Texas Order Form – Fill Out and Use This PDF

Protective Orders

Although you may file these forms without having a lawyer, you are encouraged to get a lawyer to help you in this process. Your county or district attorney or legal aid office may be able to help for free. The State Bar of Texas may also be able to refer you to a lawyer if you call 800-252-9690.

Get Ready for Court

Check all the orders you

The Applicant requests a Protective Order and asks the Court to make all Orders marked with a check want the judge to make

6Orders to Prevent Family Violence

The Applicant asks the Court to order the Respondent to (Check all that apply):

a.Not commit family violence against any person named on page 1 of this form.

b.Not communicate in a threatening or harassing manner with any person named on page 1 of this form.

c.Not communicate a threat through any person to any person named on page 1 of this form.

d.Not communicate or attempt to communicate in any manner with (Check all that apply):

Applicant Children Other Adults named on page 1 of this form.

The Respondent may communicate through: _______________________ or other person the Court appoints.

Good cause exists for prohibiting the Respondent’s direct communications.

e.Not go within 200 yards of the (Check all that apply):

f.Not go within 200 yards of the residence, workplace or school of the (Check all that apply):

g.Not go within 200 yards of the Children’s residence, child-care facility, or school, except as specifically authorized in a possession schedule entered by the Court.

h.Not stalk, follow or engage in conduct directed specifically to anyone named on page 1 of this form that is reasonably likely to harass, annoy, alarm, abuse, torment, or embarrass them.

The Applicant also asks the Court to make these Orders (Check all that apply):

i.Suspend any license to carry a concealed handgun issued to the Respondent under state law.

j.Require the Respondent to complete a battering intervention and prevention program; or if no such program is available, counseling with a social worker, family service agency, physician, psychologist, licensed therapist, or licensed professional counselor; and pay all costs for the counseling or treatment ordered.

k.Require the Respondent to follow these provisions to prevent or reduce the likelihood of family violence.

__________________________________________________________________________________________________________________

The law requires a trial court issuing a protective order to prohibit the Respondent from possessing a firearm or ammunition, unless the Respondent is a peace officer actively engaged in employment as a sworn, full-time paid employee of a state agency or political subdivision.

7Property Orders

The Residence located at:________________________________________________________________________________________________Your home address here, unless you want it to be confidential.

(Check one): is jointly owned or leased by the Applicant and Respondent; is solely owned or leased by the Applicant; or

is solely owned or leased by the Respondent; and the Respondent is obligated to support the Applicant or a child in the Applicant’s possession.

The Applicant also asks the Court to make these orders (Check all that apply):

The Applicant to have exclusive use of the Residence identified above, and the Respondent must vacate the Residence.

The sheriff, constable, or chief of police shall provide a law enforcement officer to accompany the Applicant to the Residence, to inform the Respondent that the Court has ordered the Respondent excluded from the Residence, to provide protection while the Applicant takes possession of the Residence and the Respondent removes any necessary personal property, and, if the Respondent refuses to vacate the Residence, to remove the Respondent from the Residence and arrest the Respondent for violating the Court’s Order.

The Applicant to have exclusive use of the following property that the Applicant and Respondent jointly own

or lease:______________________________________________________________________________________________________________List the property you want to use or control, like a car or

______________________________________________________________________________________________________________________furniture, even if the other person owns it with you.

The Respondent must not damage, transfer, encumber, or otherwise dispose of any property jointly owned or leased by the parties, except in the ordinary course of business or for reasonable and necessary living expenses, including, but not limited to, removing or disabling any vehicle owned or possessed by the Applicant or jointly owned or possessed by the parties (whether so titled or not).

Affidavit

to make this Affidavit. The information and events described in this Affidavit are true and correct.

1Describe the most recent time the Respondent hurt you or threatened to hurt you:

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

7Has the Respondent ever threatened or hurt you BEFORE? Describe below, including date(s).

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Do NOT sign until the notary tells you to.

____________________________________________________________

Applicant signs here

On ____ / ____ / _____, the Applicant ___________________________________ personally appeared before

me, the undersigned notary. After being sworn, the Applicant stated that she/he is qualified to make this oath, Notary fills out this part.

that she/he has read the foregoing Application and Affidavit, that she/he has personal knowledge of the facts asserted, and the facts asserted are true to the best of her/his knowledge and belief.

Subscribed and sworn to before me on ____ / ____ / _____.

_______________________________________________________________________

Notary Public in and for the State of Texas

My Commission expires: _____________________________________________

The Applicant requests a Protective Order and asks the Court to make all Orders marked with a check

6Orders to Prevent Family Violence

The Applicant asks the Court to order the Respondent to (Check all that apply):

a.Not commit family violence against any person named on page 1 of this form.

b.Not communicate in a threatening or harassing manner with any person named on page 1 of this form.

c.Not communicate a threat through any person to any person named on page 1 of this form.

d.Not communicate or attempt to communicate in any manner with (Check all that apply):

Applicant Children Other Adults named on page 1 of this form.

The Respondent may communicate through: _______________________ or other person the Court appoints.

Good cause exists for prohibiting the Respondent’s direct communications.

e.Not go within 200 yards of the (Check all that apply):

f.Not go within 200 yards of the residence, workplace or school of the (Check all that apply):

g.Not go within 200 yards of the Children’s residence, child-care facility, or school, except as specifically authorized in a possession schedule entered by the Court.

h.Not stalk, follow or engage in conduct directed specifically to anyone named on page 1 of this form that is reasonably likely to harass, annoy, alarm, abuse, torment, or embarrass them.

The Applicant also asks the Court to make these Orders (Check all that apply):

i.Suspend any license to carry a concealed handgun issued to the Respondent under state law.

j.Require the Respondent to complete a battering intervention and prevention program; or if no such program is available, counseling with a social worker, family service agency, physician, psychologist, licensed therapist, or licensed professional counselor; and pay all costs for the counseling or treatment ordered.

k.Require the Respondent to follow these provisions to prevent or reduce the likelihood of family violence.

__________________________________________________________________________________________________________________

The law requires a trial court issuing a protective order to prohibit the Respondent from possessing a firearm or ammunition, unless the Respondent is a peace officer actively engaged in employment as a sworn, full-time paid employee of a state agency or political subdivision.

7Property Orders

The Residence located at:________________________________________________________________________________________________

(Check one): is jointly owned or leased by the Applicant and Respondent; is solely owned or leased by the Applicant; or

is solely owned or leased by the Respondent; and the Respondent is obligated to support the Applicant or a child in the Applicant’s possession.

The Applicant also asks the Court to make these orders (Check all that apply):

The Applicant to have exclusive use of the Residence identified above, and the Respondent must vacate the Residence.

The sheriff, constable, or chief of police shall provide a law enforcement officer to accompany the Applicant to the Residence, to inform the Respondent that the Court has ordered the Respondent excluded from the Residence, to provide protection while the Applicant takes possession of the Residence and the Respondent removes any necessary personal property, and, if the Respondent refuses to vacate the Residence, to remove the Respondent from the Residence and arrest the Respondent for violating the Court’s Order.

The Applicant to have exclusive use of the following property that the Applicant and Respondent jointly own

or lease:______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

The Respondent must not damage, transfer, encumber, or otherwise dispose of any property jointly owned or leased by the parties, except in the ordinary course of business or for reasonable and necessary living expenses, including, but not limited to, removing or disabling any vehicle owned or possessed by the Applicant or jointly owned or possessed by the parties (whether so titled or not).

AFFIDAVIT

County of ____________________________________________

State of Texas

My name is ___________________________________________. I am ______ years old and otherwise competent

to make this Affidavit. The information and events described in this Affidavit are true and correct.

1Describe the most recent time the Respondent hurt you or threatened to hurt you:

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

2What date did this happen? _____ / ____ / _____

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

7Has the Respondent ever threatened or hurt you BEFORE? Describe below, including date(s).

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

____________________________________________________________

Applicant signs here

On ____ / ____ / _____, the Applicant ___________________________________ personally appeared before

me, the undersigned notary. After being sworn, the Applicant stated that she/he is qualified to make this oath, that she/he has read the foregoing Application and Affidavit, that she/he has personal knowledge of the facts asserted, and the facts asserted are true to the best of her/his knowledge and belief.

Subscribed and sworn to before me on ____ / ____ / _____.

_______________________________________________________________________

Notary Public in and for the State of Texas

My Commission expires: _____________________________________________

Case No.: ____________________________

Temporary Ex Parte Protective Order

Findings: The Court finds from the sworn Affidavit attached to the Application for Protective Order filed in this case that there is a clear and present danger that the Respondent named below will commit acts of family violence that will cause the Applicant, Children and/or Other Adults named below immediate and irreparable injury, loss and damage, for which there is no adequate remedy at law. The Court, therefore, enters this Temporary Ex Parte Protective Order without further notice to the Respondent or hearing. No bond is required.

1Respondent: The person named below must follow all Orders marked with a check.

What county

Name: _____________________________________________ County of Residence:_______________

Who do you want protection from?

does s/he live in?

2Protected People: The following people are protected by the terms of this Protective Order:

3Temporary Orders — To prevent family violence, the Court orders the Respondent to obey all orders marked with a check.

The Respondent (person named in 1) must:

making the orders.

b. Not communicate in a threatening or harassing manner with any person named in 2 above.

c. Not communicate a threat through any person to any person named in 2 above.

4Order: Vacate Residence Immediately

The Court finds that the Residence located at:

(Check one):

is jointly owned or leased by the Applicant and Respondent; is solely owned or leased by the Applicant; or

is solely owned or leased by the Respondent; and the Respondent is obligated to support the Applicant or a child in the Applicant’s possession.

The Court further finds that the Applicant currently resides at the Residence, or has resided there within 30 days prior to the filing of the Application for Protective Order in this case, and that the Respondent has committed family violence against a member of the household within 30 days prior to the filing of the Application for Protective Order in this case. There is a clear and present danger that the Respondent is likely to commit family violence against a member of the household.

The Respondent is therefore ORDERED to vacate the Residence on or before:

_____ a.m. p.m. on (date): _________________________ and to remain at least 200 yards away

from the Residence until further order of the Court. The Applicant shall have exclusive use and possession of the Residence until further order of the Court.

IT IS FURTHER ORDERED that the sheriff, constable, or chief of police shall provide a law enforcement officer to accompany the Applicant to the Residence, to inform the Respondent that the Court has ordered the Respondent to vacate the Residence, and to provide protection while the Applicant takes possession of the Residence, and if the Respondent refuses to vacate the Residence, provide protection while the Applicant takes possession of the Applicant’s necessary personal property.

5Go to the court hearing

IT IS FURTHER ORDERED that notice issue to the Respondent to appear, and the Respondent is ORDERED to appear in person before this Court at the time and place indicated on page 1 of this form.

The purpose of this hearing is to determine whether the Court should issue the Protective Orders and other relief requested in the Application for Protective Order filed in this case.

6Duration of Order: This Order is effective immediately and shall continue in full force and effect until twenty (20) days from the date it is signed, or further order of the Court.

7Warning: A person who violates this order may be punished for contempt of court by a fine of as much as $500 or by confinement in jail for as long as six months, or both.

No person, including a person who is protected by this order, may give permission to anyone to ignore or violate any provision of this Order. During the time in which this Order is valid, every provision of this Order is in full force and effect unless a court changes the Order.

It is unlawful for any person, other than a peace officer, as defined by Section 1.07, Penal Code, actively engaged in employment as a sworn, full-time paid employee of a state agency or political subdivision, who is subject to a Protective Order to possess a firearm or ammunition.

This Ex Parte Order signed on (date): _____________________ Time:____________ a.m. p.m.

Judge Presiding: _____________________________________________________________________

This is a Court Order. No one – except the Court – can change this Order.

Supreme Court of Texas by order in Misc. Docket No. 05-9059 (April 12, 2005)

4Order: Vacate Residence Immediately

The Court finds that the Residence located at:

(Check one):

is jointly owned or leased by the Applicant and Respondent;

is solely owned or leased by the Applicant; or

is solely owned or leased by the Respondent; and the Respondent is obligated to support the Applicant or a child in the Applicant’s possession.

The Court further finds that the Applicant currently resides at the Residence, or has resided there within 30 days prior to the filing of the Application for Protective Order in this case, and that the Respondent has committed family violence against a member of the household within 30 days prior to the filing of the Application for Protective Order in this case. There is a clear and present danger that the Respondent is likely to commit family violence against a member of the household.

The Respondent is therefore ORDERED to vacate the Residence on or before:

_____ a.m. p.m. on (date): _________________________ and to remain at least 200 yards away

from the Residence until further order of the Court. The Applicant shall have exclusive use and possession of the Residence until further order of the Court.

IT IS FURTHER ORDERED that the sheriff, constable, or chief of police shall provide a law enforcement officer to accompany the Applicant to the Residence, to inform the Respondent that the Court has ordered the Respondent to vacate the Residence, and to provide protection while the Applicant takes possession of the Residence, and if the Respondent refuses to vacate the Residence, provide protection while the Applicant takes possession of the Applicant’s necessary personal property.

5Go to the court hearing

IT IS FURTHER ORDERED that notice issue to the Respondent to appear, and the Respondent is ORDERED to appear in person before this Court at the time and place indicated on page 1 of this form.

The purpose of this hearing is to determine whether the Court should issue the Protective Orders and other relief requested in the Application for Protective Order filed in this case.

6Duration of Order: This Order is effective immediately and shall continue in full force and effect until twenty (20) days from the date it is signed, or further order of the Court.

7Warning: A person who violates this order may be punished for contempt of court by a fine of as much as $500 or by confinement in jail for as long as six months, or both.

No person, including a person who is protected by this order, may give permission to anyone to ignore or violate any provision of this Order. During the time in which this Order is valid, every provision of this Order is in full force and effect unless a court changes the Order.

It is unlawful for any person, other than a peace officer, as defined by Section 1.07, Penal Code, actively engaged in employment as a sworn, full-time paid employee of a state agency or political subdivision, who is subject to a Protective Order to possess a firearm or ammunition.

This Ex Parte Order signed on (date): _____________________ Time:____________ a.m. p.m.

Judge Presiding: _____________________________________________________________________

This is a Court Order. No one – except the Court – can change this Order.

Order is in the best interests of the Protected Person(s) and is necessary to prevent future family violence.

The Applicant and Respondent are spouses, former spouses, parents of the same child, live-in partners, or former live-in partners, and are thus “intimate partners” as defined by 18 U.S.C. § 921(a)(32).

The parties have agreed to the terms of this Protective Order.

Statutory grounds for the Protective Order have been established. (Check one or both):

The Respondent has committed family violence against the Applicant or Children named below and is likely to commit family violence in the future.

The Respondent has violated a prior Protective Order that expired or will expire within 30 days.

1Appearances: (Check any that apply): Applicant Respondent

Appeared in person and announced ready.

Appeared in person and by attorney, __________________________, and announced ready.

Appeared by signature below evidencing agreement to the entry of this Protective Order.

Although duly cited, did not appear and wholly made default.

2Protected People: The following people are protected by the terms of this Protective Order:

4Protective Orders — To prevent family violence, the Court orders the Respondent to obey all Orders marked with a check. The Respondent must:

a.Not commit an act against any person named in 2 aboveThethat isCourtintendedfills outto resultthe restin physicalof thisharform,. bodily injury, assault, or sexual assault or that is a threat thatTher asonablyjudge mayplacesaskthoseyou peoplequestionsin fear of imminent physical harm, bodily injury, assault, or sexual assaultbefore. making the orders.

d.Not communicate or attempt to communicate in any manner with: (Check all that apply)

Good cause exists for prohibiting the Respondent’s direct communications.

e.Not go within 200 yards of the: (Check all that apply)

(Except to go to court hearings or to exchange Children as authorized by a court order)

f.Not go within 200 yards of the Residence, workplace or school of the: (Check all that apply)

Applicant Other Adults named in 2 above.

The addresses of the prohibited locations are: (Check all that apply)

Deemed confidential. The clerk is ordered to strike the information from all public court records and maintain a confidential record of the information for Court use only.

Disclosed as follows:

Applicant’s Residence:____________________________________________________________

Applicant’s Workplace/School: _____________________________________________________

Other:

g.Not go within 200 yards of the Children’s Residence, child-care facility, or school, except as authorized by a court order. The addresses of the prohibited locations are: (Check all that apply)

Deemed confidential. The clerk is ordered to strike the information from all public court records and maintain a confidential record of the information for Court use only.

Disclosed as follows:

Children’s Residence: ____________________________________________________________

Children’s Child-care/School: ______________________________________________________

Other: _________________________________________________________________________

h.Not stalk, follow or engage in conduct directed specifically to any person named in 2 above that is reasonably likely to harass, annoy, alarm, abuse, torment, or embarrass them.

i. Not possess a firearm or ammunition, unless the Respondent is a peace officer actively engaged in employment as a sworn, full-time paid employee of a state agency or political subdivision. Any license to carry a concealed handgun issued to the Respondent is hereby SUSPENDED.

5Family Violence Prevention Program

The Respondent is ordered to enroll in, pay costs for, and enter the program checked below no later than __ / __ / __, and to complete the program by __ / __ / __. (Check one):

The local Battering Intervention and Prevention Program that meets the guidelines adopted by the community justice assistance division of the Texas Department of Criminal Justice:

________________________________________________________________________________

Or if no such Battering Intervention and Prevention Program is available, then:

A counseling program recommended and conducted by the following social worker, family service agency, physician, psychologist, licensed therapist, or licensed professional counselor:

________________________________________________________________________________

The Respondent is ordered to comply with any recommendation or referral for additional or alternate counseling within seven (7) days of the recommendation, and ordered to complete any additional or alternate program recommended. The Respondent is ordered to sign a waiver for release of information upon enrollment so that participation in the program may be monitored by the Applicant and/or the Court.

The Respondent must also follow these provisions to prevent family violence:

_____________________________________________________________________________________

_____________________________________________________________________________________

6Property Orders

The Court finds that the Residence located at: (Check one):

is jointly owned or leased by the Applicant and Respondent; is solely owned or leased by the Applicant; or

is solely owned or leased by the Respondent; and the Respondent is obligated to support the Applicant or a child in the Applicant’s possession.

IT IS FURTHER ORDERED that the sheriff, constable, or chief of police shall provide a law enforcement officer to accompany the Applicant to the Residence, to inform the Respondent that the Court has ordered the Respondent to be excluded from the Residence, to provide protection while the Applicant takes possession of the Residence and the Respondent removes any necessary personal property, and, if the Respondent refuses to vacate the Residence, to remove the Respondent from the Residence and arrest the Respondent for violating the Court’s Order.

7Other Property Orders

The Court finds that the Applicant and Respondent jointly own or lease the following Additional Property, and awards the Applicant the exclusive use of:

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

The Respondent must not damage, transfer, encumber, or otherwise dispose of the Additional Property identified above or any other property jointly owned or leased by the parties, except in the ordinary course of business or for reasonable and necessary living expenses, including, but not limited to, removing or disabling any vehicle owned or possessed by the Applicant or jointly by the parties (whether so titled or not).

8Spousal Support Order

IT IS ORDERED that the Respondent pay the Applicant support in the amount of $_______ per month,

with the first payment due and payable on __ / __ / __ and a like payment due and payable on the ______

day of each following month until further Order of this Court. IT IS ORDERED that all payments be sent to the Applicant at the address listed below and postmarked on or before the due date for each payment:

______________________________________________________________________________________________________________________

9Orders Related to Removal, Possession and Support of Children

The Court finds that the Respondent is a parent of the Children. The Protective Order below is in the best interests of the Applicant, Children, and/or Other Adults named in 2 above.

Removal — Check one or both:

The Respondent must:

Not remove the Children from the Applicant’s possession or from their child-care facility or school, except as specifically authorized in a possession schedule ordered by the Court.

Not remove the Children from the jurisdiction of the Court.

Possession — Check one:

The Applicant is granted exclusive possession of the Children, and the Respondent shall have no possession or access to the Children, unless and until further Orders are entered by the Court. This Order supersedes any previous order granting the Respondent possession or access to the Children.

13Copies Forwarded

The Clerk is ORDERED to forward copies of this Protective Order and accompanying Respondent Information Form to (Check all that apply):

Sheriff and Constable of _____________ County, Texas

Police Chief of the City of _____________________

Children’s child-care facility/schools listed above.

Any law enforcement agency receiving a copy of this Protective Order MUST, within 10 days, enter all required information into the Department of Public Safety’s statewide law enforcement information system.

14Duration of Order

This Protective Order is in full force and effect until (date) _________________________ (Texas law provides

that the Protective Order may last for two years after the date it is signed.) If the Respondent is confined or imprisoned on the date this Protective Order is scheduled to expire, the Protective Order will expire one year after the date of the Respondent’s release.

Warning: A person who violates this Order may be punished for contempt of court by a fine of as much as $500 or by confinement in jail for as long as six months, or both.

No person, including a person who is protected by this Order, may give permission to anyone to ignore or violate any provision of this Order. During the time in which this Order is valid, every provision of this Order is in full force and effect unless a court changes the Order.

It is unlawful for any person, other than a peace officer, as defined by Section 1.07, Penal Code, actively engaged in employment as a sworn, full-time paid employee of a state agency or political subdivision, who is subject to a Protective Order to possess a firearm or ammunition.

A violation of this Order by commission of an act prohibited by the Order may be punishable by a fine of as much as $4,000 or by confinement in jail for as long as one year, or both. An act that results in family violence may be prosecuted as a separate misdemeanor or felony offense. If the act is prosecuted as a separate felony offense, it is punishable by confinement in prison for at least two years.

Possession of a firearm or ammunition while this Protective Order is in effect may subject respondent to federal criminal penalties. It is unlawful for any person who is subject to a Protective Order to knowingly purchase, rent, lease, or receive as a loan or gift from another, a handgun for the duration of this Order.

Interstate violation of this Protective Order may subject the Respondent to federal criminal penalties. This Protective Order is enforceable in all fifty states, the District of Columbia, tribal lands, and U.S. territories.

This Protective Order signed on (date): _____________________ Time:___________ a.m. p.m.

Judge Presiding: ___________________________________________________________________________

This is a Court Order. No one – except the Court – can change this Order.

Agreed Order

By their signatures below, the Applicant and Respondent agree to the entry of the foregoing Protective Order and approve all terms stated in the Order:

Receipt Acknowledged – The Respondent hereby acknowledges receipt of a copy of this Protective Order.

_________________________________________

Respondent

The possession schedule previously entered on __ / __ / __, in case number _____________,

styled ___________________________________________________________, shall continue to

govern the Respondent’s possession and access to the Children, except that no exchanges of the Children shall occur at a prohibited location described in this Protective Order.

Child Support — Nothing in this Protective Order shall be construed as relieving the Respondent of any past or future obligation to pay child support as previously ordered. — Check one:

The Respondent is ordered to pay child support to the Applicant in the amount of $__________

per month, with the first such payment due and payable on __ / __ / __, and a like payment due and payable on the ______ day of each month thereafter for the term of this Protective

Order or until further Order of the Court, whichever occurs first.

The Respondent is ordered to make all child support payments payable to the Applicant, and must mail all payments to:

Texas Child Support Disbursement Unit, P.O. Box 659791, San Antonio, TX 78265-9791

That agency will send the payment to the Applicant for the support of the Children. The Respondent must keep the child support registry informed of the Respondent’s Residence and work addresses.

On this date, the Court signed an Income Withholding Order, ordering the employer and any subsequent employer of the Respondent to withhold court-ordered child support from the Respondent’s earnings. The existence of the Order for withholding from earnings for child support does not excuse the Respondent from personally making any child support payment herein, except to the extent the Respondent’s employer actually makes the payment on behalf of the Respondent.

The child support Order previously entered on __ / __ / __, in case number _____________,

styled __________________________________________, shall continue to govern the

Respondent’s child support obligations with respect to the Children.

10Fees and Costs

Within 60 days after this Order is signed, the Respondent must pay the Total Fees and Costs as follows: Total to be paid: $__________________

(This includes fees for service: $ _________________ + all other Court fees and costs: $ ________________)

Address where Respondent must pay the Clerk of the Court with cash, cashier’s check, or money order:

____________________________________________________________________________________________________________________

11Attorney’s Fees

Within 60 days after this Order is signed, the Respondent must pay the attorney who helped enter this Protective Order the Attorney Fees listed below. Pay with cash, cashier’s check, or money order.

Attorney Fees awarded by the Court: $ _______________________________________

Attorney’s name: _________________________________________________________________________________________________

Attorney’s address: _______________________________________________________________________________________________

Attorney (name)____________________________________________ shall have and recover judgment against the

Respondent (name) ________________________________________ for $ _____________ , such judgment bearing interest

at _________ percent per annum compounded annually from the date this judgment and Order is signed

until paid, for which let execution issue if it is not paid.

12Service

13Copies Forwarded

The Clerk is ORDERED to forward copies of this Protective Order and accompanying Respondent Information Form to (Check all that apply):

Sheriff and Constable of _____________ County, Texas Police Chief of the City of _____________________

Children’s child-care facility/schools listed above.

Any law enforcement agency receiving a copy of this Protective Order MUST, within 10 days, enter all required information into the Department of Public Safety’s statewide law enforcement information system.

14Duration of Order

This Protective Order is in full force and effect until (date) _________________________ (Texas law provides

that the Protective Order may last for two years after the date it is signed.) If the Respondent is confined or imprisoned on the date this Protective Order is scheduled to expire, the Protective Order will expire one year after the date of the Respondent’s release.

Warning: A person who violates this Order may be punished for contempt of court by a fine of as much as $500 or by confinement in jail for as long as six months, or both.

No person, including a person who is protected by this Order, may give permission to anyone to ignore or violate any provision of this Order. During the time in which this Order is valid, every provision of this Order is in full force and effect unless a court changes the Order.

It is unlawful for any person, other than a peace officer, as defined by Section 1.07, Penal Code, actively engaged in employment as a sworn, full-time paid employee of a state agency or political subdivision, who is subject to a Protective Order to possess a firearm or ammunition.

A violation of this Order by commission of an act prohibited by the Order may be punishable by a fine of as much as $4,000 or by confinement in jail for as long as one year, or both. An act that results in family violence may be prosecuted as a separate misdemeanor or felony offense. If the act is prosecuted as a separate felony offense, it is punishable by confinement in prison for at least two years.

Possession of a firearm or ammunition while this Protective Order is in effect may subject respondent to federal criminal penalties. It is unlawful for any person who is subject to a Protective Order to knowingly purchase, rent, lease, or receive as a loan or gift from another, a handgun for the duration of this Order.

Interstate violation of this Protective Order may subject the Respondent to federal criminal penalties. This Protective Order is enforceable in all fifty states, the District of Columbia, tribal lands, and U.S. territories.

This Protective Order signed on (date): _____________________ Time:___________ a.m. p.m.

Judge Presiding: ___________________________________________________________________________

This is a Court Order. No one – except the Court – can change this Order.

Agreed Order

By their signatures below, the Applicant and Respondent agree to the entry of the foregoing Protective Order and approve all terms stated in the Order:

Receipt Acknowledged – The Respondent hereby acknowledges receipt of a copy of this Protective Order.

_________________________________________

Respondent

Respondent Information

Fill out this form then file it with the clerk. Law enforcement needs this information to serve the Respondent and enter it into the state database for protective orders.

Respondent’s Name: ______________________________________________________________________

Alias (Nickname): ___________________________________________________________________

Respondent’s relationship to Applicant:______________________________________________________

You do not have to fill out the rest of this form. But, it may help law enforcement serve the Respondent.

Respondent works at (name of business): ____________________________________

Other Information: _________________________________________________________________________

Other Information: _________________________________________________________________________

Respondent Information