Fillable Order Of PrOtectiOn (Administrative Office of the Courts)

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Order Of PrOtectiOn (Administrative Office of the Courts)

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BROWSE ADMINISTRATIVE OFFICE OF THE COURTS (KY) FORMS

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PETITIONER/PLAINTIFF
First Middle Last
q Petitioner ling on his/her own behalf; and/or
q
Petitioner ling on behalf of minor identied herein.
Persons Protected by this Order:
q Petitioner: _______________________ DOB: ________
q Minor on whose behalf Petition was led:
Name: ____________________________ DOB: ________
q Other protected person(s) or protected minor(s):
Name: ____________________________ DOB: ________
Name: ____________________________ DOB: ________
Name: ____________________________ DOB: ________
Name: ____________________________ DOB: ________
V.
RESPONDENT/DEFENDANT RESPONDENT/DEFENDANT IDENTIFIERS
First Middle Last
Relationship to Petitioner: q spouse q former spouse
q unmarried, child in common q unmarried, currently or formerly
living together q parent q child q stepparent q grandparent
q grandchild q person who lives in the same household as a
child(ren) if the child(ren) is the alleged victim
q currently or previously in a dating relationship
q none of the above relationships apply, but Respondent is alleged
to have committed q stalking or q sexual assault
Respondent Address: ___________________________________
_____________________________________________________
CAUTION:
Distinguishing Features: ______________________________
__________________________________________________
__________________________________________________
__________________________________________________
SEX RACE
DOB
HT WT
EYES HAIR Social Security #
DRIVERS LICENSE # STATE EXP. DATE
Weapon involved
Armed and Dangerous
Divorce/Custody/Visitation case pending
THE COURT HEREBY FINDS:
That it has jurisdiction over the parties and subject matter, and Kentucky law providing Respondent notice and opportunity
to be heard.
q Additional ndings of this order are as set forth below.
THE COURT HEREBY ORDERS:
q That the Respondent be restrained from committing further acts of abuse or threats of abuse, stalking, or
sexual assault.
q That the Respondent be restrained from any unauthorized contact with the Petitioner/Plaintiff or other protected
person(s) named in this Order.
q Additional terms of this order are as set forth below.
Case No.
Court
County State
Division _______________________________
AOC-275.2 Doc. Code: OEP
Rev. 1-16 TIPO
Page 1 of 2
www.courts.ky.gov
KRS Chapter 403;
KRS Chapter 456;
FCRPP Part IV
Order Of PrOtectiOn
q emergency PrOtective Order (ePO)
q temPOrary interPersOnal PrOtective Order (tiPO)
Continuance of an unserved EPO/TIPO is limited to six (6) months. If Respondent has not been served with this order and the Court
has not otherwise withdrawn it, this order will expire in six (6) months, on
, .
KRS 403.735;
456.050.
The terms of this order shall expire upon the conclusion of the hearing required by KRS 403.735 or KRS 456.050
unless continued or withdrawn by subsequent order of the Court.
see attached summOns fOr date and time Of hearing. KRS 403.730; 456.040.
WARNING TO RESPONDENT:
This order shall be enforced, even without registration, by the courts of any state, the District of Columbia, any U.S.
Territory, and may be enforced by Tribal Lands (18 U.S.C. Section 2265). Crossing state, territorial, or tribal boundaries to
violate this order may result in federal imprisonment (18 U.S.C. Section 2262).
Only the Court can change this order.
AOC-275.2 Doc Code: OEP
Rev. 1-16
Page 2 of 2
ADDITIONAL FINDINGS: The Court, having reviewed the petition and being sufciently advised, nds that the allegations
indicate an immediate and present danger of q domestic violence and abuse q dating violence and abuse q stalking
q sexual asault.
THEREFORE, IT IS FURTHER ORDERED:
q That the Respondent be restrained from any contact or communication with the Petitioner and the following other
protected person(s): __________________________________________________________________________
___________________________________________________________________________________________
q except as follows (the following contact or communication is authorized): __________________________
___________________________________________________________________________________________.
q That the Respondent remain at all times and places at least ___________ feet (not to exceed 500) away from
Petitioner and all other protected person(s) in this Order.
q except as follows: ________________________________________________________________________
___________________________________________________________________________________________.
q That, Petitioner having established specic demonstrable danger, the Respondent be restrained from going to
or within the distance(s) specied of the location(s) described below:
Location: __________________________________________________________________ __________ feet.
Location: __________________________________________________________________ __________ feet.
Location: __________________________________________________________________ __________ feet.
q except as follows: ________________________________________________________________________
___________________________________________________________________________________________.
q That the Respondent be restrained from disposing of, or damaging, any property of the parties.
q That the Respondent vacate the residence shared by the parties located at (specic address) _________
___________________________________________________________________________________________
q In accordance with the criteria of KRS 403.270, 403.320 and 403.822, temporary custody of _________
___________________________________________________________________________________________
be awarded to ______________________________________________________________________________.
q In order to assist in eliminating future acts of domestic violence and abuse, dating violence and abuse, stalking,
or sexual assault __________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
________________. (The Court cannot order the Petitioner to take afrmative action. KRS 403.740; KRS 456.060)
Case No.
Date Issued
Judge
VIOLATION OF THIS ORDER SHALL CONSTITUTE CONTEMPT OF THIS COURT AND MAY RESULT IN
CRIMINAL CHARGES. ANY PEACE OFFICER SHALL ARREST THE RESPONDENT WITHOUT A WARRANT
UPON PROBABLE CAUSE THAT A VIOLATION OF THIS ORDER HAS OCCURRED. ONLY THE COURT
MAY MODIFY THIS ORDER. THE PETITIONER OR RESPONDENT MAY MOVE TO AMEND THE ORDER.
Copies to:
Court le; Petitioner; Court Clerk in county of Petitioner's usual residence, if different; Law Enforcement Agency/dispatch center
responsible for LINK entry; Law Enforcement Agency(ies) designated for service; Local Dept. for Community Based Services (CHFS).
Ensure entries in boxes are complete and legible. Without correct information in each box, Order MAY NOT be entered into LINK.
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Order Of PrOtectiOn (Administrative Office of the Courts)

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Completed 26 December 2022

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