Free So that the Order of Protection is valid, - Indiana

So that the Order of Protection is valid, after you print, YOU MUST REPLACE THIS PAGE with the

Cover Sheet: Order of Protection
(available for download in PDF format)

CHPO-0101

Approved 7-1-07 Revised 7-1-08

STATE OF INDIANA ) COUNTY OF ___________ ) SS: Department of Child Services, Petitioner v. _________________________ Alleged Perpetrator/ Respondent

IN THE ________________COURT ____ (_____________ DIVISION, ROOM ___)

Case Number _____________

_____________________________ Parent or other adult with whom the child will continue to reside In the Matter of: ) ) ) ) ) ) )

___________________, Initials of the Child(ren) Alleged to be a Child in Need of Services

CHILD PROTECTIVE ORDER AFTER NOTICE AND HEARING - CHINS Comes now the Court, under Indiana Code § 31-34-2.3 and issues this Child Protective Order. Findings a. The Court finds the Department of Child Services filed a Verified Petition for a

Child Protective Order. b. The Court finds: (1) A Temporary Child Protective Order was issued on the _____ day of ____________, at ____, __ m. (2) A hearing was held on _____________________________. (3) The Alleged Perpetrator/Respondent, _____________________________, had notice of this hearing and an opportunity to be heard. The Alleged Perpetrator/Respondent was/was not present. (4) ________________________, the Parent or other adult, with whom the child(ren)

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CHPO-0101

Approved 7-1-07 Revised 7-1-08

_____________________________ (insert initials of child(ren)) will continue to reside, has had notice of this hearing and an opportunity to be heard. The Parent or other adult was/was not present. c. (1) The Court also finds: the child(ren) is not in danger of child abuse or neglect from a parent or other adult with whom the child(ren) will continue to reside in the child(ren)'s residence; and (2) one (1) or more of the following exist: [choose one or both of the following provisions] ____ (a) the presence of the alleged perpetrator of child abuse or neglect

in the child(ren)'s residence constitutes a continuing danger to the physical health or safety of the child(ren). ____ (b) the child(ren) has been the victim of sexual abuse, and there is a substantial risk the child(ren) will be the victim of sexual abuse in the future if the alleged perpetrator of child abuse or neglect remains in the child(ren)'s residence. d. The Court finds the best interests of the child(ren) will be served if the Alleged

Perpetrator/Respondent is removed from the child(ren)'s residence. ORDER 1. THE ALLEGED PERPETRATOR/RESPONDENT, 04
IDACS Codes

_________________________, shall be removed from the child's residence at ________________________________________________. 2. THE ALLEGED shall PERPETRATOR/RESPONDENT, not enter the child's residence

___________________________,

04

at______________________________________________. 3. ___________________________, the parent or other adult with whom the child will continue to reside in the child's residence shall make reasonable efforts: (a) to monitor the residence; and (b) to report to the department and the appropriate law enforcement agency any attempt by the alleged perpetrator of child abuse or neglect to return to the child's residence.

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CHPO-0101

Approved 7-1-07 Revised 7-1-08

4.

Other relief as provided under Indiana Code § 34-26-5-9: _________________ ________________________________________________________________.

This order is valid until one (1) of the following occurs: (1) (2) The Court determines the child(ren) is not a child in need of services. The child(ren) is adjudicated a child in need of services and the Court

enters a dispositional decree. 5. All references in this cause to the child(ren) shall be by initials only in order to protect the confidentiality of the child(ren). DATE: _______________ ___________________________________ Judge IMPORTANT NOTICE VIOLATION OF THIS ORDER IS PUNISHABLE BY CONFINEMENT IN JAIL, PRISON, AND/OR A FINE. IF SO ORDERED BY THE COURT, THE RESPONDENT IS FORBIDDEN TO ENTER OR STAY AT THE PETITIONER'S RESIDENCE OR RESIDENCE OF ANY CHILD WHO IS THE SUBJECT OF THE ORDER, EVEN IF INVITED TO DO SO BY THE PETITIONER OR ANY OTHER PERSON. IN NO EVENT IS THE ORDER FOR PROTECTION VOIDED. PURSUANT TO 18 U.S.C. 2265, THIS ORDER FOR PROTECTION SHALL BE GIVEN FULL FAITH AND CREDIT IN ANY OTHER STATE OR TRIBAL LAND AND SHALL BE ENFORCED AS IF IT WERE AN ORDER ISSUED IN THAT STATE OR TRIBAL LAND. PURSUANT TO 18 U.S.C. 922(g), ONCE A RESPONDENT HAS RECEIVED NOTICE OF THIS ORDER AND AN OPPORTUNITY TO BE HEARD, IT IS A FEDERAL VIOLATION TO PURCHASE, RECEIVE, OR POSSESS A FIREARM WHILE SUBJECT TO THIS ORDER IF THE PROTECTED PERSON IS: (A) THE RESPONDENT'S CURRENT OR FORMER SPOUSE; (B) A CURRENT OR FORMER PERSON WITH WHOM THE RESPONDENT RESIDED WHILE IN AN INTIMATE RELATIONSHIP; OR (C) A PERSON WITH WHOM THE RESPONDENT HAS A CHILD. INTERSTATE VIOLATION OF THIS ORDER MAY SUBJECT THE RESPONDENT TO FEDERAL CRIMINAL PENALTIES UNDER 18 U.S.C. 2261 AND 18 U.S.C. 2262. A PARENT OR OTHER ADULT WITH WHOM A CHILD CONTINUES TO RESIDE AFTER THE ISSUANCE OF A CHILD PROTECTIVE ORDER FOR REMOVAL OF AN ALLEGED PERPETRATOR OF CHILD ABUSE OR NEGLECT WHO KNOWINGLY OR INTENTIONALLY FAILS TO COMPLY WITH THIS ORDER COMMITS A CLASS A MISDEMEANOR.

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CHPO-0101

Approved 7-1-07 Revised 7-1-08

STATEMENT OF RESPONDENT I have read the above Order and I understand it. I also understand that violation of this Order constitutes a Class A misdemeanor in violation of Indiana Code § 31-342.3-8. However, the offense is a Class D felony if the alleged perpetrator has a prior unrelated conviction under this section. A copy of this Order has been given to me this ________ day of ________________, _______.

_______________________________________ Signature of Respondent

STATEMENT OF PARENT OR ADULT I have read the Order and I understand it. I also understand that violation of this Order constitutes a Class A misdemeanor in violation of Indiana Code § 31-34-2.3-7. A copy of this Order has been given to me this ________ day of ________________, _______.

_______________________________________ Signature of parent or other adult with whom the child will continue to reside

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