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SC-30 Dating Violence Twelve Month Protective Order ORI Number SC-30 THE SUPERIOR COURT FOR THE COUNTY OF COLUMBIA STATE OF GEORGIA , : Petitioner, : Civil Action File v. : , : No. Respondent. : DATING VIOLENCE TWELVE MONTH PROTECTIVE ORDER A hearing was held on this matter on for which Respondent had notice as required by law and at which Respondent appeared and/or was provided with the opportunity to be heard and Petitioner requested that the Protective Order entered in this case be continued. Having heard the evidence presented, reviewed the petition and the entire record concerning this case and for good cause shown, the court FINDS that the parties are currently, or within the last six months were, in a dating relationship or that a party to this action is currently pregnant with the other party’s child: FINDINGS OF FACT/S – At least one of the following is found as initialed by the Judge: a. There is a committed romantic relationship between the parties that is not associated with mere friendship or ordinary business, social, or educational fraternization; b. Factors exist which corroborate the dating relationship; c. The parties developed interpersonal bonding above a mere casual fraternization; d. The length of the relationship between the parties is indicative of a dating relationship; e. The nature and frequency of the parties’ interactions, including communications, indicate the parties intended to be in a dating relationship; f. The parties by statement or conduct demonstrated an affirmation of their relationship to others; g. Both parties have acknowledged the dating relationship; or, h. A party to this action is currently pregnant with the other party’s child. The Court relied on the following specific facts in finding the above: For your convenience, this form has been designed to be completed online. The information typed on the first page will automatically update to the other pages. Please be sure all pertinent information is completed before printing. Once the form is completed, select 'Print' to print the form. Selecting 'Reset' will clear the entire form. Print Reset ---PAGE BREAK--- CIVIL ACTION FILE NO. 2 The Court further finds by a preponderance of the evidence that the following act(s) of Dating Violence has/have occurred in the past and may occur in the future: Simple battery (O.C.G.A. § 16-5-23) Battery (O.C.G.A. § 16-5-23.1) Simple assault (O.C.G.A. § 16-5-20) Stalking (O.C.G.A. § 16-5-90) The felony offense(s) of IT IS HEREBY ORDERED AND ADJUDGED: 1. That these proceedings be filed in the office of the Clerk of this Court. 2. That this Order applies in every county throughout the state and it shall be the duty of every court and every law enforcement official to enforce and carry out the provisions of this Order pursuant to O.C.G.A. § 19-13A-4 Law enforcement may use their arrest powers pursuant to O.C.G.A. § 17-4-20 to enforce the terms of this Order. 3. This Order shall remain in effect for up to twelve (12) months from this date until 4. Respondent has violated the Dating Violence Act, O.C.G.A. § 19-13A-1 et seq. by committing dating violence, and represents a credible threat to the physical safety of Petitioner. Respondent is hereby enjoined and restrained from doing or attempting to do, or threatening to do any act of injury, maltreating, molesting, following, harassing, harming, or abusing Petitioner in any manner. Respondent is not to interfere with Petitioner’s travel, transportation, or communication. Respondent shall not follow, place under surveillance, or contact the petitioner at any place of Petitioner for the purpose of harassing and intimidating Petitioner. 5. That this Court determined that it had jurisdiction over the parties and the subject matter under the laws of the State of Georgia and the Court ordered that Respondent be given reasonable notice and opportunity to be heard sufficient to protect Respondent’s due process rights. This Order shall be presumed valid and pursuant to 18 U.S.C. § 2265 shall be accorded full faith and credit by any other state or local jurisdiction and shall be enforced as ordered as if an Order of the enforcing state or jurisdiction. [pco01] ---PAGE BREAK--- CIVIL ACTION FILE NO. 3 [pco01, 04] [pco05] ONLY THE FOLLOWING THAT ARE INITIALED BY THE JUDGE SHALL APPLY: 6. Respondent is ordered to permit Petitioner to enter Respondent’s residence to retrieve Petitioner’s property and law enforcement (sheriff or police department) is ordered to assist Petitioner in returning to Respondent’s residence and retrieving Petitioner’s property. 7. Respondent shall immediately surrender to law enforcement (sheriff or police department) all and any keys, garage door openers and other security devices to Petitioner’s residence and law enforcement shall ensure that these are given to Petitioner. 8. Petitioner’s address is ordered to be kept confidential. 9. Respondent is ordered to stay away from Petitioner’s residence at and workplace at and school and any subsequent residence or workplace or school of Petitioner. 10. That Respondent is restrained and enjoined from approaching within yards of Petitioner. 11. Respondent is ordered not to have any contact, direct, indirect, or through another person, with Petitioner, by telephone, fax, e-mail, electronic media, or any other means of communication except as specified in this Order. 12. That Respondent, only when accompanied by local law enforcement, shall be able to remove his/her clothing and personal items from Petitioner’s residence as follows: 20__ at 13. Respondent is ordered not to interfere with Petitioner including that Respondent may not sell, encumber, trade, damage, contract to sell, or otherwise dispose of or remove from the jurisdiction of this court any of the property of Petitioner. 14. That Petitioner shall be allowed to remove the following property from Respondent’s residence for Petitioner’s use: and on 20 at law enforcement (sheriff or police department) is hereby ordered to assist Petitioner during this removal. [pco04] ---PAGE BREAK--- CIVIL ACTION FILE NO. 4 15. That Respondent shall be required to return the following property for Petitioner’s and on 20 at law enforcement (sheriff or police department) is hereby ordered to assist Petitioner during this return. 16. Respondent is ordered to undergo appropriate or educational services (initial all that apply): Respondent is ordered to undergo evaluation for drug/alcohol abuse and to follow the recommended treatment. Respondent is ordered to undergo health evaluation and to follow the recommended treatment. It is further Ordered that Respondent shall make arrangements to begin a Georgia Commission on Family Violence (GCFV) certified family violence intervention program (FVIP) within fourteen (14) days of the signing of this Order, or if appropriate within fourteen (14) days upon release from incarceration. A list of local certified agencies can be found at www.gcfv.ga.gov. Furthermore, Respondent shall appear before this court at for a hearing on the status of his/her application, attendance and/or completion of the FVIP. At that hearing, Respondent is ordered to present to this court a written status report from the agency providing the certified FVIP. The status report shall detail Respondent’s application, attendance and/or completion of or failure to apply, attend and/or complete the FVIP and shall be signed by an officer of the agency. 17. Petitioner is awarded costs and attorney fees in the amount of 18. Respondent is awarded attorney fees in the amount of 19. It is further Ordered: SO ORDERED day of [pco08] ---PAGE BREAK--- CIVIL ACTION FILE NO. 5 JUDGE, SUPERIOR COURT County Print or stamp Judge’s name Violation of the above Order may be punishable by arrest. ---PAGE BREAK--- CIVIL ACTION FILE NO. 6 NOTICE TO RESPONDENT 1. Violation of this Order may result in immediate arrest and criminal prosecution that may result in jail time and/or fines and/or may subject you to prosecution and penalties for contempt of court. 2. This Order shall remain in effect unless specifically superseded by a subsequent signed and filed Order, by operation of law, or by Order of dismissal, whichever occurs first. Only this Court can void, modify or dismiss this Order. Either party may ask this Court to change or dismiss this Order. 3. A person commits the offense of Aggravated Stalking when such person, in violation of a temporary or permanent protective Order prohibiting this behavior, follow, places under surveillance, or contacts Petitioner on public or private property for the purpose of harassing and intimidating the other person. This activity can subject Respondent to arrest and prosecution for felony Aggravated Stalking, which carries penalties of imprisonment for not less than 1 year nor more than 10 years and a fine of up to $10,000.00. ---PAGE BREAK--- CIVIL ACTION FILE NO. 7 Pursuant to O.C.G.A. § 19-13A-3, Petitioner assisted by Name: Address: Telephone: ---PAGE BREAK--- CIVIL ACTION FILE NO. 8 *REMOVE THIS PAGE FROM ORDER AND FILE SEPARATELY UNDER SEAL* *For transmittal to the Georgia Protective Order Registry and, if applicable, the National Crime Information Center.* RESPONDENT’S IDENTIFYING FACT SHEET (please complete as much as possible; one of these must be provided to have the order placed in the National Crime Information Center registry: Respondent’s date of birth OR social security number) Respondent’s social security number is date of birth is sex color of hair color of eyes height weight Respondent’s race is ethnic background Respondent has distinguishing marks (tattoos, scars, Respondent drives a license tag and has a ____(state) driver’s license no: Respondent’s home address and is employed at and works from to on Respondent has the following known aliases: PROTECTED PARTIES’ IDENTIFYING INFORMATION Petitioner: DOB sex race Other: DOB sex race Other: DOB sex race Other: DOB sex race Other: DOB sex race Transmitted to Georgia Protective Order Registry Date Clerk Rev’d 1/22 CONFIDENTIAL INFORMATION FORM - ATTENTION COURT STAFF: THIS PAGE IS A RESTRICTED-ACCESS DOCUMENT. This document is not accessible to the public or to other parties.