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THE SUPERIOR COURT FOR THE COUNTY OF STATE (Cherokee County, Georgia)

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ORI Number
SC-17
THE SUPERIOR COURT FOR THE COUNTY OF
STATE OF GEORGIA
, :
Petitioner, : Civil Action File
v. :
, : No. __________________
Respondent. :
STALKING EX PARTE TEMPORARY PROTECTIVE ORDER
Upon proceedings before me, the Petitioner having demanded pursuant to O.C.G.A. §
16-5-94 that a Protective Order be issued; and alleged that Respondent has knowingly and
willfully committed or attempted to commit acts in violation of O.C.G.A. § 16-5-90 et seq.,
and such acts were not at the home of the Respondent, had no legitimate purpose and that
Petitioner is in reasonable fear of her/his safety and/or the safety of her/his immediate family;
and it appearing to the Court that probable cause exists to believe that similar events will occur
in the future, IT IS HEREBY ORDERED AND ADJUDGED:
1. That Respondent is enjoined and restrained from any acts directly or indirectly
[pco01,02] which harass and/or intimidate the Petitioner or her/his immediate family.
2. That Respondent is enjoined from approaching within yards
of Petitioner.
[pco01,04]
3. That Respondent have no contact of any type, direct or indirect, or through
another person with Petitioner, or her/his immediate family, including but not
limited to telephone, fax, or any other means of communication.
4. That the Respondent appear before this Court, on the day
of , 20 at ______m. in room of the
County Courthouse at to
show cause why the requests of the Petitioner should not be granted.
5. That a copy of this Order be given to local law enforcement and the
Respondent be served with a copy of this Order and Petition for Stalking
Temporary Protective Order instanter.
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.
Print
Reset
CIVIL ACTION FILE NO.
6. That this Order applies in every county throughout the state and it shall be the
duty of every court and every law enforcement official to enforce and carry out
the provisions of this Order pursuant to O.C.G.A. §§ 16-5-94 (e) and 19-13-4
(d). Law enforcement may use their arrest powers pursuant to O.C.G.A. §§
16-5-91 and 17-4-20 to enforce the terms of this Order.
7. That these proceedings be filed in the office of the Clerk of this Court.
8. That this Court determined that it had jurisdiction over the parties and the
subject matter under the laws of the State of Georgia and the Court ordered that
the Respondent be given reasonable notice and opportunity to be heard
sufficient to protect the Respondent’s due process rights and this Order shall be
presumed valid and pursuant to 18 U.S.C. § 2265(a) shall be accorded full faith
and credit by any other state or local jurisdiction and shall be enforced as
ordered as if an Order of the enforcing state or jurisdiction.
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.
2
CIVIL ACTION FILE NO.
3
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. 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.
CIVIL ACTION FILE NO.
4
Pursuant to O.C.G.A. § 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.
CIVIL ACTION FILE NO.
5
*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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THE SUPERIOR COURT FOR THE COUNTY OF STATE (Cherokee County, Georgia)

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Completed 23 June 2021

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