Ex Parte Order Of Protection Form Page 3
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3Office of the Circuit Clerk, _______________County, _____________________, AR ___________
Phone: _____________________
WARNINGS TO RESPONDENT
--Pursuant to A.C.A. §9-15-207, a violation of an Order of Protection is a Class A
misdemeanor carrying a maximum penalty of one year imprisonment in the county
jail or a fine of up to $2,500, or both. A violation of an Order of Protection under this
section within five (5) years of a previous conviction for violation of an Order of
Protection is a Class D felony punishable by up to six years in prison or up to a
$10,000 fine or both.
--It is a federal offense for an individual who is subject to a Final Order of Protection
or convicted of a misdemeanor of domestic violence to ship, transport, or possess a
firearm or ammunition pursuant to 18 U.S.C. §922(g)(8) and (9).
--Crossing state, territorial, or tribal boundaries to violate this Order may result in
federal imprisonment pursuant to 18 U.S.C. §2262.
NOTICE TO LAW ENFORCEMENT
--This Order of Protection is enforceable in every county of this state by any court or
law enforcement officer. See A.C.A. §9-15-207(g).
PROOF OF SERVICE
Case #_____________________
Court Date:______________________________
SERVED: Date_______________ Time:___________ Place______________________
Attempts Made: List only date and time
1) ____________________ 2)____________________3)____________________
________________________________________________________________________
Served On (Print Name)
Manner of Service
_____________________________________________________________________________________________________
Served By (Print Name)
Title
Badge #
DECLARATION OF SERVER
I declare, under penalty of perjury under the laws of the State of Arkansas that the foregoing information
contained in the proof of service is true and correct.
Executed on ________________
______________________________________________________
Date
Signature of Server
______________________________________________________
Address of Server
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