Form 23.4 - Petition For Temporary Restraining Order To Prevent Interference With Investigation Of Reported Abuse Of An Adult - Hamilton County, Ohio

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PROBATE COURT OF HAMILTON COUNTY, OHIO
RALPH WINKLER, 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
FORM 23.4 – PETITION FOR TEMPORARY RESTRAINING ORDER TO PREVENT INTERFERENCE WITH
INVESTIGATION OF REPORTED ABUSE OF AN ADULT
01/01/2010

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