Fillable Form 3.: EMERGENCY PROTECTIVE ORDER (See reverse for (California)

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Form 3.: EMERGENCY PROTECTIVE ORDER (See reverse for (California)

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EMERGENCY PROTECTIVE ORDER (See reverse for important notices.)
EPO-001
ONE copy to court, ONE copy to restrained person, ONE copy to protected person, ONE copy to issuing agency
LAW ENFORCEMENT CASE NUMBER:
1.
PROTECTED PERSONS (insert names of all persons protected by this Order):
2.
RESTRAINED PERSON (name):
Sex:
M F
Ht.: Wt.: Hair color: Eye color: Race: Age: Date of birth:
3.
TO THE RESTRAINED PERSON:
a.
YOU MUST NOT harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy any
personal property of, disturb the peace of, keep under surveillance, or block the movements of each person named in item 1.
b.
YOU MUST NOT contact, either directly or indirectly, by any means, including but not limited to by telephone, mail, e-mail or
other electronic means, any person named in item 1.
c.
YOU MUST
stay away at least:
yards from each person named in item 1.
stay away at least:
yards from
move out immediately from
(address):
d.
YOU MUST NOT own, possess, purchase, receive, or attempt to purchase or receive any firearm or ammunition. If you have
any firearms, you must turn them in to a law enforcement agency or sell them to, or store them with, a licensed gun dealer.
e.
YOU MUST NOT take any action, directly or through others, to obtain the addresses or locations of any person named in item 1.
4.
(Name):
is given temporary care and control of the following
minor children of the parties (names and ages):
5.
THIS ORDER WILL EXPIRE AT THE CLOSE OF THE COURT BUSINESS DAY ON:
INSERT DATE OF FIFTH COURT DAY OR SEVENTH
CALENDAR DAY, WHICHEVER IS EARLIER; DO NOT
COUNT DAY THE ORDER IS GRANTED
6.
TO THE PROTECTED PERSON: If you need protection for a longer period of time,
you must request restraining orders from the court in the county where you live:
(Name and address of court):
If you go to court to request restraining orders, take your copy of this form with you. If a juvenile petition is pending, file in that court.
7.
Reasonable grounds for the issuance of this Order exist, and an emergency protective order is necessary to prevent the occurrence
or recurrence of domestic violence, child abuse, child abduction, elder or dependent adult abuse, or stalking.
8.
Judicial officer (name):
granted this Order on (date):
at (time):
APPLICATION
9.
The events that caused the protected person to fear immediate and present danger of domestic violence, child abuse, child
abduction, elder or dependent adult abuse (except solely financial abuse), or stalking are (give facts and dates; specify weapons):
10.
Firearms were:
observed reported searched for seized
11.
The person to be protected lives with the person to be restrained and requests an order that the restrained person move out
immediately from the address in item 3c.
12.
The person to be protected has minor children in common with the person to be restrained, and a temporary custody order is
requested because of the facts alleged in item 9. A custody order exist.
does not
does
By:
(PRINT NAME OF LAW ENFORCEMENT OFFICER)
u
(SIGNATURE OF LAW ENFORCEMENT OFFICER)
Agency:
Telephone No.: Badge No.:
PROOF OF SERVICE
13.
Person served (name):
14.
I personally delivered copies of this Order to the person served as follows:
Date: Time:
Address:
15.
At the time of service, I was at least 18 years of age and not a party to this cause.
I am a California law enforcement officer.
16.
My name, address, and telephone number are (this does not have to be server's home telephone number or address):
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(TYPE OR PRINT NAME OF SERVER)
u
(SIGNATURE OF SERVER)
EMERGENCY PROTECTIVE ORDER (CLETS–EPO)
(Domestic Violence, Child Abuse, Elder or Dependent Adult Abuse, or Stalking)
Form Adopted for Mandatory Use
Judicial Council of California
EPO-001 [Rev. January 1, 2014]
Approved by DOJ
Page 1 of 2
Family Code, §§ 6240-6275;
Penal Code, § 646.91
www.courts.ca.gov
EMERGENCY PROTECTIVE ORDER
WARNINGS AND INFORMATION
EPO-001
TO THE RESTRAINED PERSON: VIOLATION OF THIS ORDER IS A MISDEMEANOR PUNISHABLE BY A $1,000 FINE, ONE
YEAR IN JAIL, OR BOTH, OR IT MAY BE PUNISHABLE AS A FELONY. THIS PROTECTIVE ORDER SHALL BE ENFORCED BY
ALL LAW ENFORCEMENT OFFICERS IN THE STATE OF CALIFORNIA WHO ARE AWARE OF OR SHOWN A COPY OF THE
ORDER. THE TERMS AND CONDITIONS OF THIS ORDER REMAIN ENFORCEABLE REGARDLESS OF THE ACTS OF THE
PARTIES; IT MAY BE CHANGED ONLY BY ORDER OF THE COURT (PENAL CODE SECTION 13710(b)).
YOU ARE PROHIBITED FROM OWNING, POSSESSING, PURCHASING, RECEIVING, OR ATTEMPTING TO PURCHASE OR
RECEIVE A FIREARM OR AMMUNITION. (PENAL CODE SECTIONS
29825(a), 30305(a).) A VIOLATION IS SUBJECT TO A
$1,000 FINE AND IMPRISONMENT OR BOTH. WITHIN 24 HOURS OF RECEIPT OF THIS ORDER, YOU MUST TURN IN YOUR
FIREARMS TO A LAW ENFORCEMENT AGENCY, SELL THEM TO A LICENSED FIREARMS DEALER, OR STORE THEM WITH A
LICENSED FIREARMS DEALER UNTIL THE EXPIRATION OF THIS ORDER. (PENAL CODE SECTION 29830.) PROOF OF
SURRENDER, SALE, OR STORAGE MUST BE FILED WITH THE COURT WITHIN 48 HOURS OF RECEIPT OF THIS ORDER.
A la persona bajo restricción judicial: Esta orden durará hasta la fecha y hora indicada en el punto 5 al dorso. La persona protegida
puede, sin embargo, obtener una orden de entredicho (restricción judicial) más permanente de la corte. Usted puede consultar a un
abogado en conexión con cualquier asunto relacionado con esta orden. Debe consultar al abogado inmediatamente para que él o ella le
pueda ayudar a responder a la orden.
To the protected person: This order will last only until the date and time noted in item 5 on the reverse. If you wish to seek continuing
protection, you will have to apply for an order from the court at the address in item 6. You may apply for a protective order free of charge.
In the case of an endangered child, you may also apply for a more permanent order at the address in item 6, or if there is a juvenile
dependency action pending, you may apply for a more permanent order under section 213.5 of the Welfare and Institutions Code. In the
case of a child being abducted, you may apply for a Child Custody and Visitation Order from the court. You may seek the advice of an
attorney on any matter connected with your application for any future court orders. The attorney should be consulted promptly so that the
attorney may assist you in making your application. You do not have to have an attorney to get the protective order.
A la persona protegida: Esta orden durará sólo hasta la fecha y hora indicada en el punto 5 al dorso. Si usted desea que la protección
continúe, tendrá que solicitar una orden de la corte en la dirección indicada en el punto 6. La solicitud de la orden de protección es gratis.
En el caso de que un niño o una niña se encuentre en peligro, puede solicitar una orden más permanente en la dirección indicada en el
punto 6, o si hay una acción legal pendiente de tutela juvenil, puede solicitar una orden más permanente conforme a la sección 213.5 del
código titulado en inglés Welfare and Institutions Code. En el caso del secuestro de un niño o una niña, usted puede solicitar de la corte
una orden para la guarda del niño o de la niña (Child Custody and Visitation Order). Puede consultar a un abogado en conexión con
cualquier asunto relacionado con las solicitudes de órdenes de la corte que usted presente en el futuro. Debe consultar un abogado
inmediatamente para que él o ella le pueda ayudar a presentar su solicitud. Para obtener la orden de protección no es necesario que un
abogado le represente.
To law enforcement: The emergency protective order shall be served upon the restrained party by the officer, if the restrained party can
reasonably be located, and a copy shall be given to the protected party. A copy shall be filed with the court as soon as practicable after
issuance. Also, the officer shall have the order entered into the computer database system for protective and restraining orders
maintained by the Department of Justice. The availability of an emergency protective order shall not be affected by the fact that the
endangered person has vacated the household to avoid abuse. A law enforcement officer shall use every reasonable means to enforce
an emergency protective order. A law enforcement officer who acts in good faith to enforce an emergency protective order shall not be
held civilly or criminally liable.
If a child is in danger of being abducted: This order will last only until the date and time noted in item 5 on the reverse. You may apply
for a child custody order from the court.
En el caso de peligro de secuestro de un niño o de una niña: Esta orden será válida sólo hasta la hora y fecha indicada en el punto 5
al dorso
. Usted puede solicitar de la corte una orden para la guarda del niño o de la niña (Child Custody and Visitation Order).
This emergency protective order is effective when made. This order shall expire on the date and time specified in item 5 on the reverse.
The provisions of this emergency protective order take precedence in enforcement over provisions of other existing protective orders
between the same protected and restrained persons to the extent the provisions of this order are more restrictive. In other words, the
provisions in this emergency protective order take precedence over the provisions in any other protective order, including a criminal
protective order, if (1) the person to be protected is already protected by the other protective order, (2) the person to be restrained is
subject to that other order, and (3) the provisions in this emergency order are more restrictive than the provisions in that other order. The
provisions in another existing protective order remain in effect and take precedence if they are more restrictive than the provisions in this
emergency protective order.
EPO-001 [Rev. January 1, 2014]
EMERGENCY PROTECTIVE ORDER (CLETS–EPO)
(Domestic Violence, Child Abuse, Elder or Dependent Adult Abuse, or Stalking)
Page 2 of 2
At the time of service I was at least 18 years of age and not a party to this cause.
16.
I am a California sheriff or marshal.
To the restrained person: This order will last until the date and time in item 5 on the reverse. The protected person may, however,
obtain a more permanent restraining order from the court. You may seek the advice of an attorney on any matter connected with this
order. The attorney should be consulted promptly so that the attorney may assist you in responding to the order.
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Completed 6 December 2020

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