Free Elder/Disabled Person Abuse Restraining Order - Oregon


File Size: 40.8 kB
Pages: 3
Date: December 29, 2004
File Format: PDF
State: Oregon
Category: Court Forms - Local
Word Count: 523 Words, 4,874 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.ojd.state.or.us/LIN/home.nsf/Files/E11.pdf/$File/E11.pdf

Download Elder/Disabled Person Abuse Restraining Order ( 40.8 kB)


Preview Elder/Disabled Person Abuse Restraining Order
IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN

_____________________________________
Petitioner (your name) Protected Person By and thro ugh : Gua rdian Petitioner:
________________________________________ vs. ________________________________________ Respondent (person to be restrained)

) ) ) ) ) ) ) ) )

CASE NO :__________________________ RESTRAINING ORDER TO PREVENT ABUSE [Elderly Persons and Person s with Disabilities Abus e Prevention A ct]

TO THE RESPONDENT: VIOLATION OF THIS RESTRAINING ORDER MAY RESULT IN YOUR ARREST AND IN CIVIL AND/OR CRIMINAL PENALTIES. REVIEW THIS ORDER CAREFULLY. EACH PROVISION MUST BE OBEYED. The court, having reviewed the petition, makes the following findings: JUDGE'S INITIALS ___ Petitioner or _______________________________ has been abused by respondent as defined by ORS 124.005; ___ The abuse of petitioner or _________________________ by respondent occurred within the last 180 days as provided in ORS 124.010; ___ There is an immediate and present danger of further abuse to petitioner or ________________________________. IT IS HEREBY ORDERED that: Petitioner's/Guardian Petitioner's Request JUDGE'S INITIALS: 1. Respondent is restrained (prohibited) from abusing, intimidating, molesting, interfering with or menacing petitioner or the protected person named above, or attempting to abuse, intimidate, molest, interfere with or menace petitioner or the protected person. [______] Petitioner's/Guardian Petitioner's Request 2. Respondent is restrained (prohibited) from entering or attempting to enter: (Include names and address unless withheld for safety reasons.) G Petitioner's or protected person's residence:___________ ______________________________________________ [______] (Enter address of residence above) G Petitioner's or protected person's business or place of employment: __________________________________ [______] (Enter address of business above
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G

Petitioner's or protected person's school: _____________ _________________________________________________

[______]

G

Other locations: __________________________________________ _______________________________________________________ _______________________________________________________

[______]



3.

Respondent is restrained (prohibited) from: Contacting, or attempting to contact, petitioner or protected person of protected person): by telephone...............................................................................[_______] Gby mail.............................................................................. [_______] Respondent shall move from and not return to the residence described above in ΒΆ2 except with a peace officer in order to remove essential personal effects of the respondent, including, but not limited to: clothing, toiletries, medications, social security cards, birth certificates, identification, and tools of the trade.



4.

[______]



5.

A peace officer shall accompany the petitioner/guardian petitioner to the parties' residence in order to remove essential personal effects including, but not limited to: clothing, toiletries, medications, social security cards, birth certificates, identification, and tools of the trade. [______]

Petitioner's/Guardian Petitioner's Request 6. Other relief: ______________________________________________________ ______________________________________________________ ______________________________________________________ __________________________________________________ [______]



7.

No further service is necessary because respondent appeared in person before the court. [______]

IT IS FURTHER ORDERED that: SECURITY AMOUNT FOR VIOLATION OF ANY PROVISION OF THIS ORDER IS $5,000 unless otherwise specified. Other Amount ($____________) THE ABOVE PROVISIONS OF THIS RESTRAINING ORDER ARE IN EFFECT FOR A PERIOD OF ONE YEAR OR UNTIL THE ORDER IS AMENDED OR DISMISSED, WHICHEVER OCCURS FIRST. IT IS HEREBY ORDERED that:
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G

The Petition for Restraining Order to Prevent Abuse of Elderly Person or Person with Disabilities is dismissed.

DATED this __________ day of ____________________, 20___ (month) (year)

____________________________________ JUDGE (Signature) ____________________________________ Print, Type or Stamp Name of Judge Submitted by: __________________________________________________________________ Print Name Address or Contact Address Petitioner Guardian Petitioner _____________________________________________ Attorney for Petitioner/Guardian Petitioner OSB No: Telephone or Contact:___________________________________________ Telephone Number(s)_____________________________________________

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