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| Question | Answer |
|---|---|
| Form Name | Texas Order Form |
| Form Length | 27 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 6 min 45 sec |
| Other names | texas ex parte protective order form, print forms, texas protective order form, protective order tarrant county tx |
Protective Orders
What is a protective order?
It is a court order that protects you from someone who has been violent or threatened to be violent.
How can a protective order help me?
It can order the other person to:
•Not hurt you or threaten to hurt you
•Not contact you or go near you, your children, other family relatives, your home, where you work, or your children’s schools
•Not have a gun or a license to carry a gun
The police can arrest the other person for violating any of these orders.
Can I get a protective order?
You can get a protective order if:
What if the other person and I live together or have children together?
The judge can make orders about who gets to use the house, apartment or car.
The judge can also make other orders, like child custody, child support, visitation, and spousal support.
Can I get protection right away?
The judge may give you a temporary order that protects you until your court hearing. This order is called a “Temporary Ex Parte Protective Order”.
In some cases, the judge orders the other person to leave the home right away. If you want this, you should ask the judge. Be ready to testify at a hearing when you file your Application.
•Someone has hurt you, or threatened to hurt you, and
•You have a close relationship with that person (you were or are married, dating or living together, have a child together or are close relatives), and
•You are afraid that person may hurt you again.
How much does it cost?
It is free for you.
Do I have to go to court?
Yes. Even if you get a Temporary Ex Parte Protective Order, you must go to the next hearing. It should be in about 2 weeks. The judge will decide if you should have protection and for how long. If you do not go, the Temporary Ex Parte Protective Order may end.
Read Get Ready for Court in this kit. Or get it from the court clerk or from: www.texaslawhelp.org/protectiveorderkit
How do I ask for a protective order?
Fill out the forms in this kit:
-Application for Protective Order
-Temporary Ex Parte
Protective Order
- Protective Order
- Respondent Information
Where do I file the forms?
After you fill out the forms, take the forms with 2 copies to the courthouse. File them in the county where you or the other person lives. But if you have a divorce or custody case pending against the other person, file the forms in that same county or the county where you live.
How will the other person know about the protective order?
You must have the other person “served” before the court hearing. This means
The clerk can arrange for law enforcement to serve the other person the court papers for FREE (for you).
Need help?
There is an instruction sheet for each form. But, if you need more help, contact:
Family Violence Legal Line:
Or, go to: www.texaslawhelp.org/protectiveorderkit
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
Get Ready for Court
Don’t miss your hearing!
If you miss it, your Temporary Ex Parte Protective Order may end and you will have to start from the beginning.
Get ready.
•Fill out a Protective Order before you go to court and bring it with you.
•Bring any evidence you have, like photographs, medical records, torn clothing. Also bring witnesses who know about the violence, like a neighbor, relative or police. The judge may ask them to testify.
•Bring proof of your and the other person’s income and expenses, like bills, paycheck stubs, bank accounts, tax returns.
•If the Proof of Service was returned to you, file it with the clerk and bring a copy to court.
Get there 30 minutes early.
•Find the courtroom.
•When the courtroom opens, go in and tell the clerk or officer that you are present.
•Watch the other cases so you will know what to do.
•When your name is called, go to the front of the courtroom.
What if I don’t speak English?
When you file your papers, tell the clerk you will need an interpreter.
If a court interpreter is not available, bring someone to interpret for you. Do not ask a child, a protected person, or a witness to interpret for you.
What if I am deaf?
When you file your papers, ask for an interpreter or other accommodation.
What if I need child support or visitation orders?
Call the Family Violence Legal Line before you go to court:
What if I am afraid?
If you don't feel safe, call your local family crisis center or the National Domestic Violence Hotline:
Practice what you want to say.
Make a list of the orders you want and practice saying them. Do not take more than 3 minutes to say what you want.
If you get nervous at the hearing, just read from your list. Use that list to see if the judge has made every order you asked for.
The judge may ask questions.
The other person or his or her lawyer may also ask you questions. Tell the truth. Speak slowly. Give complete answers.
If you don’t understand, say, “I don’t understand the question.”
Speak only to the judge unless it is your turn to ask questions. When people are talking to the judge, wait for them to finish. Then you can ask questions about what they said.
What happens after the hearing?
If the judge agrees you need protection, the judge will sign your Protective Order.
Take your signed order to the court clerk. Ask for copies of your order (or make extra copies) and keep one with you at all times.
Give copies of your order to your children’s day care, babysitter, or school. If the other person violates the order, call the police and show them your order.
Need help?
If you are in danger, call the police: 911 Or call Family Violence Legal Line:
Or go to:
www.texaslawhelp.org/protectiveorderkit
Case No.: ______________________________
Your name here.
Applicant: ______________________________________ |
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In the ____________________________ Court |
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You are the Applicant. |
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The clerk fills |
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of |
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out this part |
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Name of person you want protection from. |
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Respondent: |
____________________________________ |
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__________________________ County, Texas |
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This is the Respondent. |
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Application for Protective Order
1Parties
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Name: |
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County of Residence: |
Applicant: |
Your name here |
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County where |
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Respondent: |
Name of person you want protection from |
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each person lives |
Respondent’s address for service: |
Best address to give the other person a copy of this form |
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Check all that apply: |
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The Applicant and Respondent are or were members of the same family or household. |
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The Applicant and Respondent are parents of the same child or children. |
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The Applicant and Respondent used to be married. The Applicant and Respondent are or were dating.
The Applicant is an adult asking for protection for the Children named below from child abuse and/or family or dating violence.
2Children: The Applicant is asking for protection for these Children under age 18:
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Name: |
Is Respondent the biological parent? |
County of Residence: |
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a. |
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Yes |
No |
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b. |
Names of children |
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Yes |
No |
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County where |
c. |
needing protection |
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Yes |
No |
each person lives |
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d. |
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Yes |
No |
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Check all that apply:
Other children are listed on a sheet attached to this Application.
The Children are or were members of the Applicant’s family or household.
The Children are the subject of a court order affecting access to them or their support.
3Other Adults: The Applicant is asking for protection for these Adults, who are or were members of the
Applicant’s family or household:
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Name: |
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County of Residence: |
a. |
Names of other adults needing protection |
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County where |
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b. |
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each person lives |
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4Other Court Cases: Are there other court cases, like divorce, custody, support, involving the Applicant,
Respondent, or the Children? |
Yes |
No |
If “Yes,” say what kind of case and if the case is active or completed. |
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If “completed,” (check one): |
A copy of the final order is attached. |
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A copy of the final order will be filed before the hearing on this Application. |
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5Grounds: Why is the Applicant asking for this Protective Order? ChReadck oneandor checkboth:
The Respondent committed family violence and is likely to commitonefamilyor bothviolence in the future.
The Respondent violated a prior Protective Order that expired, or will expire in 30 days or less. A copy of the
Order is (check one): |
Attached, or |
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Not available now but will be filed before the hearing on this Application. |
Sample Only – Do Not File |
Page 1 of 4 |
Application for Protective Order |
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Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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):
Applicant |
Children |
Other Adults named on page 1 of this form. |
f.Not go within 200 yards of the residence, workplace or school of the (Check all that apply):
Applicant |
Other Adults named on page 1 of this form. |
g.Not go within 200 yards of the Children’s residence,
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,
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).
Sample Only – Do Not File |
Page 2 of 4 |
Application for Protective Order |
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Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
8Spousal Support Order
The Applicant is married to the Respondent or otherwise legally entitled to support from the Respondent and asks
Checkthe Couheret toif orderyou wantthe Respondentspousal supportto ay support. in an amount set by the Court.
9Orders Related to Removal, Possession and Support of Children
The Respondent is a parent of the following of the Applicant’s children:
Check here and fill out this section if you want the
judge to make orders about who the children can stay
with,And, therestrictionsApplicantonaskstravel,for theseandOrderschild supportin the best. interest of the people named on page 1 of this form.
Check all that apply:
The Respondent must not remove the children from the Applicant’s possession or from their
Establish or modify a schedule for the Respondent’s possession of the Children, subject to any terms and conditions necessary for the safety of the Applicant or the Children.
Require the Respondent to pay child support in an amount set by the Court.
10Temporary Ex Parte Protective Order
Based on the information in the attached Affidavit, there is a clear and present danger of family violence that will cause the Applicant, Children or Other Adults named on page 1 of this form immediate and irreparable injury, loss and damage, for which there is no adequate remedy at law. Applicant asks the Court to issue a Temporary Ex Parte Protective Order immediately without bond, notice or hearing.
11Ex Parte Order: Vacate Residence Immediately
The Applicant now lives with the Respondent at:or has resided at this
Residence within the 30 days prior to filing this Application. The Respondent committed family violence against Checka memberhereofif theyouhouseholdwant thewithinjudgetheo 30 days prior to the filing of this Application, as described in the attached orderAffidavitthe other. Therepersonis a clearto andmovepresentou . danger that the Respondent is likely to commit family violence against a member of the household. The Applicant is available for a hearing but asks the Court to issue a Temporary Ex
Parte Protective Order immediately without bond, notice or hearing:
•Granting the Applicant exclusive use and possession of the Residence and ordering the Respondent to vacate the Residence immediately, and remain at least 200 yards away from the Residence pending further Order of the Court; and
•Directing the sheriff, constable, or chief of police to 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 either takes possession of the Residence or removes necessary personal property.
12 Keep Information Confidential
The Applicant asks the Court to keep addresses and telephone numbers for residences, workplaces, schools, and Check here if you want to keep
childcare facilities confidential. your contact information private.
13Fees And Costs
The Applicant asks the Court to order the Respondent to pay fees for service of process, all other fees and costs of Court, and reasonable attorneys’ fees, if applicable.
I have read the entire Application and it is true and correct to the best of my knowledge.
Sign Here
________________________________________
Applicant, Pro se
Address where Applicant may be contacted: __________________________________________________________
List your address/phone or another address/phone
Phone # where Applicant may be contacted: ____________________________ Fax #: _________________________
if you want yours kept confidential.
(List another address/phone if you want yours kept confidential)
Form Approved by the |
Sample Only – Do Not File |
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Application for Protective Order |
Page 3 of 4 |
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Supreme Court of Texas by order in Misc. Docket No.
Affidavit
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Write the name of |
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your county here |
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County of ____________________________________________ |
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State of Texas |
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My name is |
___________________________________________Your name here |
. 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:
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______________________________________________________________________________________________________________________ |
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______________________________________________________________________________________________________________________ |
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Answer every question on this form. |
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______________________________________________________________________________________________________________________ |
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______________________________________________________________________________________________________________________ |
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If it happened in the last 30 days, the judge |
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What date did this happen? _____ / ____ / _____ |
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3 |
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can order the Respondent to move out. |
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Was a weapon involved? |
Yes |
No |
If yes, what kind? ____________________________________________ |
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Were any children there? |
Yes |
No |
If yes, who? __________________________________________________ |
5 |
Did you call the police? |
Yes |
No |
If yes, what happened? _____________________________________ |
6 |
Did you get medical care? |
Yes |
No |
If yes, describe your injuries: _______________________________ |
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
7Has the Respondent ever threatened or hurt you BEFORE? Describe below, including date(s).
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______________________________________________________________________________________________________________________ |
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______________________________________________________________________________________________________________________ |
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______________________________________________________________________________________________________________________ |
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8 |
Were weapons ever involved? |
Yes |
No |
If yes, what kind? ____________________________ |
9 |
Were any children there? |
Yes |
No |
If yes, who? ___________________________________ |
10 |
Have the police ever been called? |
Yes |
No |
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11 |
Did you ever have to get medical care? |
Yes |
No |
If yes, describe your injuries: _______________ |
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
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: _____________________________________________
Sample Only – Do Not File |
Page 4 of 4 |
Application for Protective Order |
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Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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Case No.: ______________________________
Applicant: ______________________________________ |
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In the ____________________________ Court |
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v. |
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of |
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Respondent: ____________________________________ |
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__________________________ County, Texas |
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Application for Protective Order |
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1 Parties |
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Name: |
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County of Residence: |
Applicant: |
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Respondent: |
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Respondent’s address for service:
Check all that apply:
The Applicant and Respondent are or were members of the same family or household. The Applicant and Respondent are parents of the same child or children.
The Applicant and Respondent used to be married. The Applicant and Respondent are or were dating.
The Applicant is an adult asking for protection for the Children named below from child abuse and/or family or dating violence.
2Children: The Applicant is asking for protection for these Children under age 18:
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Name: |
Is Respondent the biological parent? |
County of Residence: |
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a. |
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Yes |
No |
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b. |
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Yes |
No |
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c. |
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Yes |
No |
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d. |
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Yes |
No |
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Check all that apply:
Other children are listed on a sheet attached to this Application.
The Children are or were members of the Applicant’s family or household.
The Children are the subject of a court order affecting access to them or their support.
3Other Adults: The Applicant is asking for protection for these Adults, who are or were members of the
Applicant’s family or household:
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Name: |
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County of Residence: |
a. |
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b. |
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4Other Court Cases: Are there other court cases, like divorce, custody, support, involving the Applicant,
Respondent, or the Children? |
Yes |
No |
If “Yes,” say what kind of case and if the case is active or completed. |
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If “completed,” (check one): |
A copy of the final order is attached. |
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A copy of the final order will be filed before the hearing on this Application. |
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5Grounds: Why is the Applicant asking for this Protective Order? Check one or both:
The Respondent committed family violence and is likely to commit family violence in the future.
The Respondent violated a prior Protective Order that expired, or will expire in 30 days or less. A copy of the
Order is (check one): |
Attached, or |
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Not available now but will be filed before the hearing on this Application. |
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Application for Protective Order |
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Page 1 of 4 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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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):
Applicant |
Children |
Other Adults named on page 1 of this form. |
f.Not go within 200 yards of the residence, workplace or school of the (Check all that apply):
Applicant |
Other Adults named on page 1 of this form. |
g.Not go within 200 yards of the Children’s residence,
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,
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).
Application for Protective Order |
Page 2 of 4 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
8Spousal Support Order
The Applicant is married to the Respondent or otherwise legally entitled to support from the Respondent and asks the Court to order the Respondent to pay support in an amount set by the Court.
9Orders Related to Removal, Possession and Support of Children
The Respondent is a parent of the following of the Applicant’s children:
And, the Applicant asks for these Orders in the best interest of the people named on page 1 of this form. Check all that apply:
The Respondent must not remove the children from the Applicant’s possession or from their
Establish or modify a schedule for the Respondent’s possession of the Children, subject to any terms and conditions necessary for the safety of the Applicant or the Children.
Require the Respondent to pay child support in an amount set by the Court.
10Temporary Ex Parte Protective Order
Based on the information in the attached Affidavit, there is a clear and present danger of family violence that will cause the Applicant, Children or Other Adults named on page 1 of this form immediate and irreparable injury, loss and damage, for which there is no adequate remedy at law. Applicant asks the Court to issue a Temporary Ex Parte Protective Order immediately without bond, notice or hearing.
11Ex Parte Order: Vacate Residence Immediately
The Applicant now lives with the Respondent at: _________________________________ or has resided at this
Residence within the 30 days prior to filing this Application. The Respondent committed family violence against a member of the household within the 30 days prior to the filing of this Application, as described in the attached Affidavit. There is a clear and present danger that the Respondent is likely to commit family violence against a member of the household. The Applicant is available for a hearing but asks the Court to issue a Temporary Ex Parte Protective Order immediately without bond, notice or hearing:
•Granting the Applicant exclusive use and possession of the Residence and ordering the Respondent to vacate the Residence immediately, and remain at least 200 yards away from the Residence pending further Order of the Court; and
•Directing the sheriff, constable, or chief of police to 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 either takes possession of the Residence or removes necessary personal property.
12Keep Information Confidential
The Applicant asks the Court to keep addresses and telephone numbers for residences, workplaces, schools, and childcare facilities confidential.
13Fees And Costs
The Applicant asks the Court to order the Respondent to pay fees for service of process, all other fees and costs of Court, and reasonable attorneys’ fees, if applicable.
I have read the entire Application and it is true and correct to the best of my knowledge.
________________________________________
Applicant, Pro se
Address where Applicant may be contacted: __________________________________________________________
Phone # where Applicant may be contacted: ____________________________ Fax #: _________________________
(List another address/phone if you want yours kept confidential)
Application for Protective Order |
Page 3 of 4 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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? _____ / ____ / _____
3 |
Was a weapon involved? |
Yes |
No |
If yes, what kind? ____________________________________________ |
4 |
Were any children there? |
Yes |
No |
If yes, who? __________________________________________________ |
5 |
Did you call the police? |
Yes |
No |
If yes, what happened? _____________________________________ |
6 |
Did you get medical care? |
Yes |
No |
If yes, describe your injuries: _______________________________ |
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
7Has the Respondent ever threatened or hurt you BEFORE? Describe below, including date(s).
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______________________________________________________________________________________________________________________ |
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______________________________________________________________________________________________________________________ |
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Were weapons ever involved? |
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If yes, what kind? ____________________________ |
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Were any children there? |
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If yes, who? ___________________________________ |
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Have the police ever been called? |
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Did you ever have to get medical care? |
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No |
If yes, describe your injuries: _______________ |
______________________________________________________________________________________________________________________
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____________________________________________________________
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: _____________________________________________
Application for Protective Order |
Page 4 of 4 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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Temporary Ex Parte Protective Order
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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:
Applicant:
Children:
Other
Adults:
Name:
Your name here
Names of children you want
to be protected by this order
Names of other adults needing protection
County of Residence:
County where each person lives
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:
a. |
The Court fills out the rest |
Not commit an act against any person named in 2 above that is intended to result in physical |
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harm, bodily injury, assault, or sexual assault or that is a threat that reasonably places those |
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people in fear of imminent physical harm, bodily injury, assault, or sexual assault. |
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.
Temporary Ex Parte ProtectiveSampleOrder |
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Page 1 of 3 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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d.Not communicate or attempt to communicate in any manner with: (Check all that apply)
Applicant |
Children |
Other Adults named in 2 above. The Respondent may |
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Good cause exists for prohibiting the Respondent’s direct communications.
e.Not go within 200 yards of the: (Check all that apply)
Applicant |
Children |
Other Adults named in 2 above. (except to go to court hearings) |
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 possess a firearm or ammunition, unless the Respondent is a peace officer actively engaged in employment as a sworn,
h.Not go within 200 yards of the Children’s Residence,
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
Other: __________________________________________________________________
i.Not stalk, follow or engage in conduct directed specifically toward the Applicant, Children, or Other Adults named in 2 above that is reasonably likely to harass, annoy, alarm, abuse, torment, or embarrass them.
j.Not remove the Children from their school,
k.Not remove the Children from the jurisdiction of the Court.
l.Not interfere with the Applicant’s use of the Residence located at: ___________________ , including, but not limited to, disconnecting utilities or telephone service or causing such services to be disconnected.
m.Not interfere with the Applicant’s use and possession of the following property:
___________________________________________________________________________
___________________________________________________________________________
n.Not damage, transfer, encumber, or otherwise dispose of any property jointly owned or leased by the Applicant and Respondent, 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).
Sample Only – Do Not File |
Page 2 of 3 |
Temporary Ex Parte Protective Order |
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Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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,
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.
Form Approved by the Sample Only – Do Not File |
Page 3 of 3 |
Temporary Ex Parte Protective Order |
Supreme Court of Texas by order in Misc. Docket No.
Case No.: ____________________________
Applicant: ______________________________________ |
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In the ______________________________ Court |
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__________________________ County, Texas |
Temporary Ex Parte Protective Order
Go to the court hearing on: Date: _______________ Time:____ a.m. |
p.m. |
Court Address:
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.
Name: _____________________________________________ County of Residence:_______________
2Protected People: The following people are protected by the terms of this Protective Order:
Name: |
County of Residence: |
Applicant:
Children:
Other
Adults:
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:
a.Not commit an act against any person named in 2 above that is intended to result in physical harm, bodily injury, assault, or sexual assault or that is a threat that reasonably places those people in fear of imminent physical harm, bodily injury, assault, or sexual assault.
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.
Temporary Ex Parte Protective Order |
Page 1 of 3 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
d.Not communicate or attempt to communicate in any manner with: (Check all that apply)
Applicant |
Children |
Other Adults named in 2 above. The Respondent may |
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Good cause exists for prohibiting the Respondent’s direct communications.
e.Not go within 200 yards of the: (Check all that apply)
Applicant |
Children |
Other Adults named in 2 above. (except to go to court hearings) |
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 possess a firearm or ammunition, unless the Respondent is a peace officer actively engaged in employment as a sworn,
h.Not go within 200 yards of the Children’s Residence,
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
Other: __________________________________________________________________
i.Not stalk, follow or engage in conduct directed specifically toward the Applicant, Children, or Other Adults named in 2 above that is reasonably likely to harass, annoy, alarm, abuse, torment, or embarrass them.
j.Not remove the Children from their school,
k.Not remove the Children from the jurisdiction of the Court.
l.Not interfere with the Applicant’s use of the Residence located at: ___________________ , including, but not limited to, disconnecting utilities or telephone service or causing such services to be disconnected.
m.Not interfere with the Applicant’s use and possession of the following property:
___________________________________________________________________________
___________________________________________________________________________
n.Not damage, transfer, encumber, or otherwise dispose of any property jointly owned or leased by the Applicant and Respondent, 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).
Temporary Ex Parte Protective Order |
Page 2 of 3 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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,
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.
Temporary Ex Parte Protective Order |
Page 3 of 3 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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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,
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:
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A Record of Testimony (Check one): was made by: ______________________ |
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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.
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 anyone named in 2 above.
Protective Order Sample Only – Do Not File
Form Approved by the Supreme Court of Texas by order in Misc. Docket No.
Page 1 of 5
d.Not communicate or attempt to communicate in any manner with: (Check all that apply)
Applicant |
Children |
Other Adults in 2 above (except through: ________________________ ) |
Good cause exists for prohibiting the Respondent’s direct communications.
e.Not go within 200 yards of the: (Check all that apply)
Applicant |
Children |
Other Adults named in 2 above. |
(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,
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
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,
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:
_____________________________________________________________________________________
_____________________________________________________________________________________
Protective Order |
Sample Only – Do Not File |
Page 2 of 5 |
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Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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 ORDERED that the Applicant shall have exclusive use of the |
Residence identified above, and the |
Respondent must vacate the Residence no later than: _____ a.m. |
p.m. on (date): ____________. |
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
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.
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possession of the Children pursuant to the possession schedule attached to this Protective Order as |
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Exhibit A, subject to the terms and conditions stated herein as necessary for the safety of the |
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Applicant and the Children. The possession schedule hereby ordered supersedes any previous |
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order granting the Respondent possession and access to the Children. |
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Page 3 of 5 |
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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
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
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
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Was served on the Respondent in open court. |
Shall be delivered to the Respondent by certified |
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Shall be personally served on the Respondent. |
mail, return receipt requested, or by fax, to the |
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Shall be mailed by the Clerk of the Court to the |
Respondent’s last known address or fax number, or |
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Respondent’s last known address. |
in any other manner allowed by Tex. R. Civ. P. 21a. |
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Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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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
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,
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:
________________________________________ |
________________________________________ |
Applicant |
Respondent |
Receipt Acknowledged – The Respondent hereby acknowledges receipt of a copy of this Protective Order.
_________________________________________
Respondent
Form Approved by the SupremeSampleCourt of Texas by orderOnlyin Misc. |
Page 5 of 5 |
Protective Order |
Case No.: ____________________________
Applicant: ______________________________________ |
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In the ______________________________ Court |
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Respondent: ____________________________________ |
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___________________________ County, Texas |
Protective Order
A court hearing was held on: Date: ________________ Time:________ a.m. |
p.m. |
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Findings: |
All legal requirements have been met, and the Court has jurisdiction over the parties and this case. This |
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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,
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:
Name: |
County of Residence: |
Applicant:
Children:
Other
Adults:
3 |
A Record of Testimony (Check one): was made by: ______________________ |
was waived by the parties. |
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 above that is intended to result in physical harm, bodily injury, assault, or sexual assault or that is a threat that reasonably places those people in fear of imminent physical harm, bodily injury, assault, or sexual assault.
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 anyone named in 2 above.
Protective Order |
Page 1 of 5 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
d.Not communicate or attempt to communicate in any manner with: (Check all that apply)
Applicant |
Children |
Other Adults in 2 above (except through: ________________________ ) |
Good cause exists for prohibiting the Respondent’s direct communications.
e.Not go within 200 yards of the: (Check all that apply)
Applicant |
Children |
Other Adults named in 2 above. |
(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,
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
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,
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:
_____________________________________________________________________________________
_____________________________________________________________________________________
Protective Order |
Page 2 of 5 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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 ORDERED that the Applicant shall have exclusive use of the |
Residence identified above, and the |
Respondent must vacate the Residence no later than: _____ a.m. |
p.m. on (DATE): ____________. |
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
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.
The Applicant is granted primary possession of the Children, and the Respondent may have possession of the Children pursuant to the possession schedule attached to this Protective Order as Exhibit A, subject to the terms and conditions stated herein as necessary for the safety of the Applicant and the Children. The possession schedule hereby ordered supersedes any previous order granting the Respondent possession and access to the Children.
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Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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
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
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
This Protective Order (Check all that apply):
Was served on the Respondent in open court. Shall be personally served on the Respondent. Shall be mailed by the Clerk of the Court to the Respondent’s last known address.
Shall be delivered to the Respondent by certified mail, return receipt requested, or by fax, to the Respondent’s last known address or fax number, or in any other manner allowed by Tex. R. Civ. P. 21a.
Protective Order |
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Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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
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,
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:
________________________________________ |
________________________________________ |
Applicant |
Respondent |
Receipt Acknowledged – The Respondent hereby acknowledges receipt of a copy of this Protective Order.
_________________________________________
Respondent
Protective Order |
Page 5 of 5 |
Form Approved by the Supreme Court of Texas by order in Misc. Docket No. |
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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:______________________________________________________
Respondent lives in: _________________________County |
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Street: ________________________________ City: |
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F |
DoB ______/______/____________ |
DL # _____________________ |
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Height |
___ ft ___ ___ in |
Place of birth __________________ |
Other ID# _________________ |
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Weight |
___ ___ ___ lbs |
SS # __________________________ |
State ___ Expires _________ |
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Race
American Indian or Alaskan Native (I) Asian Pacific Islander (A) Black (B)
White (W) Unknown (All other
Other:
_____________________
Ethnicity
Hispanic (H)
Unknown (U)
Eye color |
Hair color |
Skin |
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Black (BLK) |
Black (BLK) |
Albino (ALB) |
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Blue (BLU) |
Blond or Strawberry (BLN) |
Black (BLK) |
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Brown (BRO) |
Brown (BRO) |
Dark (DRK) |
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Gray (GRY) |
Gray or partially gray |
Dark Brown (DBR) |
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Green (GRN) |
(GRY) |
Fair (FAR) |
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Hazel (HAZ) |
Red or Auburn (RED) |
Light (LGT) |
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White (WHI) |
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Maroon (MAR) |
Light Brown (LBR) |
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Sandy (SDY) |
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Pink (PNK) |
Medium (MED) |
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Completely Bald or |
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Multicolored (MUL) |
Medium Brown (MBR) |
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Unknown (xxx) |
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Unknown (XXX) |
Olive (OLV) |
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Other: ______________ |
Other (style/length): __________ |
Ruddy (RUD) |
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Unknown (XXX) |
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Other: |
You do not have to fill out the rest of this form. But, it may help law enforcement serve the Respondent.
Other Identifying Information Check all that apply |
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Glasses |
Unusual markings on body (describe) |
Mental Problems________________ |
Beard |
Tattoos _______________________ |
_____________________________ |
Moustache |
Scars_________________________ |
Drug/Alcohol Problems __________ |
Missing front teeth |
Markings ______________________ |
Weapons _____________________ |
Bald |
Piercings _____________________ |
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Respondent works at (name of business): ____________________________________
Street: _____________________________________ City: |
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Phone: _______________ Hours/Dept: _______________ |
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Other contacts who may have information to help find Respondent: |
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Name: _____________________________________ |
Phone: ____________________________________ |
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Address:____________________________________ |
Relationship: _______________________________ |
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Other Information: _________________________________________________________________________
Name: _____________________________________ |
Phone: ____________________________________ |
Address:____________________________________ |
Relationship: _______________________________ |
Other Information: _________________________________________________________________________
Respondent Information