Free Notice to Respondent and Request for Hearing - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN

_____________________________________
Petitioner (your nam e) Gua rdian Petitioner,
vs. _____________________________________ Respondent (person to be restrained)

) ) ) ) ) ) ) ) )

CASE NO :__________________________ NOTICE TO R ESPONDENT / REQUEST FOR HEARING [Elderly Persons and Person s with Disabilities Abus e Prevention A ct]

THIS FORM MUST BE ATTACHED TO SERVICE COPY OF RESTRAINING ORDER TO RESPONDENT : A TEMPORARY RESTRAINING ORDER HAS BEEN ISSUED BY THE COURT W HICH AFFECTS YOUR RIGHTS AND IS NOW IN EFFECT. THIS ORDER BECOMES EFFECTIVE IMMEDIATELY . IF YOU W ISH TO CONTEST T HE CONTINUATION OF T HIS ORDER , YOU MUST COMPLETE THIS FORM AND MAIL OR DELIVER IT TO (ADDRESS OF COURT ): LINN COUNTY CIRCUIT COURT PO BOX 1749 ALBANY, OR 97321 REQUESTS FOR HEARING MUST BE MADE W ITHIN 30 DAYS AFTER YOU RECEIVE THE ORDER . YOU MUST INCLUDE YOUR ADDRESS AND TELEPHONE NUMBER WITH YOUR REQUEST FOR A HEARING . THE HEARING W ILL BE HELD W ITHIN 21 DAYS . AT THE HEARING , A JUDGE W ILL DECIDE W HETHER T HE ORDER SHOULD BE CANCELED OR CHANGED . THE ONLY PURPOSE OF THIS HEARING W ILL BE TO DETERMINE IF THE TERMS OF THE COURT 'S ORDER SHOULD BE CANCELED , CHANGED , OR EXTENDED . Keep in mind that this Order remains in effect until the court that issued the Order amends or dismisses it. It may also be renewed upon good cause shown, regardless of whether there has been a further act of abuse. If you are arrested for violating this Order, the security amount (bail) is $5,000, unless a different amount is ordered by the court. Violation of this Order constitutes contempt of court and is punishable by a fine of up to $500 or 1 percent of your annual gross income, whichever is greater, a jail term of up to six months, or both. Other sanctions may be imposed.

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REQUEST FOR HEARING I am the Respondent in the above-referenced action and I request a hearing to contest all or part of the Order as follows (mark one or more): ___ The Order restraining me from contacting or attempting to contact the petitioner. Other: I (will) (will not) be represented by an attorney at the hearing. Notice of the time and place of the hearing can be mailed to me at the address below my signature. (If you completed this document without the assistance of an attorney, you are required to complete truthfully the certificate below.) I certify that: (check the blank that applies) I selected this document for myself, and I completed it without paid assistance and without assistance from an attorney. I paid, or will pay, money to _____________________________________ for assistance in preparing this document.

Date: _____________________________

________________________________ Signature of Respondent ________________________________ Print Name Above ________________________________ Address or Contact Address ________________________________ City/State/Zip ________________________________ Telephone or Contact Telephone Number(s)

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