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L2543 (The Superior Court of California - County of Orange)

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THIS IS NOT A RESTRAINING ORDER Page ___ of ___
Approved for Optional Use
L- 2543 (New February 2017)
ELDER OR DEPENDENT ADULT ABUSE
MEDIATED SETTLEMENT AGREEMENT
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
Central Justice Center
700 Civic Center Dr. West
Santa Ana, CA 92701-4045
PETITIONER:
RESPONDENT:
ELDER OR DEPENDENT ADULT ABUSE
MEDIATED SETTLEMENT AGREEMENT
CASE NUMBER:
Petitioner ☐ present ☐ not present represented by Attorney: ___________________________________________
Respondent ☐ present ☐ not present represented by Attorney: _________________________________________
Other appearances: ___________________________________________________________________________
THE PARTIES STIPULATE AND AGREE THAT:
☐ Parties agree to the terms stated below. The case shall be taken off calendar, and if the settlement is breached,
then any document regarding the breach will be filed under the same case number.
☐ Parties agree to the terms stated below. If the respondent does not comply with this stipulation, petitioner may
file a Declaration of Non-Compliance and a new Notice of Court Hearing (EA109) and Temporary Restraining
Order (EA110), which will need to be personally served on the respondent.
PETITIONER AND RESPONDENT FURTHER STIPULATE AS FOLLOWS:
☐ _________________________________________ agrees to stay at least (specify): ___________ yards away
from _____________________________________ and the following persons named in the Request for Elder or
Dependent Adult Abuse Restraining orders: _____________________________________________________.
☐ _________________________________________ agrees to have no contact (directly or indirectly) with
(name): ________________________________________ and the following persons named in the Request for
Elder or Dependent Adult Abuse Restraining orders: ______________________________________________.
☐ Other (specify): ☐ See additional pages attached.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Attorney for Petitioner Attorney for Respondent Guardian Ad Litem
SIGNATURE OF PARTIES
We have read the entire stipulation and agreement and request the court to make our stipulation and agreement
the Court’s order. We understand it fully and this Settlement Agreement is NOT a restraining order and will not be
enforced by any law enforcement agencies. We understand that willful failure to comply with the provisions of this
order may be a contempt of court and may be punished by fine and imprisonment. We acknowledge notice of this
order.
Petitioner Respondent
IT IS ORDERED:
Date Judge/Commissioner of the Superior Court
Clear This Form
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you are done printing the form.
THIS IS NOT A RESTRAINING ORDER Page ___ of ___
Approved for Optional Use
L- 2543 (New February 2017)
ELDER OR DEPENDENT ADULT ABUSE
MEDIATED SETTLEMENT AGREEMENT
Case No. and
Petitioner Respondent
Continued from page ______
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Attorney for Petitioner Attorney for Respondent Guardian Ad Litem
SIGNATURE OF PARTIES
We have read the entire stipulation and agreement and request the court to make our stipulation and agreement
the Court’s order. We understand it fully and this Settlement Agreement is NOT a restraining order and will not be
enforced by any law enforcement agencies. We understand that willful failure to comply with the provisions of this
order may be a contempt of court and may be punished by fine and imprisonment. We acknowledge notice of this
order.
Petitioner Respondent
IT IS ORDERED:
Date Judge/Commissioner of the Superior Court
Clear This Form
For your protection and privacy, please press the Clear This Form button after
you are done printing the form.
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L2543 (The Superior Court of California - County of Orange)

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Completed 9 February 2021

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