Free jc65.pmd - Michigan

Approved, SCAO

Original -Court 1st copy - Respondent 2nd copy - Law Enforcement Agency Copies as needed JIS CODE: OAA

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY
Court address

ORDER REMOVING ALLEGED ABUSER FROM CHILD'S HOME (CHILD PROTECTIVE PROCEEDINGS)

CASE NO. PETITION NO.

Court telephone no. name(s), alias(es), DOB

1. In the matter of

Regarding alleged abuser Height Weight Race

Last name

First name Sex

Middle initial

Relationship to child Hair color Eye color

Date of birth or age Other identifying information

Driver's license no.

2. Date of hearing: Judge/Referee: Bar no. 3. Notice of hearing was given as required by law. THE COURT FINDS: 4. A petition alleging abuse of the child(ren) has been authorized and there is probable cause to believe the parent, guardian, legal custodian, or other person committed the alleged abuse. 5. The alleged abuser's presence in the home presents a substantial risk of harm to the child(ren)'s life, physical health, or mental well-being. IT IS ORDERED that: 6. The alleged abuser named above shall a. leave the home at until further order of the court and have no contact with the child(ren) named above except as follows:

b. pay $

as appropriate support to maintain a suitable home environment for the child(ren).
Name of local law enforcement agency

c. surrender any firearms or potentially dangerous weapons to 7. Other:

.

8. This order is valid from until and is effective when the alleged abuser receives notice. A violation of the terms and conditions subjects the alleged abuser to criminal contempt of court. If found guilty of violating this order, the alleged abuser may be jailed for up to 90 days and fined up to $500.00.

Recommended by:
Referee signature

Date

Judge

Do not write below this line - For court use only

MCL 712A.13a JC 65 (9/07)

ORDER REMOVING ALLEGED ABUSER FROM CHILD'S HOME (CHILD PROTECTIVE PROCEEDINGS)