EPO-001 Emergency Protective Order Victim's Email Officer's Email LAW ENFORCEMENT CASE NUMBER 1. PROTECTED PERSONS(insert names of all persons protected by this Order)2. RESTRAINED PERSON(name) Gender M F X Ht: Wt: Hair Color Eye Color Race Age Date of Birth Month Day Year 3. TO THE RESTRAINED PERSON: a. YOU MUST NOT harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy personal property of, keep under surveillance, impersonate, block movements of, annoy by phone or other electronic means (including repeatedly contact), or disturb the peace of (including coercive control), any person named in item 1. b. YOU MUST NOT contact, either directly or indirectly, by any means, including but not limited to by telephone, mail, e-mail or other electronic means, any person named in item 1. c. YOU MUST: 3. Checkbox Option C1 Stay away at least 3. Checkbox Option C2 yards from each person named in item 1.3. Checkbox Option C3 Stay away at least 3. Checkbox Option C4 yards from3. Checkbox Option C5 move out immediately from: 3. Checkbox Option C6 (address)D, E d. YOU MUST NOT take any action, directly or through others, to obtain the addresses or locations of any person named in item 1. e. YOU MUST NOT own, possess, purchase, receive, or attempt to purchase or receive any firearm (gun), firearm parts (receiver, frame, or unfinished receiver or frame (Penal Code section 16531)), or ammunition. You must immediately surrender these items if asked by law enforcement. If not asked by law enforcement to surrender immediately, you must turn them in to a law □enforcement agency or sell them to, or store them with, a licensed gun dealer within 24 hours of receiving this order. 4. (name) 4. Name text field is given temporary care and control of the following minor children of the parties (names & ages)5. Order Expires On Month Day Year at: Hours : Minutes EXPIRES ON THE 5TH COURT DAY OR 7TH CALENDAR DAY, WHICHEVER IS EARLIER. DO NOT COUNT THE DAY THE ORDER IS GRANTED.6. To Person in 1: To ask for a longer restraining order, ask for help at your local court. If there is an open juvenile case, file in that case. (Name and address of court): 7. Reasonable grounds for the issuance of this Order exist, and an emergency protective order is necessary to prevent the occurrence or recurrence of domestic violence, child abuse, child abduction, elder or dependent adult abuse, or stalking.8. Judicial officer(name) granted this Order on Month Day Year at: Hours : Minutes APPLICATION9. The events that caused the protected person to fear immediate and present danger of domestic violence, child abuse, child abduction, elder or dependent adult abuse (except solely financial abuse), or stalking are (give facts and dates; specify weapons):10. Firearms or ammunition were (check all that apply): 10. options that apply observed reported physically searched for seized 11, 12 11. The persons in 1 and 2 live together. The person in 1 asks that the perseon in 2 immediately move out from the address in item 3c 12. The person in 1 has minor children in common with the person in 2, and a temporary custody order is requested because of the facts alleged in item 9. A custody order Does exist Does not exist By: (PRINT NAME OF LAW ENFORCEMENT OFFICER) SIGNATURE OF LAW ENFORCEMENT OFFICERAgency Telephone No.Badge No. PROOF OF SERVICE13. I personally delivered (served) copies of this Order to the person named in 2 on Month Day Year At: Hours : Minutes Address where person in 2 was served: 14 . At the time of service, I was at least 18 years of age and not a party to this cause. I am a California law enforcement officer 15. My name, address, and telephone number are (this does not have to be server's home telephone number or address): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.Date Month Day Year TYPE NAME OF SERVER SIGNATURE OF SERVER