Extended Order for Protection, Domestic Violence - Passport Cover Sheet ©2010 Nevada Supreme Court
Extended Order for Protection
Domestic Violence
Nevada Revised Statute 33.017 et seq.
Passport Cover Sheet
Case No. ________________________________
Dept. No. ________________________________
Court ___________________________________
County __________________________________
APPLICANT
First Middle Last
And/or on behalf of the following persons (list name(s) and age(s)):
___________________________________ _______________
Name Age
___________________________________ _______________
Name Age
___________________________________ _______________
Name Age
VS.
ADVERSE PARTY
First Middle Last
Adverse Party’s Home Address and Phone Number:
__________________________________________________
CAUTION: ACCESS TO WEAPONS OTHER: ______________________________
THE COURT HEREBY FINDS:
That it has jurisdiction over the parties and subject matter, and the Adverse Party received reasonable notice of the hearing
at which such person had an opportunity to participate and be heard.
THE COURT HEREBY ORDERS:
That the Adverse Party be prohibited from committing further unlawful acts of domestic violence as defined in NRS
33.018. Additional terms of this order are as set forth on the following pages.
The terms of this order shall expire at 11:59 p.m. on
unless otherwise ordered by the Court.
This Order may meet the Full Faith and Credit provisions of the Violence Against Women Act and may be enforceable in all 50 states, the District of
Columbia, U.S. Territories and Indian Nations. All other courts and law enforcement with jurisdiction within the United States and all Indian
Nations may give full faith and credit to this Order pursuant to 18 U.S.C. Sec. 2265. Violation of the Order may subject you to federal charges and
punishment pursuant to 18.U.S.C. Sec. 2261(a)(1) and (2) and 2262(a)(1) and (2).
