Ex Parte Order Of Protection Form
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__________________________
Ex Parte Order
Case No.
Protection
of
Court:
Div.
Amended Order
County:
, Arkansas
Petitioner/Plaintiff
This Order is Effective Until:
First
Middle
Last
Pursuant to Federal law, this
Order shall be enforced by law
Petitioner’s Date of Birth (mm/dd/yyyy)
Race
Sex
enforcement officers in all
Minor Children Protected under this Order:
states, territories, districts and
________________________________d.o.b.___________
tribal lands regardless of
________________________________d.o.b.___________
whether this Order of
Protection is registered locally.
________________________________d.o.b.___________
________________________________d.o.b.___________
Versus
Respondent/Defendant
Respondent Identifiers
Sex
Race
DOB
Ht
Wt
mm/dd/yyyy
First
Middle
Last
Eyes
Hair
SS#
___________________________________
Address:
___________________________________
Phone #
DL # or other ID#
CAUTION:
Respondent possesses a firearm
Respondent has history of extreme violence
Relationship Identifiers
:
Current or former spouses
Parents of child(ren) in common
Lived together
Current or past dating relationship
Other Relative (Explain)_______________________________
THE COURT HEREBY FINDS AND ORDERS:
That there is jurisdiction over the parties and subject matter, and the Petitioner has presented sufficient evidence to
show: 1.) that the victim(s) is (are) in immediate and present danger of domestic abuse or 2.) that the Respondent is
scheduled to be released from incarceration within thirty(30) days, and upon the Respondent’s release there will be an
immediate and present danger of domestic abuse. The Ex Parte Temporary Order of Protection is hereby granted
pursuant to the terms herein.
The Respondent is ordered to appear before the Court on the ______ day of ________________, 2_____ at
_____a.m./p.m. in the Courthouse located at ___________________________________, ______________, AR.
If you fail to appear, the Court will likely make this Order permanent without further notice to you.
The Respondent is hereby restrained from committing any criminal act against the victim(s) including, but not limited
to: acts of violence or Domestic Abuse, A.C.A §9-15-103 (3); Harassment A.C.A §5-71-208; Harassing Communications
A.C.A. §5-71-209; Stalking A.C.A. §5-71-229; or Terroristic Threatening A.C.A. §5-13-301.
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