Fillable CC 376, Personal Protection Order ( Domestic Relationship) (Little River Band of Ottawa Indians Tribal Government)

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CC 376, Personal Protection Order ( Domestic Relationship) (Little River Band of Ottawa Indians Tribal Government)

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PERSONAL PROTECTION ORDER
(DOMESTIC RELATIONSHIP)
Use this form if you filled out the Petition for Personal Protection Order.
INSTRUCTIONS FOR COMPLETING "PERSONAL PROTECTION ORDER"
Please print neatly.
Items A through D must be completed before you give this form to the court clerk. Please read the instructions for
each item.
Then fill in the correct information for that item on the form.
A
If you checked box
G
on form on the petition, check the box "Ex Parte."
B
Fill in the “Case No.” that was on the petition.
C
Fill in the “petitioner” information the same way you did on the Petition. If you want your address and
telephone number to be kept from the respondent, do not write your address here. Put in the address
of a relative or friend or a post office box where the court can contact you.
D
Write in the respondent’s information and as much of the other information as you know. This information will
help the police to identify the respondent if he or she disobeys the restraining order. Be sure to identify the
respondent accurately. The race, sex, and date of birth are required for law enforcement to enter an
order on the Law Enforcement Information Network (LEIN).
The court will complete the rest of this form.
Important:
If the respondent violates this personal protection order and is arrested, the court will set a date, time, and place for
a hearing on the charges against the respondent to be held within 72 hours after arrest. The court or prosecutor
is responsible for giving you notice of this hearing. If you are not notified within 24 hours of the arrest, contact the
judge who signed this order. If a hearing is not held within 72 hours, the respondent may be released from jail after
posting bond pending the hearing.
If the respondent violates this personal protection order and there is no arrest, use the form Motion and Order to
Show Cause for Violating Personal Protection Order. This form is available from the court clerk.
LITTLE RIVER BAND OF
OTTAWA INDIANS
TRIBAL COURT
PERSONAL PROTECTION ORDER
EX PARTE
(DOMESTIC RELATIONSHIP)
CASE NO.
Court telephone no.Court address
ORI
MI-
A B
3rd copy - Petitioner
4th copy - Return
Original - Court
1st copy - Law enforcement
2nd copy - Respondent
Date: Judge:
Bar no.
1. This order is entered without a hearing. **after hearing.
THE COURT FINDS:
2. A petition requested respondent be prohibited from entry onto the premises, and either the parties are married, petitioner
has a property interest in the premises, or respondent does not have a property interest in the premises.
3. Petitioner requested an ex parte order, which should be entered without notice because irreparable injury, loss, or damage
will result from the delay required to give notice or notice itself will precipitate adverse action before the order can be issued.
** 4. Respondent poses a credible threat to the physical safety of petitioner and/or a child of petitioner.
5. Respondent **is the spouse or former spouse of petitioner, had a child in common with petitioner, or is
residing or had resided in the same household as petitioner. has or had a dating relationship with petitioner.
IT IS ORDERED:
6.
Name
is prohibited from:
a. entering onto property where petitioner lives.
b. entering onto property at .
** c. assaulting, attacking, beating, molesting, or wounding
Name
.
d. removing minor children from petitioner who has legal custody, except as allowed by custody or parenting-time order
provided removal of the children does not violate other conditions of this order. An existing custody order is dated
.
**
. An existing parenting-time order is dated
e. stalking as defined under Ordinance # 11-400-03 Sec. 8.03 that includes but is
notlimited to:
following petitioner or appearing within his/her sight. appearing at petitioner’s workplace or residence.
sending mail or other communications to petitioner. contacting petitioner by telephone.
approaching or confronting petitioner in a public place or on private property.
entering onto or remaining on property owned, leased, or occupied by petitioner.
placing an object on or delivering an object to property owned, leased, or occupied by petitioner.
(SEE OTHER PAGE) PERSONAL PROTECTION ORDER (Domestic Relationship)
Petitioner’s name
v
Respondent’s name, address, telephone no., and driver’s license no.
Address and telephone no. where court can reach petitioner
Height Weight Race* Sex* Date of birth or age* Hair color Eye color Other identifying information
*These items must
belledinforthepolice/sherifftoenteronLEIN;theotheritemsarenotrequiredbutarehelpful. **NeededforNCICentry
C
D
D
3031 Domres Road, Manistee Michigan 49660
(231) 398-3406
Personal Protection Order
of Case No.
IT IS ORDERED:
6. (continued)
f. interfering with petitioner’s efforts to remove his/her children/personal property from premises solely owned/leased by
respondent.
**
Name
g. threatening to kill or physically injure .
h. interfering with petitioner at his/her place of employment or education or engaging in conduct that impairs his/her
employment or educational relationship or environment.
i. having access to information in records concerning a minor child of petitioner and respondent that will reveal petitioner's
address, telephone number, or employment address or that will reveal the child's address or telephone number.
j. intentionally causing petitioner mental distress or exerting control over petitioner by:
injuring, killing, torturing, or neglecting, or threatening to injure, kill, torture, or neglect any animal in which petitioner
has an ownership interest.
removing any animal from his/her possession in which petitioner has an ownership interest.
retaining or obtaining possession of any animal in which petitioner has an ownership interest.
** k. purchasing or possessing a firearm.
l. other:
7. As a result of this order, federal and/or state law may prohibit you from possessing or purchasing ammunition or a firearm.
8. Violation of this order subjects respondent to immediate arrest and to the civil and criminal contempt powers of the court. If
found guilty, respondent shall be imprisoned for not more than 90 days and may be fined not more than $5,000 (Under
Ordinance # 04-400-04 Sec. 9.06)
9. This order is effective when signed, enforceable immediately, and remains in effect until .
This order is enforceable anywhere in this state by any law enforcement agency when signed
by a judge, and upon service,
may also be enforced by another state, another Indian tribe, or a territory of the United States. If respondent violates this
order in a jurisdiction other than this state, respondent is subject to enforcement and penalties of the state, Indian tribe, or
United States territory under whose jurisdiction the violation occurred.
10.
Name of law enforcement agency
The court clerk shall file this order with who will enter it into the LEIN.
11. Respondent may file a motion to modify or terminate this order. For ex parte orders, the motion must be filed within 14
days after being served with or receiving actual notice of the order. Forms and instructions are available from the clerk of court.
12. A motion to extend the order must be filed 3 days before the expiration date in item 9 or a new petition must be filed.
Date and time issued Judge
Little River Band Department of Public Safety
Personal Protection Order
Case No.
TO PROCESS SERVER: You must serve the personal protection order and file proof of service with the court clerk. If you are
unable to complete service, you must return this original and all copies to the court clerk.
OFFICER CERTIFICATE
I certify that I am a sheriff, deputy sheriff, bailiff, appointed
court officer, or attorney for a party, and that:
(notarization not required)
OR
AFFIDAVIT OF PROCESS SERVER
Being first duly sworn, I state that I am a legally competent
adult who is not a party or an officer of a corporate party,
and that: (notarization required)
I served a copy of the personal protection order by:
personal service registered mail, delivery restricted to the respondent (return receipt attached)
on:
Name of respondent Complete address of service Day, date, time
Law enforcement agency Complete address of service Day, date, time
I have personally attempted to serve a copy of the personal protection order on the following respondent and have been
unable to complete service.
Name of respondent Complete address of service
I declare that the statements above are true to the best of my information, knowledge, and belief.
Signature
Name (type or print)
Title
Subscribed and sworn to before me on
Date
County, Michigan.
My commission expires:
Date
,
Signature
Court clerk/Notary public
Notary public, State of Michigan, County of
I acknowledge that I have received a copy of the personal protection order on
Day, date, time
.
Signature of respondent
CERTIFICATE/AFFIDAVIT OF SERVICE/NONSERVICE
ACKNOWLEDGMENT OF SERVICE
PROOF OF SERVICE
Service fee
$
Miles traveled Fee
$
Incorrect address fee
$
Miles traveled Fee TOTAL FEE
$
$
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CC 376, Personal Protection Order ( Domestic Relationship) (Little River Band of Ottawa Indians Tribal Government)

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Completed 12 August 2020

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