Fillable SC 24 Stalking Three Year Permanent Protective Order (Cherokee County, Georgia)

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SC 24 Stalking Three Year Permanent Protective Order (Cherokee County, Georgia)

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1
ORI Number ____________________
SC-24
THE SUPERIOR COURT FOR THE COUNTY OF________________
STATE OF GEORGIA
_____________________, :
Petitioner, : Civil Action File
v. :
_____________________, : No. _____________________
Respondent. :
STALKING THREE YEAR/PERMANENT PROTECTIVE ORDER
A civil hearing was held on this matter on _______________, 20 at which the
Respondent appeared and/or was provided with the opportunity to be heard and the Petitioner
requested, pursuant to O.C.G.A. §§ 16-5-94 (e) and 19-13-4 (c), that a permanent Protective Order
be issued. Having heard the evidence presented, reviewed the petition and the record concerning this
case and for good cause shown, IT IS HEREBY ORDERED AND ADJUDGED:
1. The Respondent has knowingly and willfully violated O.C.G.A. §§ 16-5-90 et seq.
[pco01,02] and placed the Petitioner in reasonable fear for the Petitioner’s safety, because
.
Respondent is hereby enjoined and restrained from doing or attempting to do, or
threatening to do any act constituting a violation of O.C.G.A. §§ 16-5-90 et seq. and
of harassing, interfering, or intimidating the Petitioner or Petitioner’s immediate family.
Any future acts committed by the Respondent towards the Petitioner which are in
violation of this statute and this Protective Order can amount to AGGRAVATED
STALKING, pursuant to O.C.G.A. § 16-5-91, which is a felony. A person convicted
of Aggravated Stalking shall be punished by imprisonment for not less than 1 nor more
than 10 years and by a fine of not more than $10,000.00.
2. Respondent is permanently enjoined and restrained from approaching within ______
[pco01,04] yards of Petitioner and/or Petitioner’s immediate family, and/or residence,
place of employment, or school or subsequent residence, place of
employment or school.
3. Respondent is not to have any contact of any type, direct, indirect, or through
[pco05] another person with the Petitioner or her/his immediate family, including but not limited
to telephone, fax, e-mail, or any other means of communication.
4. That this order be filed in the office of the Clerk of this Court.
For your convenience, this form has been designed to be completed
online. The information typed on the first page will automatically
update to the other pages. Please be sure all pertinent information is
completed before printing. Once the form is completed, select 'Print' to
print the form. Selecting 'Reset' will clear the entire form.
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2
5.
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[pco07]
SO ORDERED this day of , 20 .
JUDGE, SUPERIOR COURT
County
Print or stamp Judge’s name
Violation of the above Order may be punishable by arrest.
3
CIVIL ACTION FILE NO.
NOTICE TO RESPONDENT
1.
Violation of this Order may result in immediate arrest and criminal prosecution that may result in jail time
and/or fines and/or may subject you to prosecution and penalties for contempt of court.
2. This Order shall remain in effect unless specifically superseded by a subsequent signed and filed Order, by
operation of law, or by Order of dismissal, whichever occurs first. Only this Court can void, modify or dismiss
this Order. Either party may ask this Court to change or dismiss this Order.
3.
If after a hearing, of which the Defendant received notice and opportunity to participate, a protective order is
issued which restrains Defendant from harassing, stalking or threatening an intimate partner, Defendant
is prohibited from possessing, receiving, or transporting a firearm or ammunition which has been shipped
or transported in interstate or foreign commerce for the duration of the Order. 18 U.S.C. § 922(g).
4. A person commits the offense of Aggravated Stalking when such person, in violation of a temporary or
permanent protective Order prohibiting this behavior, follows, places under surveillance, or contacts
Petitioner on public or private property for the purpose of harassing and intimidating the other person. This
activity can subject the Respondent to arrest and prosecution for felony Aggravated Stalking, which carries
penalties of imprisonment for not less than 1 year nor more than 10 years and a fine of up to $10,000.00.
4
CIVIL ACTION FILE NO.
Pursuant to O.C.G.A. Section § 19-13-3,
Petitioner assisted by
Name:
Address:
Telephone:
Note to Judges: This form is promulgated as a Uniform Superior Court Rule under the auspices of
O.C.G.A. § 19-13-53. To order a specific provision, please initial in the space provided. The court
should delete or otherwise make inoperative any provision in the standardized form which is not
supported by the evidence in the case and in order to comply with the court’s application of the law
and facts to an individual case.
5
CIVIL ACTION FILE NO.
*REMOVE THIS PAGE FROM ORDER AND FILE SEPARATELY UNDER SEAL*
*For transmittal to the Georgia Protective Order Registry and, if applicable,
the National Crime Information Center.*
RESPONDENT’S IDENTIFYING FACT SHEET
(please complete as much as possible; one of these must be provided to have the order placed in the National Crime
Information Center registry: Respondent’s date of birth OR social security number)
Respondent’s social security number is _______________, date of birth is _________, sex ____, color of
hair __________, color of eyes ______________, height _______, weight _____. Respondent’s race is
__________, ethnic background ____________. Respondent has distinguishing marks (tattoos, scars,
etc.)_____________________. Respondent drives a __________________________, license tag
no:____________(Expires:____) and has a ____(state) driver’s license no: _____________(Expires:____).
Respondent’s home address _____________________________________________ and is employed
by__________________ at _________________________________ and works from ____ to ____ on
(days)___________. Respondent has the following known aliases: ____________________________.
PROTECTED PARTIES’ IDENTIFYING INFORMATION
Petitioner: _________________________ DOB ___________ sex _______ race ______________
Other: _________________________ DOB ___________ sex _______ race ______________
Other: _________________________ DOB ___________ sex _______ race ______________
Other: _________________________ DOB ___________ sex _______ race ______________
Other: _________________________ DOB ___________ sex _______ race ______________
Transmitted to Georgia Protective Order Registry Date __________ Clerk ___________________________
Rev’d 8/14
CONFIDENTIAL INFORMATION FORM - ATTENTION COURT STAFF:
THIS PAGE IS A RESTRICTED-ACCESS DOCUMENT.
This document is not accessible to the public or to other parties.
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SC 24 Stalking Three Year Permanent Protective Order (Cherokee County, Georgia)

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Completed 23 June 2021

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