Form Lpor 14 V.8 - Louisiana Uniform Abuse Prevention Order
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1------FOR LPOR USE ONLY-----
PNO# _________________________
Date Entered: ___________________
Initials:_______ Verified by: _______
LOUISIANA UNIFORM ABUSE PREVENTION ORDER
COURT NAME AND PARISH/CITY:
DOCKET No.: ___________________________
DIV.: ________
FILED: _________________
CLERK: _____________________
□
□
ORDER TO
MODIFY
DISSOLVE
A PRIOR LOUISIANA UNIFORM ABUSE PREVENTION ORDER
Pursuant to La. R.S. 9:372, La. R.S. 9:361 et seq. or La. C.C.P. Art. 3601 et seq.
Court Approved Consent Agreement
PETITIONER’S NAME: _____________________________________________________________________
First
Maiden/Middle
Last
□
□
Date of Birth ____________________
Sex:
F
M
Race: ______________
month/day/year
□
□
Protected person is:
Petitioner
other(s) List other(s) name & date of birth:
____________________________________________________________________________________________
____________________________________________________________________________________________
V.
DEFENDANT’S NAME: ______________________________________________________________________
□
□
Alias: ___________________
Date of Birth:_________________
Sex:
F
M
Race: ______
month/day/year
Address:_____________________________________________________________________________________
No. & Street
Apt. No.
City
State
Zip Code
Social Security #: ______________________ Dr. Lic. # ___________________ State ____ Exp. _________
(date)
IT IS ORDERED THAT THE DEFENDANT BE SERVED WITH A COPY OF THIS ORDER.
□
1. IT IS HEREBY ORDERED, ADJUDGED, and DECREED that the Louisiana Uniform Abuse Prevention
Order issued in the above-captioned and numbered matter in the form of a
□
□
□
Temporary Restraining Order
Preliminary Injunction
Permanent Injunction
on ______________________
, pursuant to:
(month/day/year)
□
□
□
La. R.S. 9:372
La. R.S. 9:361 et seq.
La. C.C.P. Art. 3601 et seq.
is hereby modified on this date as indicated on the attached Louisiana Uniform Abuse Prevention Order
form LPOR 9 (if La. R.S. 9:372), LPOR 11 (if La. R.S. 9:361) or LPOR 13 (if La. C.C.C.P. Art 3601).
OR
□
2. IT IS HEREBY ORDERED, ADJUDGED, AND DECREED that the Louisiana Uniform Abuse
Prevention Order issued in the above-captioned and numbered matter in the form of a
□
□
□
Temporary Restraining Order
Preliminary Injunction
Permanent Injunction
on ______________________
, pursuant to:
(month/day/year)
□
□
□
La. R.S. 9:372
La. R.S. 9:361 et seq.
La. C.C.P. Art. 3601 et seq.
be and the same is hereby dissolved.
□
3. THE COURT ORDERS THE DEFENDANT to pay all court costs.
Date of Order
___________________________________
SIGNATURE OF JUDGE
__________________
month/day/year
____________________________________________
PRINT OR STAMP JUDGE’S NAME
_______________________
_______________________________
PETITIONER
DEFENDANT
□
DEFENDANT WAS SERVED AT CLOSE OF HEARING.
Date _________________________
Clerk _______________________________
□
FAXED OR ELECTRONICALLY TRANSMITTED TO LOUISIANA PROTECTIVE ORDER REGISTRY
Date _________________________
Clerk _______________________________
Copies to: 1) Court file 2) Petitioner/protected person(s) 3) Defendant 4) Chief Law Enforcement Official of the
parish where the protected person(s) resides 5) Louisiana Protective Order Registry.
Page 1 of 1
LPOR 14
v.8
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