Stalking Twelve Month Protective Order Template Page 3
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3Civil Action File No.
NOTICE TO RESPONDENT
NOTICE TO RESPONDENT
1.
1.
Violation of this Order may result in immediate arrest and criminal prosecution that
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
may result in jail time and/or fines and/or may subject you to prosecution and penalties
for contempt of court.
for contempt of court.
This Order shall remain in effect unless specifically superceded by a subsequent signed
This Order shall remain in effect unless specifically superceded by a subsequent signed
2.
2.
and filed Order, by operation of law, or by Order of Dismissal, whichever occurs first.
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
Only this Court can void, modify, or dismiss this Order. Either party may ask this Court
to change or dismiss this Order.
to change or dismiss this Order.
A person commits the offense of Aggravated Stalking when such person, in violation of
3.
3.
tem
temporary or
porary or p per erman
manen ent p t pro rote tect cti i v v e o
e ord rder er p pro roh h i i b b i i ti tin n g g th thi i s s b beh eha a v v i i o o r f r fo o l l l l o o w w s s , , places und
places under er
surveillance, or c
surveillance, or contacts P
ontacts Petitioner
etitioner on pu
on pub b l l i i c c o o r r p p rivate property for the purpose of
rivate property for the purpose of
harassing of
harassing of intimidating the other
intimidating the other person. Thi
person. This activity can su
s activity can subject
bject the Re
the Respon
spondent to
dent to
arre
arrest st and prosec
and prosecution for
ution for felon
felony y Aggravat
Aggravated ed Stalki
Stalking, which car
ng, which carries
ries penalties of
penalties of
im
imprisonme
prisonment for not less than
nt for not less than 1 year nor m
1 year nor more
ore that 10 year
that 10 years and
s and a fi
a fine of u
ne of up to
p to
$10,000.00.
$10,000.00.
RESPONDENT'S IDENTIFYING FACT SHEET
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
(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, social security number, or driver's license number)
Information Center registry: Respondent's date of birth, social security number, or driver's license number)
Respondent's social security number is_______________ , date of birth is_______ , sex ___, color
Respondent's social security number is_______________ , date of birth is_______ , sex ___, color
of hair___________ , color of eyes_ ____________ , height_______ , weight _____. Respondent's
of hair___________ , color of eyes_ ____________ , height_______ , weight _____. Respondent's
race is _ _____ , ethnic background_ ___________ . Respondent has distinguishing marks (tattoos,
race is _ _____ , ethnic background_ ___________ . Respondent has distinguishing marks (tattoos,
scars, etc.)_ _____________________ . Respondent drives a _____________________ , license tag
scars, etc.)_ _____________________ . Respondent drives a _____________________ , license tag
number _ _________________ and has a ____(state) driver's license number
number _ _________________ and has a ____(state) driver's license number
.
.
Respondent's home address _ _____________________________________ and
Respondent's home address _ _____________________________________ and
is employed
is employed
by_________________ at ______________________________ and works from ____ to ____ on
by_________________ at ______________________________ and works from ____ to ____ on
(days)___________ .
(days)___________ .
PETITIONER'S IDENTIFYING INFORMATION
Protected parties
DOB
sex
race
DOB
sex
race
DOB
sex
race
DOB
sex
race
Transmitted to Georgia Protective Order Registry
Date
Clerk Rev'd
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