Ohio Probate Form - Petition For Temporary Restraining Order To Prevent Interference With Investigation Of Reported Abuse Of 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 INVESTIGATION OF REPORTED ABUSE OF AN ADULT
[R.C. 5101.63]
1.
Petitioner, _____________________________, is an authorized provider of adult
protective services pursuant to R.C. 5101.60, et seq. and has received a report that the above
named Adult is in need of protective services.
2.
The Adult, _____________________________, residing at _______________________
____________________________is ________years of age, with a date of birth of ___________
and is alleged to be an incapacitated person subject to abuse, neglect, or exploitation.
3.
The Respondent (Name and Address):_________________________________________
______________________________________________________________________________
denied or obstructed access by Petitioner to the residence of the Adult.
4.
Unless Respondent is restrained, Petitioner will be unable to perform its duty to
investigate the report as mandated by R.C. 5101.62.
5.
An Affidavit setting forth the facts to support this petition is attached.
WHEREFORE, the Petitioner requests the Court to issue an order restraining Respondent from
obstructing or in any way interfering with Petitioner’s access to the residence of the Adult and
further ordering access to the Adult by any Peace Officer requesting to accompany the Petitioner.
______________________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 23.4 – PETITION FOR TEMPORARY RESTRAINING ORDER TO PREVENT INTERFERENCE WITH
INVESTIGATION OF REPORTED ABUSE OF AN ADULT
Eff. Date: January 1, 2010
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