Petition For Temporary Restraining Order To Prevent Interference {23.6}

PROBATE COURT OF BUTLER COUNTY, OHIO RANDY T. ROGERS, JUDGE IN THE MATTER OF: CASE NO. PETITION FOR TEMPORARY RESTRAINING ORDER TO PREVENT INTERFERENCE WITH THE PROVISION OF PROTECTIVE SERVICES TO AN ADULT [R.C. 5101.68] , AN ADULT 1. The above-named Adult is in need of protective services for the following reasons: 2. 3. The Adult has consented to the protective services. The Respondent (Name and Address): has interfered with the provision of these services in the following manner: 4. Unless Respondent is restrained, Petitioner will be unable to provide protective services in accordance with Chapter 5101. Of the Revised Code. WHEREFORE, the Petitioner requests the Court to issue an order restraining Respondent from interfering with the provision of protective services to the Adult and such further relief as may be equitable. Butler County Department of Job & Fam ily Services By: Attorney Address Title Address Phone Number (including area code) Registration No. Phone Number (including area code) E-mail E-mail FORM 23.6 - PETITION FOR TEMPORARY RESTRAINING ORDER TO PREVENT INTERFERENCE WITH THE PROVISION OF PROTECTIVE SERVICES TO AN ADULT Eff. Date: January 1, 2010 American LegalNet, Inc. www.FormsWorkFlow.com