Fillable Ex Parte Protection Order printable pdf download

State of Alabama Unified Judicial System, Form C-4 Page 1 of 3

Ex Parte Protection Order

Rev. 6/07

Case No.

(Protection from Abuse Act)

§30-5-1, et seq., Ala. Code 1975

In the

Circuit or

District Court of

_________________________________ County, ALABAMA

Amended Order

PLAINTIFF

First

Middle

Last

Date of Birth (DOB) of Plaintiff

and/or any minor(s) or minor child(ren) on whose behalf the

Other Protected Persons(s) [List Name(s) and DOB(s)]:

Petition for Protection from Abuse filed [List Name(s) and DOB(s)]

______________________________________

DEFENDANT

_________________________________________

DEFENDANT IDENTIFIERS

SEX

RACE

DOB

First

Middle

Last

Relationship to Plaintiff :

EYES

HAIR

DISTINGUISHING FEATURES

Spouse

Ex-Spouse

Child

Parent

Relation within 6

Degree Consanguinity or Affinity

Common Law Marriage

Child in Co mon

Present or Former Household Member

DRIVERS LICENSE #

STATE

EXP DATE

__________

Defendant’s Home Address & Telephone #:

_____________________________________

VEHICLE

TAG#

CAUTION : WEAPONS INVOLVED

Firearm

Knife

Hands, Feet, Fist

Other:__________________

Weapon Present on the Property

THE COURT HEREBY FINDS (Check all that apply):

Pursuant to the sworn Affidavit/Petition and/or testimony of the Plaintiff seeking protection from abuse, the Court finds that it has jurisdiction over the parties and subject

matter and that:

A temporary order is necessary to prevent abuse.

The Defendant represents a credible threat to the physical safety of the:

Plaintiff; and/or

Minor(s): and/or

Minor child(ren); and/or

Any designated family or household member to wit:________________________________________________________________________________.

THE COURT HEREBY ORDERS (Check all that apply):

That the above-named Defendant be restrained from committing further acts of abuse or threats of abuse as defined in the Protection from Abuse Act.

That the above-named Defendant be restrained from any contact with the

Plaintiff, and/or

Minor(s): and / or

Minor Child(ren); and/or

Any designated household or family member, to wit : _______________________________________________________.

Additional terms of this order follow on succeeding pages.

The terms of this order shall be effective until:

_____________________ , _________________ ; or

further Order of the Court.

NOTICE TO LAW ENFORCEMENT

This Order shall be enforced, even without registration, by courts and any law enforcement officer of any state, the District of

Columbia, any U.S. territory, and may be enforced by Tribal lands (18 U.S.C.A. Section 2265).

WARNINGS TO DEFENDANT :

This Order shall be enforced, even without registration, by the courts and any law enforcement officer of any State, the District

of Columbia, and any U.S. territory, and may be enforced by Tribal Lands (18 U.S.C.A. Section 2265). Crossing state, territorial,

or tribal boundaries to violate this Order may result in penalties, including federal imprisonment (18 U.S.C.A. Section 2262).

Federal law provides penalties for possessing, transporting, shipping, or receiving any firearm or ammunition while subject to

a qualified protection order or after being convicted of a misdemeanor crime of domestic violence [18 U.S.C.A. Sections 922(g)(8)

and 922(g)(9)]. This Order is also enforceable on U.S. Department of Defense installations (10 U.S.C.A. Section 1561a). A willful

violation of this ORDER is a Class A misdemeanor punishable by a fine not to exceed six thousand dollars ($6,000) or imprisonment

for up to a year in jail, or both, and is also punishable for civil contempt (Section 30-5-8, Ala. Code 1975). In addition, Sections

30-5-9 and 30-5A-3(c)(2), Ala. Code 1975, further outline penalties for violations of protection, restraining, or injunctive orders.

ONLY THE COURT CAN CHANGE THIS ORDER

Original-Court Record

Copy-Law Enforcement

Copy-Plaintiff

Copy-Defendant

Ex Parte Protection Order

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