FORM 10.03-G: HOW TO OBTAIN A CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION
ORDER
Amended: March 1, 2014
Discard all previous versions of this form
FORM 10.03-G:
HOW TO OBTAIN A PETITION FOR A
CIVIL STALKING PROTECTION ORDER
OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER
These instructions are intended to assist you in preparing the Petition for a Civil Stalking Protection Order or
Sexually Oriented Offense Protection Order, which can only be heard by the court of common pleas in your
county. Throughout the Petition, you (the party to be protected) are called Petitioner and the person you
are filing this Petition against is called Respondent.
SOME HINTS BEFORE YOU BEGIN
All forms must be typed or printed.
Write your name and the Respondent's name the same way throughout the Petition.
When you print your name on the Petition, use the same name you use when you write your signature.
Fill out the Petition as completely and accurately as possible.
If you have any questions about completing the Petition contact your local domestic violence program or the
Ohio Domestic Violence Network at 800-934-9840.
FILLING OUT THE PETITION: Mark each instruction below after you read and complete it.
On the front page, leave the “Case No.” line and “Judge/Magistrate” lines blank. The Clerk of Court’s
office will fill in this information.
On the top left-hand side of the front page, fill in the requested information about yourself. If you want
your address to remain confidential, do not write your address on the Petition. However, you must write
another mailing address where you can safely receive notices from the Court.
Also on the top left-hand side of the front page, fill in the requested information about Respondent as
best you can. You may use the Respondent’s work address if you do not know the Respondent’s home
address. If you do not know Respondent’s date of birth, leave that line blank. Do not attempt to obtain this
information unless it is safe to do so.
Paragraph 1: If you are filing the Petition on behalf of yourself, mark the first box.
Paragraph 2: If you are filing the Petition on behalf of a family or household member, mark the box and fill in
their name(s) and the other information requested in the chart. The Petitioner and the Respondent need not
be related in any way for the Petitioner to obtain the protection order. You may attach additional pages if you
need more room.
Paragraph 3(a): State the date(s) of the incident(s) that caused you to file the Petition. Exact date(s) is not
necessary. Approximate time frame may be sufficient. If you are requesting a civil stalking protection order
due to menacing by stalking, provide a brief description of the pattern of conduct (two or more instances) that
caused you to believe that the Respondent will cause physical harm or cause mental distress to you or
another family member. If you are aware of any prior convictions of the Respondent for menacing by stalking
or similar offenses, or prior convictions of the Respondent for any sexually oriented offenses, list what
information you know about those convictions. You may attach additional pages if you need more room to
complete your description.
Paragraph 3(b): State the date(s) of the incident(s) that caused you to file the Petition. Exact date(s) is not
necessary. Approximate time frame may be sufficient. If you are requesting a civil sexually oriented offense
protection order due to a sexually oriented offense, you do not have to provide a description of a pattern of
conduct. A brief description of what happened that caused you to request the protection order will be enough.
[Page 2 of 3 Form 10.03-G]
FORM 10.03-G: HOW TO OBTAIN A CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION
ORDER
Amended: March 1, 2014
Discard all previous versions of this form
If you are aware of any prior convictions of the Respondent for menacing by stalking or similar offenses, or
prior convictions of the Respondent for any sexually oriented offenses, list what information you know about
those convictions. You may attach additional pages if you need more room to complete your description.
Paragraph 3(c): State the date(s) of the incident(s) that caused you to file the Petition and request electronic
monitoring of the Respondent. Exact date(s) is not necessary. Approximate time frame may be sufficient. If
you are requesting electronic monitoring of the Respondent, describe the nature and extent of the
Respondent’s conduct before the filing of this Petition that puts you or your family or household members
health, welfare, or safety at risk. Also describe how the Respondent presents a continuing danger to you or
your family or household members.
See definition section on Offenses on the last page for the legal definition of menacing by stalking and sexually
oriented offense.
Paragraph 4: Indicate the action you want the Court to take by marking the boxes next to the numbered
paragraphs that apply to your situation.
Paragraph 4(f): Write any special court orders you believe would help protect you and your family or
household members.
Paragraph 5: If you need an emergency (“ex parte”) protection order, mark the box next to Paragraph 5.
Paragraph 9: List ALL present and pertinent past court cases or investigations that involve the Respondent.
This includes all civil, criminal, divorce, custody, visitation, and any other case that may have a bearing on
your or your family or household members’ safety. Write the case name, the court, the case number, and the
result of the case, if known. If the case is not over, write “pending”. You may attach additional pages if you
need more room.
SIGNING THE PETITION
Try to fill out the Petition before you go to the courthouse. AFTER YOU HAVE FILLED OUT THE PETITION,
TAKE THE PETITION TO A NOTARY PUBLIC TO HAVE YOUR SIGNATURE NOTARIZED. DO NOT SIGN THE
PETITION UNLESS YOU ARE IN FRONT OF THE PERSON WHO WILL NOTARIZE THE PETITION FOR YOU.
FILING THE PETITION
After you have your signature notarized, file your Petition at the Clerk of Court’s office. The Clerk of Court’s office
will tell you when and where your ex parte hearing, if one has been requested, will take place.
FEES
You cannot be charged any costs or fees for filing, modifying, enforcing, dismissing, withdrawing, serving, or
obtaining a protection order.
DISCOVERY
Unless you have received an order from the Court regarding discovery, you have no obligation to comply with a
deposition notice, interrogatories, request for production of documents, physical or mental examination, or request
for admissions.
If ordered, the Court will indicate each of the following:
1. The time and place where discovery will be held;
2. The name of persons who can be in the room during discovery, including a victim advocate;
3. The necessary terms and conditions to keep everyone safe, including keeping the Petitioner’s address
confidential.
Discovery must be completed prior to the full hearing.
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Print Form
FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE
PROTECTION ORDER
FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION
ORDER
Amended: March 1, 2014
Discard all previous versions of this form
IN THE COURT OF COMMON PLEAS
Petitioner
:
Case No.
Address
:
Judge/Magistrate
City, State, Zip Code
:
Date of Birth:
/
/
:
v.
:
PETITION FOR CIVIL STALKING PROTECTION
ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE
PROTECTION ORDER (R.C. 2903.214)
:
Respondent
:
Address
:
City, State, Zip Code
:
Date of Birth:
/
/
CHECK EVERY THAT APPLIES. IF YOU ARE REQUESTING YOUR ADDRESS REMAIN CONFIDENTIAL,
DO NOT WRITE YOUR ADDRESS ON THIS FORM. PLEASE PROVIDE ANOTHER MAILING ADDRESS
WHERE YOU CAN SAFELY RECEIVE NOTICES FROM THE COURT. THIS FORM IS A PUBLIC RECORD.
1.
Petitioner seeks relief on Petitioner’s own behalf.
2.
Petitioner seeks relief on behalf of the following family or household members:
NAME
DATE OF BIRTH
HOW RELATED TO PETITIONER
/
/
/
/
/
/
/
/
/
/
Ohio law defines “Menacing by Stalking” as follows:
“No person by engaging in a pattern of conduct shall knowingly cause another person to believe that the
offender will cause physical harm to the other person or cause mental distress to the other person. R.C.
2903.211(A)(1).
“No person, through the use of any electronic method of remotely transferring information, including, but not
limited to, any computer, computer network, computer program, or computer system, shall post a message
with purpose to urge or incite another to commit a violation of division (A)(1) of this section (above)R.C.
2903.211(A)(2).
Ohio law defines “Sexually Oriented Offenses” in R.C 2950.01.
[Page 2 of 4 Form 10.03-D]
Case No._____________________
FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION
ORDER
Amended: March 1, 2014
Discard all previous versions of this form
3.
Petitioner states that Respondent has engaged in the following act(s) which create an immediate and
present danger. For (a), (b), or (c) below, attach additional pages if necessary.
(a)
For a civil stalking protection order due to menacing by stalking, describe the nature and extent
of the pattern of conduct that causes you to believe that Respondent will cause you physical
harm or causes (or has caused) mental distress. Also describe any previous convictions of
Respondent for the crime of Menacing by Stalking, if known.
(b)
For a civil sexually oriented offense protection order due to a sexually oriented offense, describe
the acts of Respondent as fully as possible. You do not need to include any pattern of conduct
information for a protection order due to a sexually oriented offense.
(c)
For electronic monitoring of the Respondent, describe the nature and extent of the Respondent’s
conduct before the filing of this Petition that puts you or your family or household members’
health, welfare, or safety at risk. Also describe how the Respondent presents a continuing danger
to you or your family or household members.
4.
Petitioner requests the Court grant relief under R.C. 2903.214 for the Petitioner and the family or
household members named in this Petition by granting a Civil Stalking Protection Order or Civil Sexually
Oriented Offense Protection Order that:
[Page 3 of 4 Form 10.03-D]
Case No._____________________
FORM 10.03-D: PETITION FOR CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION
ORDER
Amended: March 1, 2014
Discard all previous versions of this form
(a)
Requires Respondent to not abuse the Petitioner and the family or household members named in
this Petition by harming, attempting to harm, threatening, following, stalking, harassing,
contacting, forcing sexual relations upon them, or by committing sexually oriented offenses
against them.
(b)
Requires Respondent to refrain from entering the residence, school, business, place of
employment, child care providers, or day care centers of Petitioner and the family or household
members named in this Petition, including the buildings, grounds, and parking lots at those
locations.
(c)
Requires Respondent not to interfere with Petitioner's right to occupy the residence including, but
not limited to canceling any utilities or insurance or interrupting phone service, mail delivery, or
the delivery of any other documents or items.
(d)
Requires Respondent not to remove, damage, hide, or dispose of any property or pets owned or
possessed by the Petitioner and Petitioner's family or household members named in this Petition.
(e)
Requires Respondent not to possess, use, carry, or obtain any deadly weapon.
(f)
Requires Respondent to be electronically monitored.
(g)
Includes the following additional provisions:
5.
Petitioner further requests that the Court issue an ex parte (emergency) protection order under R.C.
2903.214(D) and this Petition.
6.
Petitioner further requests that the Court not issue any mutual protection orders or other orders against
Petitioner unless all of the conditions of R.C. 2903.214(E)(3) are met.
7.
Petitioner further requests that if Petitioner has a victim advocate, the Court permit the victim advocate
to accompany Petitioner at all stages of these proceedings as required by R.C. 2903.214(L).
8.
Petitioner further requests that the Court grant such other relief as the Court considers equitable and
fair.
9.
The following is a list of all present and past court cases involving Respondent, that Petitioner knows of:
CASE NAME
CASE NUMBER
COURT/COUNTY
OUTCOME OF CASE
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FORM 10.03-E: CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER EX PARTE
FORM 10.03-E: CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER EX PARTE
Amended: March 1, 2014
Discard all previous versions of this form
IN THE COURT OF COMMON PLEAS
COUNTY, OHIO
Order of Protection
Case No.
Per R.C. 2903.214(F)(3), this Order is indexed at
Judge/Magistrate
State
OHIO
LAW ENFORCEMENT AGENCY WHERE INDEXED
( )
-
CIVIL STALKING PROTECTION ORDER EX PARTE
(R.C. 2903.214)
PHONE NUMBER
CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION
ORDER EX PARTE (R.C. 2903.214)
PETITIONER:
PERSON(S) PROTECTED BY THIS ORDER:
Petitioner:
DOB:
Petitioner’s Family or Household Members :
( Additional forms attached.)
DOB:
First Middle Last
DOB:
DOB:
v.
DOB:
RESPONDENT:
RESPONDENT IDENTIFIERS
SEX
RACE
HT
WT
EYES
HAIR
DATE OF BIRTH
First
Middle
Last
/
/
DRIVER’S LIC. NO. EXP. DATE STATE
Relationship to Petitioner:
Address where Respondent can be found:
Distinguishing features:
WARNING TO LAW ENFORCEMENT: RESPONDENT HAS FIREARMS ACCESS PROCEED WITH
CAUTION
(Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for
enforcement.)
THE COURT HEREBY FINDS:
That it has jurisdiction over the parties and subject matter, and the Respondent will be provided with reasonable notice and
opportunity to be heard within the time required by Ohio law. Additional findings of this Order are set forth below.
THE COURT HEREBY ORDERS:
That the above named Respondent be restrained from committing acts of abuse or threats of abuse against the Petitioner and
other protected persons named in this Order. Additional terms of this Order are set forth below.
The terms of this Order shall be effective until
/
/
(DATE CERTAIN).
WARNING TO RESPONDENT: See the warning page attached to the front of this Order.
[Page 2 of 4 Form 10.03-E]
Case No.___________________________
FORM 10.03-E: CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER EX PARTE
Amended: March 1, 2014
Discard all previous versions of this form
This proceeding came on for an ex parte hearing on
/
/
(Respondent not
being present), upon the filing of a Petition by Petitioner for a civil stalking protection order or civil sexually oriented
offense protection order against the Respondent, pursuant to R.C. 2903.214. In accordance with R.C.
2903.214(D)(1), the Court held an ex parte hearing not later than the next day that the Court was in session after
the Petition was filed.
The Court finds that the protected persons herein are in immediate and present danger and, for good cause shown,
the following temporary orders are necessary to protect the persons named in this Order.
RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations
upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02]
ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO THE RESPONDENT
1.
RESPONDENT SHALL NOT ENTER or interfere with the residence, school, business, place of
employment, day care centers, or child care providers of the protected persons named in this Order,
including the buildings, grounds, and parking lots at those locations. Respondent may not violate this
Order even with the permission of a protected person. [NCIC 04]
2.
RESPONDENT SHALL NOT INTERFERE with protected persons' right to occupy the residence including,
but not limited to canceling utilities or insurance or interrupting telephone service, mail delivery, or the
delivery of any other documents or items.
3.
RESPONDENT SHALL SURRENDER all keys and garage door openers to the following residence:
at the earliest possible opportunity after service of this Order to the law enforcement agency that serves
Respondent with this Order or as follows:
4.
RESPONDENT SHALL STAY AWAY FROM PETITIONER and all other protected persons named in this
Order, and not be present within 500 feet or
(distance) of any protected persons wherever
those protected persons may be found, or any place the Respondent knows or should know the protected
persons are likely to be, even with the protected persons’ permission. If Respondent accidentally
comes in contact with protected persons in any public or private place, Respondent must depart
immediately. This Order includes encounters on public and private roads, highways, and thoroughfares.
[NCIC 04]
5.
RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY OR PETS
owned or possessed by the protected persons named in this Order.
6.
RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT with the protected persons named in
this Order or their residences, businesses, places of employment, schools, day care centers, or child care
providers. Contact includes, but is not limited to, landline, cordless, cellular or digital telephone; text;
[Page 3 of 4 Form 10.03-E]
Case No.___________________________
FORM 10.03-E: CIVIL STALKING PROTECTION ORDER OR CIVIL SEXUALLY ORIENTED OFFENSE PROTECTION ORDER EX PARTE
Amended: March 1, 2014
Discard all previous versions of this form
instant messaging; fax; e-mail; voice mail; delivery service; social networking media; blogging; writings;
electronic communications; or communications by any other means directly or through another person.
Respondent may not violate this Order even with the permission of a protected person. [NCIC 05]
7.
RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY PERSON to do any act prohibited by this
Order.
8.
RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON at any
time while the Order remains in effect unless Respondent is excepted for official use pursuant to
18 U.S.C. 925(a)(1). [NCIC 07]
RESPONDENT SHALL TURN OVER ALL DEADLY WEAPONS AND CONCEALED CARRY WEAPON
LICENSE in Respondent’s possession to the law enforcement agency that serves Respondent with this
Order or as follows:
Any law enforcement agency is authorized to take possession of deadly weapons pursuant to this
paragraph and hold them in protective custody until further Court order. [NCIC 07]
9.
IT IS FURTHER ORDERED: [NCIC 08]
10.
ALL DISCOVERY SHALL STRICTLY COMPLY with Civ.R. 65.1(D).
11.
IT IS FURTHER ORDERED that the Clerk of Court shall cause a copy of the Petition and this Order to be
delivered to the Respondent as required by Civ.R. 65.1. The Clerk of Court shall also provide certified
copies of the Petition and this Order to Petitioner upon request. This Order is granted without bond.
No costs or fees shall be assessed against the Petitioner for filing, issuing, registering, modifying,
enforcing, dismissing, withdrawing, or serving this protection order.
12.
ALL OF THE TERMS OF THIS ORDER SHALL REMAIN IN FULL FORCE AND EFFECT UNTIL
/
/
.
IT IS SO ORDERED.
JUDGE/MAGISTRATE
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