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Last updated: 9/13/2018
Modified Protective Order
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Description
Modified Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 1 of 7 Modified Protective Order Case Number: District: County: State: Utah Judge: Petitioner (protected person): Commissioner: Fi rst Name Middle Last Address and phone # (to keep private, leave blank): Other people protected by this order Street Name (Initials only if under 18) Age Relationship to Petitioner City --- State --- Zip Phone # of birth: Respondent Describe Respondent (person Petitioner is protected from): Sex Race Date of Birth Ht. Wt. First Name Middle Last Other Names Used Eyes Hair Social Security # (only the last 4 numbers) Relationship to Petitioner: Address (street): Distinguishing features (like scars, tattoos, limp, etc.) City --- State --- Zip (State): Expires: Phone Number: Warning! [] Weapon involved (Box to be initialed by Court, if applicable) There was a hearing on (date): . The Respondent was given notice and an opportunity to be heard in the hearing that gave rise to this order. The following people were present at the hearing: [] Petitioner [] Pet(name): [] Respondent (name): [] Other (name) American LegalNet, Inc. www.FormsWorkFlow.com Modified Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 2 of 7 The Court reviewed the Request for Modified Protective Order, has received argument and evidence, and finds the original protective order listed immediately below should be modified. The Court orders the Respondent to obey all orders initialed on this form and to not abuse or threaten to abuse anyone protected by this order. O rders 1 - 6 expire (date) Warnings: This is a court order. No one except the court can change it. If you do not obey this order, you can be arrested, fined, and face other charges. This order is valid in all U.S. states and territories, the District of Columbia, and tribal lands. If you go to another U.S. state, territory or tribal land to violate this order, a federal judge can send you to prison. No guns or firearms! (See page 3, item 5.) Violence Against Women Act of 1994, 18 U.S.C. Sec. 2265, 2262, 18 U.S.C. 922(g)(8) The Respondent must obey all orders initialed by the judicial officer. If you do not obey orders 1 6 below, the court can send you to jail for up to 1 year and order you to pay a fine. A second or subsequent violation can result in more severe penalties. 1 [] Personal Conduct Order -- Do not commit, try to commit or threaten to commit any form of violence against the Petitioner or any person listed on the first page of this form. This includes stalking, harassing, threatening, physically hurting, or causing any other form of abuse. 2 [] No Contact Order -- Do not contact, phone, mail, e-mail, or communicate in any way with the Petitioner and the people listed on the first page of this order either directly or indirectly except as allowed by the parent-time provisions of this order. 3 [] Contact during Mediation -- You are allowed to have contact with the Petitioner only during mediation sessions for your divorce or custody case that are scheduled with a Court Qualified Mediator. 4 [] Stay Away Order [ ] a. Stay at least (distance) from the Petitioner. [ ] b. Stay away from Petitioner's Home: (address) Work : (address) School: (address) Place of worship: (address) [ ] c. Must comply with the following restrictions while at Respondent's and Petitioner's American LegalNet, Inc. www.FormsWorkFlow.com Modified Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 3 of 7 Work : (address) School: (address) Place of worship: (address) [ ] d. Stay away from the people listed on the first page of this form at their: Home: (address) Work : (address) The respondent [ ] does [ ] does not work at the same place as the people listed on the first page of this form. School: (address) The respondent [ ] does [ ] does not go to the same school as the people listed on the first page of this form. Place of worship: (address) The respondent [ ] does [ ] does not attend the same place of worship as the people listed on the first page of this form. [ ] e. Must comply with the following restrictions while at Respondent's and the people listed on the first page of this form's: Work : (address) School: (address) Place of worship: (address) [] f. Other (specify): American LegalNet, Inc. www.FormsWorkFlow.com Modified Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 4 of 7 5 [] No Guns or Other Weapons -- The Court finds that your use or possession of a weapon poses a serious threat of harm to the Petitioner. You cannot possess, have, or buy a gun or firearm or any of these weapons: Warning! If a final protective order is issued against you after the hearing, you will then become subject to the federal law making it a crime to possess, transport, ship or receive any firearm or ammunition, including a hunting weapon. 6 [] Property Orders -- Until further court order, Only the Petitioner can use, control and possess the following property and things, but cannot dispose of this property without court approval: [] a. Home at (address): [] b. Car, truck or other property (describe): You must obey orders 7 13 initialed by the judge. If you do not, you will be in contempt of court and may be punished. These orders will [] expire [] be reviewed by the court in days. 7 [] Property Orders [ ] You cannot interfere with or change Petitioner's phone, utility or other services. [ ] You must maintain Petitioner's existing wireless phone contracts or accounts. 8 [] Transfer Wireless Phone Number(s) You must transfer the Petitioner's current wireless phone number(s) to a new account of their choice. The court will issue a separate order to the wireless service provider to transfer Petitioner's wireless phone number(s) to a new account. 9 [] Child Custody & Parent-time Orders [ ] The Petitioner (the person asking for protection) [ ] (name) will have temporary custody of the minor children of the parties listed below. The person with custody may give a copy daycare. If you do not obey the custody and parent-time orders listed here, the person with custody You will have parent-time as follows: American LegalNet, Inc. www.FormsWorkFlow.com Modified Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 5 of 7 or person with custody only about parent-time matters through: 10 [] No Alcohol or Illegal Drugs -- Do not use alcohol or illegal drugs before or during visitation. 11 [] No Travel with Children -- Do not take the children listed above out of Utah. 12 [] Child Support, Spousal Support and other Expenses -- The Respondent will: [] a. Pay $ / month in child support. [] b. (Utah Code 62A-11, Parts 4 and 5) [] c. Pay $ / month in spousal support. [] d. Pay 50% of the minor chi [] e. Pay deductibles and co-payments. [] f. Pay abuse and $ for the 13 [] Other Assistance Needed (List below any other orders needed to protect you and other protected people listed on page 1 of this form): Orders to Agencies 14 [] Law Enforcement to Assist A law enforcement officer from: will enforce the orders checked below: [] a. Help the Petitioner gain and keep control over home, car or other personal belongings. [] b. Help the Petitioner obtain custody of the children. [] c. Help the [] Respondent or [] Petitioner remove essential personal belongings from the home. a job or go to school. Warning to the Respondent: Do not go into the home or other protected places without the officer.. Law enforcement can evict you or keep you away from protected places, if needed. American LegalNet, Inc. www.FormsWorkFlow.com Modified Protective Order Approved Board of District Court Judges May 21, 2008 Revised May 8, 2018 Page 6 of 7 15 [] Investigate Possible Child Abuse -- This matter will be referred to the Division of Child and Family Services for review and possible investigation of child abuse. NOTICE TO PETITIONER: The court may amend or dismiss a protective order after one year if it finds that the basis for the issuance of the protective order no longer exists and the peti