Rule 10.05. Standard Civil Protection Order Forms - Juvenile Division

(A) Distribution of packet A juvenile division of a court of common pleas that has jurisdiction to issue a civil protection order against a minor pursuant to R.C. 2151.34 and 3113.31 shall distribute, upon request, a forms packet for use in juvenile civil protection order proceedings against a juvenile respondent pursuant to R.C. 2151.34 and 3113.31. The packet shall include, at a minimum, forms that are substantially similar to "Forms 10-C, 10.05-A, and 10.05-B."

(B) Civil protection order form and protection order warning In every case in which a juvenile division of a court of common pleas issues an ex parte or full hearing civil protection order against a minor pursuant to R.C. 2151.34 , it shall use the applicable form that is substantially similar to " Form 10.05-C or 10.05-D" and include a cover sheet that is substantially similar to "Form 10-C" and send a completed form that is substantially similar to "Form 10-A" and copy of the order to the local law enforcement agency for entry of the order into the "National Crime Information Center Protection Order File."

(C) Domestic violence civil protection order form and protection order warning In every case in which a juvenile division of a court of common pleas issues an ex parte or full hearing domestic violence civil protection order against a minor pursuant to R.C. 3113.31, it shall use the applicable form that is substantially similar to " Form 10.05-C or 10.05-E" and include a cover sheet that is substantially similar to "Form 10-C" and send a completed form that is substantially similar to "Form 10-A" and copy of the order to the local law enforcement agency for entry of the order into the "National Crime Information Center Protection Order File."

(D) Wireless service transfer order In every case in which a juvenile division of a court of common pleas orders the transfer of wireless service as a term of an ex parte or full hearing civil protection order, it shall complete a form that is substantially similar to "Form 10-E."

(E) Remote access exception A juvenile division of a court of common pleas shall not make available through remote access pursuant to Sup.R.

44 through 47 any record of a civil protection order case that is likely to reveal the identity or location of a petitioner or another party to be protected or could be protected by a protection order. INFORMATION ABOUT FILING A JUVENILE CIVIL PROTECTION ORDER OR A JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER PETITION Amended: April 15, 2021 Discard all previous versions of this form FORM 10.05-A: INFORMATION ABOUT FILING A JUVENILE CIVIL PROTECTION ORDER OR A JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER PETITION • If you have any questions about completing the Petition for a Juvenile Civil Protection Order or Domestic Violence Juvenile Civil Protection Order (Form 10.05-B), contact the local victim assistance program, domestic violence program, or Ohio Domestic Violence Network at 800-934-9840. • Neither the Clerk of Court's Office nor the local domestic violence program can give legal advice. If you need legal advice, talk to a lawyer. Only a lawyer can give you legal advice. • There is NO FEE for filing the Petition. • Once completed, take the Petition and other necessary documents to the Clerk of Court's Office. • If you want an emergency order, also known as an Ex Parte Protection Order, check "want" in paragraph 2 of the Petition. • The Court will consider your request for an Ex Parte Protection Order and may ask you questions. • Regardless if an Ex Parte Protection Order was requested, granted, or denied, a full hearing will be scheduled. • You must attend the full hearing. Your victim advocate may also be present at the hearing. • On the day of the full hearing, be prepared to (1) tell the Court what happened, (2) bring with you any witnesses, evidence, and documentation to prove your case, and (3) ask Respondent questions. • Respondent may be represented by a private lawyer or a court-appointed lawyer. [R.C. 2151.34(O)] You may represent yourself or ask the Court for a continuance to obtain a lawyer. [R.C. 2151.34(D)(2)(a)(iii) or 3113.31(D)(2)(a)(iii)] • Respondent or Respondent's lawyer may present evidence and may ask you questions. • The Court cannot issue a protection order against you unless Respondent has filed a Petition. DEFINITIONS Aggravated Assault [R.C. 2903.12] No person, while under the influence of sudden passion or in a sudden fit of rage, either of which is brought on by serious provocation occasioned by the victim that is reasonably sufficient to incite the person into using deadly force, shall knowingly cause serious physical harm to another or to another's unborn. No person, while under the influence of sudden passion or in a sudden fit of rage, either of which is brought on by serious provocation occasioned by the victim that is reasonably sufficient to incite the person into using deadly force, shall knowingly cause or attempt to cause physical harm to another or to another's unborn by means of a deadly weapon or dangerous ordnance, as defined in [the law]. Aggravated Menacing [R.C. 2903.21] No person shall knowingly cause another to believe that the offender will cause serious physical harm to the person or property of the other person, the other person's unborn, or a member of the other person's immediate family. Aggravated Trespass [R.C. 2911.211] No person shall enter or remain on the land or premises of another with purpose to commit on that land or those premises a misdemeanor, the elements of which involve causing physical harm to another person or causing [Page 2 of 3 Form 10.05-A] FORM 10.05-A: INFORMATION ABOUT FILING A JUVENILE CIVIL PROTECTION ORDER OR A JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER PETITION Amended: April 15, 2021 Discard all previous versions of this form another person to believe that the offender will cause physical harm to the person. Assault [R.C. 2903.13] No person shall knowingly cause or attempt to cause physical harm to another or to another's unborn. No person shall recklessly cause serious physical harm to another or to another's unborn. Domestic Violence [R.C. 3113.31] "Domestic violence" means the occurrence of one or more of the following acts against a family or household member: attempting to cause or recklessly causing bodily injury; placing another person by the threat of force in fear of imminent serious physical harm or committing [menacing by stalking or aggravated trespass]; committing any act with respect to a child that would result in the child being an abused child, as defined [by law]; or committing a sexually oriented offense. Family or Household Member [R.C. 3113.31(A)(3) through (4)] "Family or household member" means any of the following: Any of the following who is residing with or has resided with Respondent, such as a spouse, a person living as a spouse, or a former spouse of Respondent; a parent, a foster parent, or a child of Respondent, or another person related by consanguinity or affinity (blood or marriage) to Respondent; a parent or a child of a spouse, person living as a spouse, or former spouse of Respondent, or another person related by consanguinity or affinity (blood or marriage) to a spouse, person living as a spouse, or former spouse of Respondent. The natural parent of any child of whom Respondent is the other natural parent or is the putative other natural parent. "Person living as a spouse" means a person who is living or has lived with Respondent in a common law marital relationship, who otherwise is cohabiting with Respondent, or who otherwise has cohabited with Respondent within five years prior to the date of the alleged occurrence of the act in question. Felonious Assault [R.C. 2903.11] No person shall knowingly cause serious physical harm to another or to another's unborn. [R.C. 2903.11(A)(1)] No person shall knowingly cause or attempt to cause physical harm to another or to another's unborn by means of a deadly weapon or dangerous ordnance. No person, with knowledge that the person has tested positive as a carrier of a virus that causes AIDS, shall knowingly do any of the following: (1) engage in sexual conduct with another person without disclosing that knowledge to the other person prior to engaging in the sexual conduct; (2) engage in sexual conduct with a person whom the offender knows or has reasonable cause to believe lacks the mental capacity to appreciate the significance of the knowledge that the offender has tested positive as a carrier of a virus that causes AIDS; or (3) engage in sexual conduct with a person under eighteen years of age who is not the spouse of the offender. Menacing [R.C. 2903.22] No person shall knowingly cause another to believe that the offender will cause physical harm to the person or property of the other person, the other person's unborn, or a member of the other person's immediate family. Menacing by Stalking [R.C. 2903.211] No person by engaging in a pattern of conduct shall knowingly cause another person to believe that the offender will cause physical harm to the other person or cause mental distress to the other person. No person, through the use of any electronic method of remotely transferring information, including, but not limited to, any computer, computer network, [Page 3 of 3 Form 10.05-A] FORM 10.05-A: INFORMATION ABOUT FILING A JUVENILE CIVIL PROTECTION ORDER OR A JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER PETITION Amended: April 15, 2021 Discard all previous versions of this form computer program, or computer system, shall post a message with purpose to urge or incite another to commit a violation [this law]. Pattern of Conduct [R.C. 2903.211(D)(1)] Pattern of conduct means two or more actions or incidents closely related in time. Mental Distress [R.C. 2903.211(D)(2)] Mental distress means: (a) any mental illness or condition that involves some temporary substantial incapacity would normally require psychiatric treatment, psychological treatment, or other mental health services, regardless if psychiatric treatment, psychological treatment, or other mental health services was requested or received. Sexually Oriented Offense [ R.C. 2950.01.] Sexually oriented offenses are defined at R.C. 2950.01. FORM 10.05-B: PETITION FOR JUVENILE CIVIL PROTECTION ORDER AND JUVENILE DOMESTIC VIOLENCE PROTECTION ORDER FORM 10.05-B: PETITION FOR JUVENILE CIVIL PROTECTION ORDER AND JUVENILE DOMESTIC VIOLENCE PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form IN THE COURT OF COMMON PLEAS, Petitioner Address (Safe mailing address) City, State, Zip Code Date of Birth: / / v. Respondent Address (If home address unknown, put the school or work address) City, State, Zip Code Date of Birth: / / IF YOU ARE ASKING FOR YOUR ADDRESS TO BE KEPT CONFIDENTIAL, PLEASE PUT A MAILING ADDRESS WHERE YOU CAN SAFELY RECEIVE MAIL. IF YOU ARE A PARTICIPANT IN THE SECRETARY OF STATE'S ADDRESS CONFIDENTIALITY PROGRAM, PLEASE USE THE P.O. BOX ADDRESS GIVEN TO YOU. THIS FORM IS A PUBLIC RECORD. 1.

I need or a witness needs a foreign language interpreter in or an American Sign Language interpreter per Sup.R. 88. 2.

I want do not want an ex parte (emergency) protection Petitioner further requests a full hearing trial even if the ex parte protection order is granted, denied, or not requested. 3. Who needs protection? Me My minor child A family or household member, who is not a minor child Other: 4. The relationship of Petitioner to Respondent is that of: Parent or foster parent of Respondent Respondent is the parent of my child Relative by blood or marriage of Respondent or Petitioner and has lived with Respondent (please specify how you are related): [Page 2 of 5 Form 10.05-B] FORM 10.05-B: PETITION FOR JUVENILE CIVIL PROTECTION ORDER AND JUVENILE DOMESTIC VIOLENCE PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form Petitioner is not related to Respondent (please specify how you know Respondent) 5. I have listed below all family or household members who need protection other than me or the person for whom I am filing the Petition (Leave blank if you are not including other family or household members) . NAME (first, middle initial, and last) / / / / / / / / 6. Petitioner is in fear and in continuing danger and requests the Court grant Order or Juvenile Domestic Violence Civil Protection Order 7. You must describe the threats or acts that made you or your family or household members afraid, include if children were present when the acts happened. When did it happen? (If you do not know exact dates, give approximate dates). Explain why you believe you or your family or household members are in danger. If you need more space, attach an additional page. 8. Petitioner has listed court cases (including custody, visitation, paternity, child support, children service case, pending criminal case or conviction for domestic violence, felonious assault, aggravated assault, assault, aggravated menacing, menacing by stalking, menacing, or aggravated trespass; no contact order; stay away order; or other protection order) and other legal matters regarding Respondent, which may relate to this case: CASE NAME CASE NUMBER [Page 3 of 5 Form 10.05-B] FORM 10.05-B: PETITION FOR JUVENILE CIVIL PROTECTION ORDER AND JUVENILE DOMESTIC VIOLENCE PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form 9. Petitioner requests the Court grant relief under R.C. 2151.34 or 3113.31. Check all that apply. a. Directs Respondent to not abuse Petitioner and the other persons named in this Petition by harming, attempting to harm, threatening, following, stalking, harassing, contacting, forcing sexual relations upon, or committing sexually oriented offenses against them. b. Directs Respondent to not enter or have limited access to the following places (include name and address, as applicable) where Petitioner and the persons named in this Petition may be found, including the buildings, grounds, and parking lots at these places. Residence: School: Business or Place of Employment: Other (specify): c. Directs Respondent to not approach or have contact by any means with Petitioner and persons named in this Petition. d. Directs Respondent not to remove, damage, hide, or dispose of any property, companion animals, or pets owned by Petitioner. e. Grants Petitioner permission to take Petitioner's companion animals or pets, as described below, away from the possession of Respondent: f. Directs Respondent to not possess, use, carry, or obtain any deadly weapon, firearms, and ammunition. g. Directs Respondent to be electronically monitored because Respondent's conduct has put or puts the health, welfare, or safety of Petitioner and the persons named in this Petition at risk. Describe Respondent's conduct and how Respondent continues to present a danger to Petitioner and the persons named in this Petition. If you need more space, attach an additional page. h. Directs Respondent to complete batterer counseling, substance abuse counseling, or other counseling as determined necessary by the Court. [Page 4 of 5 Form 10.05-B] FORM 10.05-B: PETITION FOR JUVENILE CIVIL PROTECTION ORDER AND JUVENILE DOMESTIC VIOLENCE PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form i. Directs the wireless service provider to separate Petitioner's account from Respondent's account, per R.C. 3113.45 to 3113.459. Petitioner will assume all financial responsibility for any costs associated with the wireless service number and any costs for the device associated with the wireless service number. Respondent's billing telephone number is: Petitioner's contact information is on page 1 of this Petition. The wireless service numbers to be transferred to Petitioner which are used by Petitioner or the minor children in the care of Petitioner is: j. Includes the following additional provisions: 10. Petitioner further requests that the Court grant such other relief as the Court considers equitable and fair.

I swear or affirm that the answers above are true, complete, and accurate to the best of my knowledge. I understand that making false statements in this document may result in a contempt of court finding against me which could result in a jail sentence and fine, and may also subject me to criminal penalties for perjury under R.C. 2921.11. SIGNATURE OF PETITIONER Name of Attorney (if applicable) Signature of Petitioner's Attorney Attorney's Address City, State, Zip Code [Page 5 of 5 Form 10.05-B] FORM 10.05-B: PETITION FOR JUVENILE CIVIL PROTECTION ORDER AND JUVENILE DOMESTIC VIOLENCE PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form IN THE COURT OF COMMON PLEAS Petitioner : v. : Respondent : REQUEST FOR SERVICE TO THE CLERK OF COURT: Pursuant to Civ.R. 65.1(C)(2), please serve Respondent a copy of the Petition, and any other accompanying documents to the address below and as follows: Personal service Other (specify) Other (address): Personal Service Other (specify) SPECIAL INSTRUCTIONS TO SHERIFF: RETURN OF SERVICE Respondent was served on Officer and Badge Number Date CLERK'S CERTIFICATE OF MAILING Service of Process was sent by Attest: FORM 10.05-C: JUVENILE CIVIL PROTECTION ORDER OR JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER FORM 10.05-C: JUVENILE CIVIL PROTECTION ORDER OR JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form IN THE COURT OF COMMON PLEAS, DIVISION Order of Protection Per R.C. 2151.34(F)(3) or 3113.31(F)(3), this Order is indexed at OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - PHONE NUMBER PETITIONER: First Middle Initial Last v. RESPONDENT: First Middle Initial Last / / Distinguishing Features: Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent will be provided with reasonable notice and opportunity to be heard within the time required by Ohio law. below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until Respondent will attain 19 years of age on WARNING TO RESPONDENT: See the warning page attached to the front of this Order. [Page 2 of 5 Form 10.05-C] FORM 10.05-C: JUVENILE CIVIL PROTECTION ORDER OR JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form This proceeding came for an ex parte hearing on / / being present), upon the filing of a Petition by Petitioner for a juvenile civil protection order or juvenile domestic violence civil protection order against Respondent, pursuant to R.C. 2151.34 or 3113.31. The Court held an ex parte hearing in accordance with R.C. 2151.34(D)(1) or 3113.31(D)(1). The Court finds that protected persons named herein are in immediate and present danger and for good cause shown, the following temporary orders are necessary to protect the persons named in this Order. RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO RESPONDENT 1. RESPONDENT SHALL NOT ENTER the places indicated in this Order, including the buildings, grounds, and parking lots at those locations, except as specifically provided. [NCIC 04] Residence: School: Business or Place of Employment: Other: RESPONDENT IS A MINOR AND WILL RESIDE otherwise: 2. RESPONDENT SHALL STAY AWAY FROM [NCIC 04]: 3. RESPONDENT IS ALLOWED CONTACT WITH [Page 3 of 5 Form 10.05-C] FORM 10.05-C: JUVENILE CIVIL PROTECTION ORDER OR JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form 4. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY, COMPANION ANIMALS, OR PETS owned or possessed by the protected persons named in this Order. RESPONDENT MAY REMOVE THE FOLLOWING: 5. PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS owned by Petitioner from the possession of Respondent: Exchange of the listed companion animals or pets shall take place as follows: 6. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT this Order. Contact includes, but is not limited to, landline, cordless, or cellular telephone; text; instant messaging; fax; e-mail; voicemail; delivery service; social media; writings; blogging; electronic communications; posting a message; or communications by any other means regardless if directly or through another person, and as follows: [NCIC 05] 7. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. 8. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY OTHER PERSON by this Order. 9. RESPONDENT SHALL NOT INTERFERE device on the network, or incur further contractual or financial obligations related to the transferred numbers. Wireless service rights to and billing responsibility for the wireless service number or numbers in use by Petitioner shall be transferred to Petitioner, pursuant to R.C. 3113.31(E)(1)(k), by separate order. 10. IT IS FURTHER ORDERED: [NCIC 08] 11. ALL DISCOVERY SHALL STRICTLY COMPLY [Page 4 of 5 Form 10.05-C] FORM 10.05-C: JUVENILE CIVIL PROTECTION ORDER OR JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form 12. THE CLERK OF COURT SHALL CAUSE A COPY OF THE PETITION, THIS ORDER, AND ANY OTHER ACCOMPANYING DOCUMENT to be served on Respondent and Respondent's parent, guardian, or legal custodian as set forth in Civ.R. 65.1(C)(2). 13. SUBJECT TO FURTHER ORDER OF THIS COURT, this Order and all records of the proceeding shall be sealed upon the happening of the earliest of the following: (1) Dismissal of this Petition; (2) Expiration of the Order, or (3) Respondent's 19th birthday. 14. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON, INCLUDING FIREARMS, OR AMMUNITION and protection of the protected persons named in the Order. Upon the expiration or termination of this Order and if a full hearing order is not issued or consent agreement approved, Respondent may reclaim any deadly weapons held in protective custody by law enforcement pursuant to this unless Respondent is otherwise disqualified as verified by a check of the NCIC protection order file. 15. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. 16. THIS ORDER DOES NOT EXPIRE because of a failure to serve notice of the full hearing upon Respondent before the date set for the full hearing or because the Court grants a continuance, as set forth in R.C. 2151.34(D)(2)(b) and 3113.31(D)(2)(b). 17. RESPONDENT WILL ATTAIN 19 years of age on: IT IS SO ORDERED. JUDGE/MAGISTRATE NOTICE TO RESPONDENT, PARENTS, GUARDIAN, OR LEGAL CUSTODIAN NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERMS OF THIS ORDER EVEN WITH THE PROTECTED PERSON'S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. [Page 5 of 5 Form 10.05-C] FORM 10.05-C: JUVENILE CIVIL PROTECTION ORDER OR JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form A FULL HEARING on this Order, and all other issues raised by the Petition, shall be held before Judge/Magistrate on / / at a.m. p.m.at the following location: On the day of the Full Hearing, come prepared to (1) tell the Court what happened, (2) bring with you any witnesses, evidence, and documentation to prove your case, and (3) be aware that the other party or party's attorney may ask you questions. If you do not have an attorney, you may ask for a brief continuance to obtain an attorney per R.C. 2151.34(D)(2)(a)(iii) or 3113.31(D)(2)(a)(iii). The Court may, at its discretion, appoint an attorney for the Respondent per R.C. 2151.34(O). Parties do not have to give discovery, answer questions, or give information to the other party or the other party's lawyer unless ordered by judge or magistrate (Civ.R. 65.1(D)(2)). FORM 10.05-D: JUVENILE CIVIL PROTECTION ORDER FULL HEARING FORM 10.05-D: JUVENILE CIVIL PROTECTION ORDER FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form IN THE COURT OF COMMON PLEAS, Order of Protection Per R.C. 2151.34(F)(3), this Order is indexed at OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - PHONE NUMBER PETITIONER: First Middle Initial Last v. RESPONDENT: First Middle Initial Last / / Distinguishing Features: Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent will be provided with reasonable notice and opportunity to be heard within the time required by Ohio law. below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until Respondent will attain 19 years of age on WARNING TO RESPONDENT: See the warning page attached to the front of this Order. [Page 2 of 6 Form 10.05-D] FORM 10.05-D: JUVENILE CIVIL PROTECTION ORDER FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form This proceeding came for a hearing on / / Juvenile Civil Protection Order Ex Parte filed on / / 2151.34. The following individuals were present: The Court hereby makes the following findings of facts: Additional findings on a separate page are included and attached herein. The Court finds by a preponderance of the evidence that 1) Petitioner and/or Petitioner's family or household members are in danger of being or have been harmed by Respondent as defined in R.C. 2903.11, 2903.12, 2903.13, 2903.21, 2903.211, 2903.22, 2911.211, and 2950.01; and 2) the following orders are equitable, fair, and necessary to protect the persons named in this Order from offenses of violence. Pursuant to R.C. 2151.34(E)(1)(b), the Court finds by clear and convincing evidence that 1) Petitioner and Petitioner's family or household members reasonably believed Respondent's conduct before the filing of the Petition endangered the health, welfare, or safety of Petitioner and Petitioner's family or household members, 2) Respondent presents a continuing danger to Petitioner and Petitioner's family or household members, and 3) the following orders are equitable, fair, and necessary to protect the persons named in this Order. RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against the protected persons named in this Order. [NCIC 01 and 02] ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO RESPONDENT 1. RESPONDENT SHALL NOT ENTER the places indicated in this Order, including the buildings, grounds, and parking lots at those locations, except as specifically provided. [NCIC 04] [Page 3 of 6 Form 10.05-D] FORM 10.05-D: JUVENILE CIVIL PROTECTION ORDER FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form Residence: School: Business or Place of Employment: Other: RESPONDENT IS A MINOR AND WILL RESIDE otherwise: 2. RESPONDENT SHALL STAY AWAY FROM [NCIC 04]: 3. RESPONDENT IS ALLOWED CONTACT 4. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY, COMPANION ANIMALS, OR PETS owned or possessed by the protected persons named in this Order. RESPONDENT MAY REMOVE THE FOLLOWING: 5. PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS owned by Petitioner from the possession of Respondent: Exchange of listed companion animals or pets shall take place as follows: [Page 4 of 6 Form 10.05-D] FORM 10.05-D: JUVENILE CIVIL PROTECTION ORDER FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form 6. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT this Order. Contact includes, but is not limited to, landline, cordless, or cellular telephone; text; instant messaging; fax; e-mail; voicemail; delivery service; social media; writings; blogging; electronic communications; posting a message; or communications by any other means regardless if directly or through another person, and as follows: [NCIC 05] 7. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. 8. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY OTHER PERSON by this Order. 9. RESPONDENT SHALL COMPLETE THE FOLLOWING COUNSELING PROGRAM: Respondent shall contact this program within and immediately arrange for an initial appointment. written notice when Respondent attends the initial appointment, if Respondent fails to attend or is discharged, and when Respondent completes the program. Respondent is required to sign all necessary waivers to allow the Court to receive information from the program. Respondent is ordered to appear before Judge or Magistrate on / / Respondent's compliance with this Order. Respondent is warned: If you fail to attend the above- named program you may be held in contempt of court. 10. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON, INCLUDING FIREARMS, OR AMMUNITION of the protected persons named in this Order. Upon the expiration or termination of this Order, Respondent may reclaim any deadly weapons held in protective custody by law enforcement pursuant to this Order unless Respondent otherwise disqualified as verified by a check of the NCIC protection order file. 11. RESPONDENT SHALL BE ELECTRONICALLY MONITORED. forth in R.C. 2151.34(E)(1)(b). Respondent is ordered to report to for the installation of a global positioning system for the purpose of electronic monitoring for the duration of this Order or until The Court further imposes the following terms and conditions: 12. IT IS FURTHER ORDERED: [NCIC 08] [Page 5 of 6 Form 10.05-D] FORM 10.05-D: JUVENILE CIVIL PROTECTION ORDER FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form 13. THE CLERK OF COURT SHALL CAUSE A COPY OF THE PETITION AND THIS ORDER on Respondent as set forth in Civ.R. 5(B) and 65.1(C)(3) and Respondent's parent, guardian, or legal custodian. 14. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. 15. THE COSTS OF THIS ACTION ARE assessed against Respondent 16. THE COURT WILL SEAL THIS RECORD ON RESPONDENT'S 19 determines otherwise . 17. RESPONDENT WILL ATTAIN 19 years of age on: 18. IF THE FULL HEARING PROCEEDING WAS REFERRED TO A MAGISTRATE, the magistrate's granting of this Order and finds no error of law or other defect evident on the face of the Order. Accordingly, the Court adopts the magistrate's granting of the Order as set forth in Civ.R. 65.1. IT IS SO ORDERED. MAGISTRATE NOTICE TO RESPONDENT, PARENTS, GUARDIAN, OR LEGAL CUSTODIAN NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERMS OF THIS ORDER EVEN WITH THE PROTECTED PERSON'S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING. NOTICE OF FINAL APPEALABLE ORDER Copies of this Order, which is a final appealable Order, were served on or delivered to the parties indicated pursuant to Civ.R. 5(b) and 65.1(C)(3), including by ordinary mail, on a following date: / / . By: [Page 6 of 6 Form 10.05-D] FORM 10.05-D: JUVENILE CIVIL PROTECTION ORDER FULL HEARING Amended: April 15, 2021 Discard all previous versions of this form FORM 10.05-E: JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER AND CONSENT AGREEMENT PROTECTION ORDER FORM 10.05-E: JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER AND CONSENT AGREEMENT PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form IN THE COURT OF COMMON PLEAS, Order of Protection Per R.C. 3113.31(F)(3), this Order is indexed at OHIO LAW ENFORCEMENT AGENCY WHERE INDEXED ( ) - PHONE NUMBER PETITIONER: First Middle Initial Last v. RESPONDENT: First Middle Initial Last Distinguishing Features: Violence Against Women Act, 18 U.S.C. 2265, Federal Full Faith & Credit Declaration: Registration of this Order is not required for enforcement. THE COURT HEREBY FINDS: That it has jurisdiction over the parties and subject matter, and Respondent will be provided with reasonable notice and opportunity to be heard within the time required by Ohio law. below. THE COURT HEREBY ORDERS: That the above named Respondent be restrained from committing acts of abuse or threats of abuse against Petitioner and other protected persons named in this Order. Additional terms of this Order are set forth below. The terms of this Order shall be effective until Respondent will attain 19 years of age on WARNING TO RESPONDENT: See the warning page attached to the front of this Order. [Page 2 of 6 Form 10.05-E] FORM 10.05-E: JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER AND CONSENT AGREEMENT PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form This proceeding came for a hearing on / / Petition filed on / / The Court hereby makes the following findings of facts: Additional findings on a separate page are included and attached herein. The Court finds by a preponderance of the evidence that 1) Petitioner and Petitioner's family or household members are in danger of being or have been a victim of domestic violence or sexually oriented offenses, as defined in R.C. 3113.31(A), committed by Respondent; and 2) the following orders are equitable, fair, and necessary to protect the persons named in this Order from offenses of violence. The parties agree to waive their notice and hearing rights. Therefore, the Court approves the Juvenile Domestic Violence Consent Agreement Protection Order pursuant to R. C. 3113.31(E)(1). RESPONDENT SHALL NOT ABUSE, harm, attempt to harm, threaten, follow, stalk, harass, force sexual relations upon, or commit sexually oriented offenses against ALL OF THE PROVISIONS CHECKED BELOW ALSO APPLY TO RESPONDENT 1. RESPONDENT SHALL IMMEDIATELY VACATE 2. RESPONDENT IS A MINOR AND WILL RESIDE otherwise: [Page 3 of 7 Form 10.05-E] FORM 10.05-E: JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER AND CONSENT AGREEMENT PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form 3. RESPONDENT SHALL NOT INTERFERE WITH THE PROTECTED PERSONS' RIGHT residence, including, but not limited to canceling utilities or insurance or interrupting telecommunications (e.g., telephone, internet, cable) services, mail delivery, or the delivery of any other documents or items. [NCIC 03] 4. RESPONDENT SHALL NOT ENTER the places indicated in this Order, including the buildings, grounds, and parking lots at those locations, except as specifically provided. [NCIC 04] Residence: School: Business or Place of Employment: Other: 5. RESPONDENT SHALL STAY AWAY FROM [NCIC 04]: 6. RESPONDENT SHALL NOT REMOVE, DAMAGE, HIDE, OR DISPOSE OF ANY PROPERTY, COMPANION ANIMALS, OR PETS owned or possessed by the protected persons named in this Order. 7. PETITIONER IS AUTHORIZED TO REMOVE THE FOLLOWING COMPANION ANIMALS OR PETS, owned by Petitioner, from the possession of Respondent: Exchange of listed companion animals or pets shall take place as follows: [Page 4 of 6 Form 10.05-E] FORM 10.05-E: JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER AND CONSENT AGREEMENT PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form 8. RESPONDENT SHALL NOT INITIATE OR HAVE ANY CONTACT this Order. Contact includes, but is not limited to, landline, cordless, or cellular telephone; text; instant messaging; fax; e-mail; voicemail; delivery service; social media; writings; blogging; electronic communications; posting a message; or communications by any other means regardless if directly or through another person, and as follows: [NCIC 05] 9. RESPONDENT SHALL NOT use any form of electronic surveillance on protected persons. 10. RESPONDENT SHALL NOT CAUSE OR ENCOURAGE ANY OTHER PERSON by this Order. 11. RESPONDENT IS ALLOWED CONTACT 12. RESPONDENT MAY PICK UP CLOTHING the company of uniformed law enforcement officer within seven or days of the filing of this Order. Arrangements may be made by contacting: 13. RESPONDENT SHALL COMPLETE THE FOLLOWING COUNSELING PROGRAM: Respondent shall contact this program within immediately arrange for an initial appointment. notice when Respondent attends the initial appointment, if Respondent fails to attend or is discharged, and when Respondent completes the program. Respondent is required to sign all necessary waivers to allow the Court to receive information from the program. Respondent is ordered to appear before Judge/Magistrate on / / review Respondent's compliance with this Order. Respondent is warned: If you fail to attend the above-named program you may be held in contempt of court. 14. RESPONDENT SHALL NOT POSSESS, USE, CARRY, OR OBTAIN ANY DEADLY WEAPON, INCLUDING FIREARMS, OR AMMUNITION cessation of violence. Upon the expiration or termination of this Order, Respondent may reclaim any deadly weapons held in protective custody by law enforcement pursuant to this Order unless Respondent otherwise disqualified as verified by a check of the NCIC protection order file. 15. RESPONDENT SHALL NOT INTERFERE device on the network, or incur further contractual or financial obligations related to the transferred numbers. Wireless service rights to and billing responsibility for the wireless service number or numbers in use by Petitioner or any minor children in the care of Petitioner shall be transferred to Petitioner by separate order. [Page 5 of 7 Form 10.05-E] FORM 10.05-E: JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER AND CONSENT AGREEMENT PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form 16. IT IS FURTHER ORDERED: [NCIC 08] 17. THE CLERK OF COURT SHALL CAUSE A COPY OF THE PETITION AND THE ORDER on Respondent as set forth in Civ.R. 5(B) and 65.1(C)(3) and Respondent's parent, guardian, or legal custodian. 18. IT IS FURTHER ORDERED NO COSTS OR FEES SHALL BE ASSESSED AGAINST PETITIONER filing, issuing, registering, modifying, enforcing, dismissing, withdrawing, serving, subpoenaing witnesses for, or obtaining a certified copy of this Order. This Order is granted without bond. 19. THE COSTS OF THIS ACTION ARE assessed against Respondent 20. THE COURT WILL SEAL THIS RECORD ON RESPONDENT'S 19 determines otherwise . 21. RESPONDENT WILL ATTAIN 19 years of age on: 22. IF THE FULL HEARING PROCEEDING WAS REFERRED TO A MAGISTRATE, the magistrate's granting of this Order and finds no error of law or other defect evident on the face of the Order. Accordingly, the Court adopts the magistrate's granting of the Order as set forth in Civ.R. 65.1. IT IS SO ORDERED. MAGISTRATE NOTICE TO RESPONDENT, PARENTS, GUARDIAN, OR LEGAL CUSTODIAN NO PERSON PROTECTED BY THIS ORDER CAN GIVE YOU LEGAL PERMISSION TO CHANGE OR VIOLATE THE TERMS OF THIS ORDER. IF YOU VIOLATE ANY TERMS OF THIS ORDER EVEN WITH THE PROTECTED PERSON'S PERMISSION, YOU MAY BE HELD IN CONTEMPT OR ARRESTED. ONLY THE COURT CAN CHANGE THIS ORDER. YOU ACT AT YOUR OWN RISK IF YOU DISREGARD THIS WARNING.

I have read this Consent Agreement and agree to its terms. SIGNATURE OF PETITIONER Address of Petitioner Signature of Petitioner's Attorney [Page 6 of 6 Form 10.05-E] FORM 10.05-E: JUVENILE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER AND CONSENT AGREEMENT PROTECTION ORDER Amended: April 15, 2021 Discard all previous versions of this form Address of Petitioner's Attorney NOTICE OF FINAL APPEALABLE ORDER Copies of this Order, which is a final appealable Order, were served on or delivered to the parties indicated pursuant to Civ.R. 5(B) and 65.1(C)(3), including ordinary mail, on the following date: / / .