Free gf - New York

F.C.A. 446, 551, 656, 842 & 1056 ORI No: Order No: NYSID No:PRESENT: Hon. In the M atter of a Proceeding under Article Of the Family Court Act Petitioner Date of Birth: v. Respondent Date of Birth: At a Term of the County of (address)

General Form 5a 10/2008 Court ,State of New York

ORDER OF PROTECTION [Articles 4, 5, 6, 8 and 10] Docket No. Family Unit No. (check one) Upon Default Both Parties Present In Court

NOTICE: YOUR W ILLFUL FAILURE TO OBEY THIS ORDER M AY SUBJECT YOU TO M ANDATORY ARREST AND CRIM INAL PROSECUTION, WHICH M AY RESULT IN YOUR INCARCERATION FOR UP TO SEVEN YEARS FOR CRIM INAL CONTEM PT, AND/OR M AY SUBJECT YOU TO FAM ILY COURT PROSECUTION AND INCARCERATION FOR UP TO SIX M ONTHS FOR CONTEM PT OF COURT. A petition under Article of the Family Court Act, sworn to on , having been filed in this Court in the above-entitled proceeding,, and the Respondent having been [check applicable box]: present in Court and advised of the issuance and contents of this Order not present in Court, and this Court [check applicable box]: after hearing on consent , having determined that good cause has been shown for the issuance of this Order, Now, therefore, it is hereby ordered that [specify first name, middle initial and last name]: observe the following conditions of behavior: (Check Applicable Paragraphs and Subparagraphs) [01] Stay away from [A] [name(s) of protected persons]: and/or from the [B] home of , [C] school of ; [D] business of , [E] place of employment of , [F] other [specify location] ; [14 Refrain from communication or any other contact or by mail, telephone, e-mail, voice-mail or other means with [specify protected person(s)]:

[02] Refrain from assault, stalking, harassment, aggravated harassment, menacing, reckless endangerment, disorderly conduct, criminal mischief, intimidation, threats or any criminal offense against [specify protected person(s) and/or, members of protected person's family or household, and/or person(s) with custody of child(ren)]: ; [15] Refrain from intentionally injuring or killing without justification the following companion animal(s) (pet(s)) [specify type(s) and, if available, name(s)]: ; [11] Permit [specify individual]: to enter the residence at [specify]: during [specify date/time]: with [specify law to remove personal belongings not in issue in litigation [specify ;

enforcement agency, if any]: items]:

[04] Refrain from [indicate acts]: that create an unreasonable risk to the health, safety or welfare of [specify child(ren), family or household member(s) ]: ; [05] Permit [specify individual]: written agreement to visit with [specify child(ren)]: following periods of time [specify]: [specify]: [07] Custody of [specify child(ren)]: , entitled by a court order or separation or other during the under the following terms and conditions ; shall be awarded to

GF-5-a [specify individual]: [12] under the following terms and conditions [specify]:

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; Surrender any and all handguns, pistols, revolvers, rifles, shotguns and other firearms owned or possessed, including, but not limited to, the following: and do not obtain any further guns or other firearms. Such surrender shall take place immediately, but in no event later than [specify date/time]: at [specify location]: ; Pay or provide access to health or medical insurance for necessary medical care and treatment arising from the incident or incidents forming the basis of the order [specify beneficiary of treatment and coverage] ;

Arts. 5,6&8 only Arts. 4,5&6 only

Pay counsel fees (and/or) any costs associated with the order to [specify person and terms] ; Participate in an educational program, (and pay the costs thereof)[(specify program] ; ;

Art. 8 only Participate in a batterer's education program designed to help end violent behavior (and pay the costs thereof)[specify program] Art. 8 only Pay to the petitioner/victim(s) restitution, as follows [specify terms and amount up to $1 0,000]: ; and [99] Observe such other condition(s) as are necessary to further the purposes of protection [specify conditions]:

;

Art. 8 only [check if applicable]: Respondent is on probation [FCA§842 requires order to state if Respondent is on probation]. Aggravating Circumstances Finding [check box and fill in if applicable]: The court has made a finding on the record of the existence of the following AGGRAVATING CIRCUM STANCES:

It is further ordered that the above-named Respondent's license to carry, possess, repair, sell or otherwise dispose of a firearm or firearms, if any, pursuant to Penal Law '400.00, is [check applicable box(es)]: [13A] suspended, or [13B] revoked, (note: final order only) and/or [13C] the Respondent shall remain ineligible to receive a firearm license while this Order is in effect. It is further ordered that this temporary order of protection shall remain in effect until and including [specify date]: The Family Court Act provides that presentation of a copy of this order of protection to any police officer or peace officer acting pursuant to his or her special duties authorizes, and sometimes requires, the officer to arrest a person who is alleged to have violated its terms and to bring him or her before the Court to face penalties authorized by law. Federal law requires that this order is effective outside, as well as inside, New York State. It must be honored and enforced by state and tribal courts, including courts of a state, the District of Columbia, a commonwealth, territory or possession of the United States, if the person restrained by the order is an intimate partner of the protected party and has or will be afforded reasonable notice and opportunity to be heard in accordance with state law sufficient to protect due process rights (18 U.S.C. §§ 2265, 2266). It is a federal crime to: · cross state lines to violate this order or to stalk, harass or commit domestic violence against an intimate partner or family member; · buy, possess or transfer a handgun, rifle, shotgun or other firearm or ammunition while this Order remains in effect (Note: there is a limited exception for military or law enforcement officers but only while they are on duty) ; and · buy, possess or transfer a handgun, rifle, shotgun or other firearm or ammunition after a conviction of a domestic violence-related crime involving the use or attempted use of physical force or a deadly weapon against an intimate partner or family member, even after this Order has expired.. (18 U.S.C. ''922(g)(8), 922(g)(9), 2261, 2261A, 2262). Dated: JUDGE OF THE FAMILY COURT COURT (COURT SEAL)

PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE LAW GUARDIAN UPON THE APPELLANT, WHICHEVER IS EARLIEST.
Check Applicable Box(es): Party against whom order was issued was present in Court and was advised in Court of issuance and contents of Order Order personally served in Court upon party against whom order was issued Service directed by other means [specify]: [Modifications or extensions only]: Order mailed on [specify date and to whom mailed]: Warrant issued for party against whom order was issued [specify date]: