Filing For Foreign Protective Order {DC-684}

FILING OF FOREIGN PROTECTIVE ORDER Commonwealth of Virginia VA. CODE §§ 16.1-279.1, 19.2-152.10 Case No. ...................................................................................... .......................................................................................................................................................................................................................................................... Court Name of Party Filing Foreign Protective Order: Virginia Address of Party Filing Order: ................................................................................................................................................................ ................................................................................................................................................................................. .......................................................................................................................................................................... Name of Person(s) Protected by the Order: Name of Defendant/Respondent: ................................................................................................................................................................................................ Issuing Jurisdiction: ........................................................................................................................................................................................................................... STATE COUNTY OR CITY Name of Court which issued Order: ........................................................................................ Case No. ........................................................................ ..................................................................... Date of Entry: .................................................................................................... Expiration Date (if any): _____________________________________________________________ SIGNATURE OF PARTY FILING ORDER Defendant/Respondent's Description (for VCIN entry): Full Name: ................................................................................................................................................................................................................................................................................ Address: ..................................................................................................................................................................................................................................................................................... COMPLETE DATA BELOW IF KNOWN Telephone No. ............................................................................................. RACE SEX MO. SSN BORN DAY YR. FT. HT. IN. WGT. EYES HAIR CLERK'S CERTIFICATION An attested or exemplified copy of the above-identified foreign protective order has been filed with this Court. ...................................................................... DATE _____________________________________________________________ [ ] CLERK [ ] DEPUTY CLERK FORM DC-684 MASTER 10/15 American LegalNet, Inc. www.FormsWorkFlow.com