Ohio Probate Form - Petition For Temporary Restraining Order To Prevent Interference With The Provision Of Protective Services To An Adult
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1PROBATE COURT OF ___________________________COUNTY, OHIO
_______________________________, JUDGE
IN THE MATTER OF __________________________________________, AN ADULT
CASE NO. _______________________
PETITION FOR TEMPORARY RESTRAINING ORDER TO PREVENT
INTERFERENCE WITH THE PROVISION OF PROTECTIVE SERVICES TO
AN ADULT
[R.C. 5101.68]
1.
The above-named Adult is in need of protective services for the following reasons:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2.
The Adult has consented to the protective services.
3.
The Respondent (Name and Address):
_____________________________________________________________________________
_____________________________________________________________________________
has interfered with the provision of these services in the following manner:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
4.
Unless Respondent is restrained, Petitioner will be unable to provide protective services
in accordance with Chapter 5101. of the Revised Code.
WHEREFORE, the Petitioner requests the Court to issue an order restraining Respondent from
interfering with the provision of protective services to the Adult and such further relief as may be
equitable.
______________________County Department of Job and Family Services
_______________________________
:_________________________________
By
Attorney
_______________________________
____________________________________
Address
Title
_______________________________
____________________________________
Address
_______________________________
____________________________________
Phone Number (including area code)
_______________________________
____________________________________
Registration No.
Phone Number (including area code)
_______________________________
____________________________________
E-mail
E-mail
Print Form
FORM 23.6 – PETITION FOR TEMPORARY RESTRAINING ORDER TO PREVENT INTERFERENCE WITH
THE PROVISION OF PROTECTIVE SERVICES TO AN ADULT
Eff. Date: January 1, 2010
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