealing the same, a Clerk of this Court in City/County and th his/her testion is in due form of law Court: Address: Phone: Judge Fax: ID Number CC-DC-DV-002 (Rev 10/2017) Page 5 of 5