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ORI Number SC-17 THE SUPERIOR COURT FOR THE COUNTY OF COLUMBIA STATE OF GEORGIA , : Petitioner, : Civil Action File v. : , : No. Respondent. : STALKING EX PARTE TEMPORARY PROTECTIVE ORDER Upon proceedings before me, the Petitioner having demanded pursuant to O.C.G.A. § 16-5-94 that a Protective Order be issued; and alleged that Respondent has knowingly and willfully committed or attempted to commit acts in violation of O.C.G.A. § 16-5-90 et seq., and such acts were not at the home of the Respondent, had no legitimate purpose and that Petitioner is in reasonable fear of her/his safety and/or the safety of her/his immediate family; and it appearing to the Court that probable cause exists to believe that similar events will occur in the future, IT IS HEREBY ORDERED AND ADJUDGED: 1. That Respondent is enjoined and restrained from any acts directly or indirectly [pco01,02] which harass and/or intimidate the Petitioner or her/his immediate family. 2. That Respondent is enjoined from approaching within yards of Petitioner. [pco01,04] 3. That Respondent have no contact of any type, direct or indirect, or through another person with Petitioner, or her/his immediate family, including but not limited to telephone, fax, or any other means of communication. 4. That the Respondent appear before this Court, on the day of , 20 at in room of the County Courthouse at to show cause why the requests of the Petitioner should not be granted. 5. That a copy of this Order be given to local law enforcement and the Respondent be served with a copy of this Order and Petition for Stalking Temporary Protective Order instanter. 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. 6. 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. 16-5-94 and 19-13-4 Law enforcement may use their arrest powers pursuant to O.C.G.A. 16-5-91 and 17-4-20 to enforce the terms of this Order. 7. That these proceedings be filed in the office of the Clerk of this Court. 8. 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 the Respondent be given reasonable notice and opportunity to be heard sufficient to protect the Respondent’s due process rights and this Order shall be presumed valid and pursuant to 18 U.S.C. § 2265(a) 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. SO ORDERED this day of 20 . JUDGE, SUPERIOR COURT County Print or stamp Judge’s name Violation of the above Order may be punishable by arrest. 2 ---PAGE BREAK--- CIVIL ACTION FILE NO. 3 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, follows, 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 the 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. 4 Pursuant to O.C.G.A. § 19-13-3, Petitioner assisted by Name: Address: Telephone: Note to Judges: This form is promulgated as a Uniform Superior Court Rule under the auspices of O.C.G.A. § 19-13-53. To order a specific provision, please initial in the space provided. The court should delete or otherwise make inoperative any provision in the standardized form which is not supported by the evidence in the case and in order to comply with the court's application of the law and facts to an individual case. ---PAGE BREAK--- CIVIL ACTION FILE NO. 5 *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 8/14 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.