ORI ___________________ THE SUPERIOR COURT FOR THE COUNTY OF________________ STATE OF GEORGIA
________________, Petitioner, v. _________________, Respondent.
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Civil Action File
No._____________________
ORDER TO MODIFY PRIOR PROTECTIVE ORDER IT IS HEREBY ORDERED, ADJUDGED and DECREED that the prior Family Violence Protective Order issued _______________________, 20____ is modified as follows: ______________________________________________________________________________ ______________________________________________________________________________ _________________________________________________________________________ the remaining parts of the Protective Order issued ____________________, 20_____ remains unmodified and in full effect. This _______ day of _______________, 20___.
___________________________ JUDGE, SUPERIOR COURT __________________ County ___________________________ Print or stamp Judge's name
TRANSMITTED TO GEORGIA PROTECTIVE ORDER REGISTRY
DATE _______ CLERK _______
Rev'd 1/10/03
* REMOVE THIS PAGE FROM ORDER *
Pursuant to O.C.G.A. Section 19-13-3, Petitioner assisted by: Name: _________________________ Address: _______________________ _______________________ Telephone: _____________________