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

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1
ORI Number ____________________
SC-23
THE SUPERIOR COURT FOR THE COUNTY OF
STATE OF GEORGIA
State of Georgia :
: Accusation
v. : No. _______________
:
, :
Defendant. :
STALKING PERMANENT PROTECTIVE ORDER
PURSUANT TO CRIMINAL CONVICTION
Defendant appeared before this Court and was convicted of stalking O.C.G.A. § 16-5-90.
Pursuant to O.C.G.A. § 16-5-90(d) a permanent restraining order is issued to protect the victim and the
members of the victim’s immediate family; therefore IT IS HEREBY ORDERED AND ADJUDGED:
1. Defendant is hereby enjoined and restrained from doing or attempting to do, or
[pco01,02] threatening to do, any act constituting a violation of O.C.G.A. §§ 16-5-90 et seq. and of
harassing, interfering, or intimidating or his/her immediate family.
Any future acts committed by the Defendant towards 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. Defendant is enjoined and restrained from approaching within yards of
[pco01,04] ___________________ and/or her/his immediate family, and/or residence, place of
employment, or school and any subsequent residence, workplace or school.
3. Defendant is not to have any contact of any type, direct, indirect, or through another
[pco05] person with 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.
5. This Order shall remain in effect permanently and shall not terminate unless modified by
the 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
ACCUSATION 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 this Court determined that it had jurisdiction over the parties and the subject matter
under the laws of the State of Georgia and Defendant received reasonable notice and
had the opportunity to be heard before this Order was issued sufficient to protect the
Defendant’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 if an Order of the enforcing state or jurisdiction.
ONLY THE FOLLOWING THAT ARE INTITIALED BY THE JUDGE SHALL APPLY:
8.
Defendant is to receive appropriate psychiatric or psychological services.
9.
[pco07]
Protected party is either a spouse, former spouse, parent of a common child,
child of a protected party, child of Defendant, cohabitates or has cohabited with
Defendant and qualifies for 18 U.S.C. § 922(g)
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
ACCUSATION NO.
NOTICE TO DEFENDANT
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 Order signed
and filed, 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 another person on public or private property for the purpose of harassing and intimidating the
other person. This activity can subject the Defendant 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
ACCUSATION NO.
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.
5
ACCUSATION 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.*
DEFENDANT’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: Defendant’s date of birth OR social security number)
Defendant’s social security number is _______________, date of birth is _________, sex ____, color of hair
__________, color of eyes ______________, height _______, weight _____. Defendant’s race is __________,
ethnic background ____________. Defendant has distinguishing marks (tattoos, scars,
etc.)_____________________. Defendant drives a __________________________, license tag
no:____________(Expires:____) and has a ____(state) driver’s license no: _____________(Expires:____).
Defendant’s home address _____________________________________________ and is employed
by__________________ at _________________________________ and works from ____ to ____ on
(days)___________. Defendant 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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