Child Protective Order

______________________________ Petitioner's Name ______________________________ Address (may be omitted for privacy) ______________________________ City, State, ZIP ______________________________ Telephone (may be omitted) IN THE _____________________DISTRICT JUVENILE COURT _____________________ COUNTY, STATE OF UTAH ____________________________, Petitioner, vs. ____________________________, Respondent. ) ) ) ) ) ) ) ) ) CHILD PROTECTIVE ORDER Case No. Judge NOTICE TO RESPONDENT: YOU CAN BE ARRESTED FOR VIOLATING THIS ORDER EVEN IF ANY PERSON PROTECTED BY THE ORDER INVITES OR ALLOWS YOU TO VIOLATE THE ORDER'S PROHIBITIONS. ONLY THE COURT CAN CHANGE THE ORDER. YOU MAY BE HELD IN CONTEMPT FOR IGNORING OR ALTERING THE TERMS OF THE ORDER. This matter came for hearing on ___________________. The following parties were in attendance: 9 9 9 Petitioner Respondent 9 9 Petitioner's attorney ____________________________ Respondent's attorney __________________________ Guardian ad Litem __________________________ 1 Form Approved February 10, 2012 Board of Juvenile Court Judges American LegalNet, Inc. www.FormsWorkFlow.com The Court has reviewed Petitioner's Verified Petition for Child Protective Order and: ___ has received argument and evidence ___ has accepted the stipulation of the parties ___ has entered the default of the Respondent for failure to appear ___the Court finds that the above-named minor has been or is in imminent danger of being physically or sexually abused, therefore THE PETITIONER IS GRANTED A CHILD PROTECTIVE ORDER PURSUANT TO UTAH CODE SECTION 78B-7-204: (The Judge or Commissioner shall initial each section that is included in this Order.) _____ 1. The Respondent is restrained from attempting, committing, or threatening to commit abuse against the following children, and shall not stalk, harass, or threaten to use or attempt to use physical force that would reasonably be expected to cause physical injury to the child/ren: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _____ 2. The Respondent is prohibited from harassing, telephoning, contacting, or otherwise communicating with the minor child/ren, directly or indirectly: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 2 Form Approved February 10, 2012 Board of Juvenile Court Judges American LegalNet, Inc. www.FormsWorkFlow.com _____ 3. The Respondent shall be excluded and is ordered to stay away from the residence and its premises located at: ___________________________ and any known subsequent residence of the minor child/ren, and Respondent is prohibited from terminating or interfering with the utility services to the residence. _____ 4. The Respondent is ordered to stay away from the school, place of employment, and/or other places, and their premises, frequented by the minor child/ren. This includes any known subsequent school, place of employment, and/or other places frequented by the minor child/ren. The current addresses include: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _____ 5. The Court finds that Respondent's use or possession of a weapon may pose a serious threat of harm to minor child/ren, the Respondent is prohibited from purchasing, using, or possessing a firearm or any of the following weapons: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 3 Form Approved February 10, 2012 Board of Juvenile Court Judges American LegalNet, Inc. www.FormsWorkFlow.com _____ 6. effects: The minor child/ren are awarded possession of the following essential personal ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ This award is subject to subsequent orders concerning the listed property in future proceedings. 7. Law enforcement agencies with jurisdiction over the protected locations are hereby directed and authorized to render any necessary assistance to the above-named petitioner in retrieving the child/ren named in this Protective Order and give physical custody of said child/ren_______________________________________________________________________ _______ ______________________________________________________ to the petitioner. Such action includes, but is not limited to, obtaining access to the child/ren through locked doors and gates and restraining any persons who may attempt to prevent the removal of said child/ren. 4 Form Approved February 10, 2012 Board of Juvenile Court Judges American LegalNet, Inc. www.FormsWorkFlow.com 8. Law enforcement agenci