US Laws, Codes, Statutes & Cases

TITLE 13

PROTECTIVE PROCEEDINGS; POWERS OF ATTORNEY; TRUSTS

 

Chapter     124.     Abuse Prevention and Reporting; Civil Action for Abuse

                  125.     Protective Proceedings

                  126.     Property Held for the Benefit of Minors; Uniform Transfers to Minors Act

                  127.     Powers of Attorney; Advance Directives for Health Care; Declarations for Mental Health Treatment; Death with Dignity

                  128.     Trusts; Charitable Activities

                  129.     Uniform Principal and Income Act

                  130.     Uniform Trust Code

 

_______________

 

Chapter 124 — Abuse Prevention and Reporting; Civil Action for Abuse

 

2007 EDITION

 

ABUSE PREVENTION; REPORTING; CIVIL ACTIONS

 

PROTECTIVE PROCEEDINGS; POWERS OF ATTORNEY; TRUSTS

 

ELDERLY PERSONS AND PERSONS WITH DISABILITIES ABUSE PREVENTION ACT

 

124.005     Definitions for ORS 124.005 to 124.040

 

124.010     Petition for relief; time limitation; information to be provided petitioner; exception

 

124.012     Filing of petitions; where contempt proceedings must be conducted

 

124.015     Hearing upon request of respondent; relief; settlement; effect of proceedings

 

124.020     Ex parte hearing; required findings; judicial relief; forms; request by respondent for hearing

 

124.022     Service of restraining order by sheriff; facsimile of order

 

124.024     Notice to be given by guardian petitioner

 

124.025     Removal of personal effects; accompanying peace officer; limitation on liability

 

124.030     Proof of service of restraining order to be delivered to sheriff; entry in LEDS; expiration of restraining order; release of respondent pending hearing

 

124.035     Renewal of restraining order

 

124.040     Short title

 

REPORTING OF ABUSE OF ELDERLY PERSONS

 

124.050     Definitions for ORS 124.050 to 124.095

 

124.055     Policy

 

124.060     Duty of officials to report

 

124.065     Method of reporting; content; notice to law enforcement agency and to department

 

124.070     Duty to investigate; notice to department; evaluation

 

124.075     Immunity of person making report in good faith; identity confidential

 

124.080     Photographing of victim; photograph as record

 

124.085     Catalog of abuse records; confidentiality

 

124.090     Confidentiality of records; exceptions

 

124.095     Spiritual treatment not abuse

 

CIVIL ACTION FOR ABUSE OF VULNERABLE PERSON

 

124.100     Definitions for ORS 124.100 to 124.140; action authorized; relief; qualifications for bringing action; service on Attorney General

 

124.105     Physical abuse subject to action

 

124.110     Financial abuse subject to action

 

124.115     Persons not subject to action

 

124.120     Relief available

 

124.125     Action by Attorney General, Department of Human Services or district attorney; investigative demands

 

124.130     Statute of limitation

 

124.135     Remedies not exclusive

 

124.140     Estoppel based on criminal conviction

 

PENALTIES

 

124.990     Criminal penalty

 

ELDERLY PERSONS AND PERSONS WITH DISABILITIES ABUSE PREVENTION ACT

 

      124.005 Definitions for ORS 124.005 to 124.040. As used in ORS 124.005 to 124.040:

      (1) “Abuse” means one or more of the following:

      (a) Any physical injury caused by other than accidental means, or that appears to be at variance with the explanation given of the injury.

      (b) Neglect that leads to physical harm through withholding of services necessary to maintain health and well-being.

      (c) Abandonment, including desertion or willful forsaking of an elderly person or a person with a disability or the withdrawal or neglect of duties and obligations owed an elderly person or a person with a disability by a caregiver or other person.

      (d) Willful infliction of physical pain or injury.

      (e) Use of derogatory or inappropriate names, phrases or profanity, ridicule, harassment, coercion, threats, cursing, intimidation or inappropriate sexual comments or conduct of such a nature as to threaten significant physical or emotional harm to the elderly person or person with a disability.

      (f) Causing any sweepstakes promotion to be mailed to an elderly person or a person with a disability who had received sweepstakes promotional material in the United States mail, spent more than $500 in the preceding year on any sweepstakes promotions, or any combination of sweepstakes promotions from the same service, regardless of the identities of the originators of the sweepstakes promotion and who represented to the court that the person felt the need for the court’s assistance to prevent the person from incurring further expense.

      (g) Wrongfully taking or appropriating money or property, or knowingly subjecting an elderly person or person with a disability to alarm by conveying a threat to wrongfully take or appropriate money or property, which threat reasonably would be expected to cause the elderly person or person with a disability to believe that the threat will be carried out.

      (h) Sexual contact with a nonconsenting elderly person or person with a disability or with an elderly person or person with a disability considered incapable of consenting to a sexual act as described in ORS 163.315. As used in this paragraph, “sexual contact” has the meaning given that term in ORS 163.305.

      (2) “Elderly person” means any person 65 years of age or older who is not subject to the provisions of ORS 441.640 to 441.665.

      (3) “Guardian petitioner” means a guardian or guardian ad litem for an elderly person or a person with a disability who files a petition under ORS 124.005 to 124.040 on behalf of the elderly person or person with a disability.

      (4) “Interfere” means to interpose in a way that hinders or impedes.

      (5) “Intimidate” means to compel or deter conduct by a threat.

      (6) “Menace” means to act in a threatening manner.

      (7) “Molest” means to annoy, disturb or persecute with hostile intent or injurious effect.

      (8) “Person with a disability” means a person described in:

      (a) ORS 410.040 (7)(b); or

      (b) ORS 410.715.

      (9) “Petitioner” means an elderly person or a person with a disability who files a petition under ORS 124.005 to 124.040.

      (10) “Sweepstakes” means:

      (a) A procedure for awarding a prize that is based on chance;

      (b) A procedure in which a person is required to purchase anything, pay anything of value or make a donation as a condition of winning a prize or of receiving or obtaining information about a prize; or

      (c) A procedure that is advertised in a way that creates a reasonable impression that a payment of anything of value, purchase of anything or making a donation is a condition of winning a prize or receiving or obtaining information about a prize.

      (11) “Sweepstakes promotion” means an offer to participate in a sweepstakes. [1995 c.666 §§3,3a; 1999 c.738 §1; 1999 c.875 §6; 2003 c.257 §1a; 2003 c.264 §1; 2005 c.671 §1; 2007 c.70 §24]

 

      124.010 Petition for relief; time limitation; information to be provided petitioner; exception. (1)(a) Except as provided in subsection (8) of this section, an elderly person or a person with a disability who has been the victim of abuse within the preceding 180 days or a guardian or guardian ad litem of an elderly person or a person with a disability who has been the victim of abuse within the preceding 180 days may petition the circuit court for relief under ORS 124.005 to 124.040, if the person is in immediate and present danger of further abuse from the abuser.

      (b) The elderly person or person with a disability or the guardian or guardian ad litem of the person may seek relief by filing a petition with the circuit court alleging that the person is in immediate and present danger of further abuse from the respondent, alleging that the person has been the victim of abuse committed by the respondent within the 180 days preceding the filing of the petition and describing the nature of the abuse and the approximate dates thereof. The abuse must have occurred not more than 180 days before the filing of the petition.

      (c) A petitioner or guardian petitioner is not required to provide in the petition information regarding the relationship between the elderly person or person with a disability and the respondent.

      (d) Allegations in the petition must be made under oath or affirmation. The circuit court has jurisdiction over all proceedings under ORS 124.005 to 124.040.

      (2) The petitioner or guardian petitioner has the burden of proving a claim under ORS 124.005 to 124.040 by a preponderance of the evidence.

      (3) The right to petition for relief under ORS 124.005 to 124.040 is not affected by the fact that the elderly person or person with a disability has left the residence or household to avoid abuse.

      (4) A petition filed under ORS 124.005 to 124.040 must disclose the existence of any Elderly Persons and Persons With Disabilities Abuse Prevention Act proceedings, any Abuse Prevention Act proceedings, any marital annulment, dissolution or separation proceedings pending between the parties or any protective proceedings under ORS chapter 125.

      (5) Upon the filing of a petition under ORS 124.005 to 124.040, the clerk of the court shall give the petitioner or guardian petitioner information provided by the Department of Human Services about local adult protective services, domestic violence shelters and local legal services available.

      (6) For purposes of computing the 180-day period in this section and ORS 124.020, any time during which the respondent is incarcerated or has a principal residence more than 100 miles from the principal residence of the elderly person or person with a disability is not counted as part of the 180-day period.

      (7) If a guardian or guardian ad litem files a petition under this section on behalf of an elderly person or a person with a disability, the elderly person or person with a disability retains the right to:

      (a) Contact and retain counsel;

      (b) Have access to personal records;

      (c) File objections to the restraining order;

      (d) Request a hearing; and

      (e) Present evidence and cross-examine witnesses at any hearing.

      (8) An elderly person or a person with a disability may not file a petition under ORS 124.005 to 124.040 against a guardian or conservator for the person. [1995 c.666 §4; 1999 c.738 §2; 1999 c.1052 §11; 2003 c.257 §2a; 2003 c.264 §2; 2005 c.671 §2; 2007 c.70 §25]

 

      124.012 Filing of petitions; where contempt proceedings must be conducted. A petition under ORS 124.010 may be filed only in a county in which the petitioner or respondent resides. Any contempt proceedings for violation of a restraining order issued under ORS 124.005 to 124.040 must be conducted by the court that issued the order, or by the circuit court for a county in which a violation of the restraining order occurs. If contempt proceedings are initiated in the circuit court for a county in which a violation of the restraining order occurs, the person initiating the contempt proceedings shall file with the court a copy of the restraining order, certified by the clerk of the court that issued the order. Upon filing of the certified copy of the restraining order, the court shall enforce the order as though that court had issued the order. [2003 c.289 §4]

 

      124.015 Hearing upon request of respondent; relief; settlement; effect of proceedings. (1) The court shall hold a hearing within 21 days following the request, and may cancel or change any order issued under ORS 124.020 if the respondent, elderly person or person with a disability requests a hearing pursuant to ORS 124.020 (9).

      (2) In addition to the relief granted under ORS 124.020, the court, in a hearing held pursuant to subsection (1) of this section, may:

      (a) Require either party to move from any residence whose title or right to occupy such premises is held jointly by the parties; and

      (b) Assess against any party reasonable attorney fees and such costs as may be incurred in the hearing.

      (3)(a) If the respondent is represented by an attorney, time for the hearing may be extended for up to five days at the request of the petitioner or guardian petitioner so that the petitioner or guardian petitioner may seek representation.

      (b) If the elderly person or person with a disability is represented by an attorney, time for the hearing may be extended for up to five days at the request of the respondent or guardian petitioner so that the respondent or guardian petitioner may seek representation.

      (4) The court may approve any consent agreement to bring about a cessation of abuse of the parties. However, the court may not approve a term in a consent agreement that provides for restraint of a party to the agreement unless the other party petitioned for and was granted an order under ORS 124.010. An order or consent agreement made under this section may be amended at any time and shall continue in effect for a period of one year from the date of the order issued under ORS 124.020.

      (5) An order or agreement made under ORS 124.005 to 124.040 or ORS 133.310 and 133.381 may not in any manner affect title to any real property.

      (6) No undertaking shall be required in any proceeding under ORS 124.005 to 124.040.

      (7) Any proceeding under ORS 124.005 to 124.040 shall be in addition to and not in lieu of any other available civil or criminal remedies.

      (8) Notwithstanding any right or remedy established in ORS chapter 90 or ORS 105.105 to 105.168, a petitioner or guardian petitioner may enforce an order issued under ORS 124.005 to 124.040. [1995 c.666 §§5,5a; 2003 c.257 §3a; 2005 c.671 §9; 2007 c.70 §26]

 

      124.020 Ex parte hearing; required findings; judicial relief; forms; request by respondent for hearing. (1) When a petitioner or guardian petitioner files a petition under ORS 124.010, the circuit court shall hold an ex parte hearing in person or by telephone on the day the petition is filed or on the following judicial day. Upon a showing that the elderly person or person with a disability named in the petition has been the victim of abuse committed by the respondent within 180 days preceding the filing of the petition and that there is an immediate and present danger of further abuse to the person, the court shall, if requested by the petitioner or guardian petitioner, order, for a period of one year or until the order is withdrawn or amended, whichever is sooner:

      (a) That the respondent be required to move from the residence of the elderly person or person with a disability, if in the sole name of the person or if jointly owned or rented by the person and the respondent, or if the parties are married to each other;

      (b) That a peace officer accompany the party who is leaving or has left the parties’ residence to remove essential personal effects of the party;

      (c) That the respondent be restrained from abusing, intimidating, molesting, interfering with or menacing the elderly person or person with a disability, or attempting to abuse, intimidate, molest, interfere with or menace the person;

      (d) That the respondent be restrained from entering, or attempting to enter, on any premises when it appears to the court that such restraint is necessary to prevent the respondent from abusing, intimidating, molesting, interfering with or menacing the elderly person or person with a disability;

      (e) That the respondent be:

      (A) Restrained, effective on a date not less than 150 days from the date of the order, from mailing the elderly person or person with a disability any sweepstakes promotion;

      (B) Required to remove the elderly person or person with a disability from the respondent’s sweepstakes promotion mailing list or place the person on a list of persons to whom sweepstakes promotions may not be mailed; and

      (C) Required to promptly refund any payment received in any form from the elderly person or person with a disability after the date the order is entered by the court; or

      (f) Except as provided in subsection (2) of this section, other relief that the court considers necessary to provide for the safety and welfare of the elderly person or person with a disability.

      (2)(a) If the court finds that the elderly person or person with a disability has been the victim of abuse as defined in ORS 124.005 (1)(g), the court may order only relief that the court considers necessary to prevent or remedy the wrongful taking or appropriation of the money or property of the person, including but not limited to:

      (A) Directing the respondent to refrain from exercising control over the money or property of the person;

      (B) Requiring the respondent to return custody or control of the money or property of the person to the person;

      (C) Requiring the respondent to follow the instructions of the guardian or conservator of the person; or

      (D) Prohibiting the respondent from transferring the money or property of the elderly person or person with a disability to any person other than the elderly person or person with a disability.

      (b) The court may not use a restraining order issued under ORS 124.005 to 124.040:

      (A) To allow any person other than the elderly person or person with a disability to assume responsibility for managing any of the money or property of the elderly person or person with a disability; or

      (B) For relief that is more appropriately obtained in a protective proceeding filed under ORS chapter 125 including, but not limited to, giving control and management of the financial accounts or property of the elderly person or person with a disability for any purpose other than the relief granted under paragraph (a) of this subsection.

      (3) The showing required under subsection (1) of this section may be made by testimony of:

      (a) The elderly person or person with a disability;

      (b) The guardian or guardian ad litem of the elderly person or person with a disability;

      (c) Witnesses to the abuse; or

      (d) Adult protective services workers who have conducted an investigation.

      (4) Immediate and present danger under this section includes but is not limited to situations in which the respondent has recently threatened the elderly person or person with a disability with additional abuse.

      (5) When a guardian petitioner files a petition on behalf of an elderly person or a person with a disability, the guardian petitioner shall provide information about the person and not about the guardian petitioner where the petition, order or related forms described in subsection (6) of this section require information about the petitioner.

      (6) An instruction brochure shall be available from the clerk of the court explaining the rights set forth under ORS 124.005 to 124.040. The petition, order and related forms shall be available from the clerk of the court and shall be in substantially the following form:

______________________________________________________________________________

IN THE CIRCUIT COURT OF

THE STATE OF OREGON FOR

THE COUNTY OF ____________

 

______,           )           PETITION FOR

Petitioner         )           RESTRAINING ORDER

(your name)     )           TO PREVENT ABUSE

                        )           OF ELDERLY

                        )           PERSONS OR

                        )           PERSONS WITH

vs.                    )           DISABILITIES

                        )

                        )           NO. _____

______,           )

Respondent     )

(person to be   )

restrained)       )

 

YOU MUST PROVIDE COMPLETE AND TRUTHFUL INFORMATION. IF YOU DO NOT, THE COURT MAY DISMISS ANY RESTRAINING ORDER AND MAY ALSO HOLD YOU IN CONTEMPT OF COURT.

If you wish to have your residential address or telephone number withheld from respondent, use a contact address and telephone number so the Court and the Sheriff can reach you if necessary.

ATTACH ADDITIONAL PAGES

IF NECESSARY.

I am the Petitioner and I state that the following information is true:

I am a resident of ___________ County, Oregon.

Respondent is a resident of ________ County, Oregon.

I am either 65 years of age or older (I am ______ years of age) or I am a person with a disability (CIRCLE THE ONE THAT DESCRIBES YOU).

1.   CHECK AND FILL OUT ANY SECTION(S) that apply to you and respondent:

__  A.  Respondent and I have been living together since ______, ___ (year).

__  B.  Respondent and I lived together from ______, ___ (year), to________,___ (year).

__  C.  I have been under the care of respondent since ______,___ (year).

__  D.  I was under the care of respondent from ______, ___ (year), to________,___ (year).

__  E.   Respondent has sent me sweepstakes promotions.

__  F.   None of the above.

2.   To qualify for a restraining order, respondent must have done one or more of the following:

      Within the last 180 days, respondent has:

__  A.  Caused me physical injury by other than accidental means.

__  B.  Attempted to cause me physical injury by other than accidental means.

__  C.  Placed me in fear of immediate serious physical injury.

__  D.  Caused me physical harm by withholding services necessary to maintain my health and well-being.

__  E.   Abandoned or deserted me by withdrawing or neglecting to perform duties and obligations.

__  F.   Used derogatory or inappropriate names, phrases or profanity, ridicule, harassment, coercion, threats, cursing, intimidation or inappropriate sexual comments or conduct of such a nature as to place me in fear of significant physical or emotional harm.

__  G.  Sent me sweepstakes promotions, and I feel the need for the court’s assistance to protect me from further expense. I am an elderly person or a person with a disability. In the past year, I spent more than $500 on sweepstakes promotions that I received in the United States mail.

__  H.  Wrongfully taken or appropriated my money or property, or alarmed me by conveying a threat to me that my money or property would be wrongfully taken or appropriated, which I reasonably believed would be carried out.

__  I.    Had nonconsensual sexual contact with me or sexual contact to which I was incapable of consenting.

      NOTICE TO PETITIONER: Sweepstakes companies are allowed up to 150 days to stop sending you sweepstakes entry materials. For a time after the court issues a restraining order, you may receive additional solicitations from respondent. However, beginning on the date the restraining order is issued, the respondent must immediately reject any further orders from you and must return any money you send to the company after the date the restraining order is issued.

3.   Any period of time after the abuse occurred during which respondent was incarcerated (in jail or prison) or lived more than 100 miles from your home is not counted as part of the 180-day period, and you may still be eligible for a restraining order.

      Respondent was incarcerated from___________,___ (year), to _________, ___ (year).

      Respondent lived more than 100 miles from my home from ________, ___ (year), to________, ___ (year).

4.   Did the abuse happen within the last 180 days not including the times respondent was incarcerated (in jail or prison) or lived more than 100 miles from your home? Yes No

      Date and location of abuse:

      ______________________

      ______________________

      How did respondent injure or threaten to injure you?

      ______________________

      ______________________

      ______________________

5.   Are there incidents other than those described in question 4 above, in which respondent injured or threatened to injure you? If yes, explain:

      ______________________

      ______________________

      ______________________

6.   The abuse I am complaining about was witnessed by _________ (affidavit attached). Other persons with knowledge of the abuse are _________ (affidavit attached).

7.   I am in immediate and present danger of further abuse by respondent because:

      ______________________

      ______________________

      ______________________

8.   In any of the above incidents:

      Were drugs, alcohol or weapons involved? Yes No

      Did you need medical help? Yes No

      Were the police or the courts involved? Yes No

      If you have circled yes to any of the above questions, explain:

      ______________________

      ______________________

9.   A.  There (is) (is not) another Elderly Persons and Persons With Disabilities Abuse Prevention Act or Abuse Prevention Act proceeding pending between respondent and me. It is filed in ______ (County), ______(State), and I am (Petitioner) or (Respondent) in that case.

            The case number of the case is: _______________

      B.  There (is) (is not) another lawsuit pending between respondent and me for divorce, annulment or legal separation.

            If yes, type of lawsuit: _______________

            It is filed in ________ (County), ________(State).

      C.  There (is) (is not) a protective proceeding filed in ______ (County), ______(State).

10. Respondent may be required to move from your residence if it is in your sole name, or if it is jointly owned or rented by you and respondent, or if you and respondent are married.

      I (do) (do not) want respondent to move from my residence.

      My residence is:

      Owned Leased Rented

      By: _______________

PETITIONER ASKS THE COURT TO GRANT THE RELIEF INDICATED IN THE “PETITIONER’S REQUEST” COLUMN OF THE PROPOSED RESTRAINING ORDER, WHICH IS ATTACHED.

______________________________________________________________________________

 

PETITIONER MUST NOTIFY THE COURT

OF ANY CHANGE OF ADDRESS.

 

ALL NOTICES OF HEARING WILL

BE SENT TO THIS ADDRESS

AND DISMISSALS MAY BE

ENTERED IF YOU DO NOT APPEAR

AT A SCHEDULED HEARING.

 

If you wish to have your residential address or telephone number withheld from respondent, use a contact address and telephone number so the Court and the Sheriff can reach you if necessary.

 

                        _________

                        PETITIONER

 

STATE OF OREGON           )

                                                )           ss.

County of_____                      )

 

      SUBSCRIBED AND SWORN TO before me this _____ day of ______, 2___.

______________________

NOTARY PUBLIC FOR OREGON

My commission expires: ______

RELEVANT DATA

RESPONDENT _______________

Sex ___ Telephone # ________

Residence Address ____________

City/State/Zip _______________

County _______________

Birthdate ______ Age ___

Race ______

Height ________ Weight ________

Eye Color ________

Hair Color ________

 

PETITIONER (you)____________   GUARDIAN PETITIONER

Sex _____ *Telephone #________     Name ____________

*Residence Address____________   Address ____________

City/State/Zip_______________       __________________

County__________________            Telephone # ___________

Birthdate ________ Age _____

Race ________

Height ________ Weight ________

Eye Color ________

Hair Color ________

 

            *If you wish to have your residential address or telephone number withheld from respondent, use a contact address and telephone number so the Court and the Sheriff can reach you if necessary.

 

PLEASE FILL OUT THIS INFORMATION

TO AID IN SERVICE OF

THE RESTRAINING ORDER

 

Where is respondent most likely to be located?

      Residence  Hours ________

      Employment          Hours ________

      Address: ______

      ____________

      Employment          Hours ________

      Address: ______

      ____________

Description of vehicle ____________

___________________________

Does respondent have any weapons or access to weapons? Explain:

______________________________________________________________________________

______________________________________________________________________________

Has respondent ever been arrested for or convicted of a violent crime? Explain:

______________________________________________________________________________

______________________________________________________________________________

Is there anything about respondent’s character, past behavior or the present situation that indicates that respondent may be a danger to self or others? Explain:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

 

IN THE CIRCUIT COURT OF

THE STATE OF OREGON

FOR THE COUNTY OF ____________

_________,                             )

Petitioner                                 )

(your name)                             )           RESTRAINING ORDER

                                                )           TO PREVENT ABUSE

                                                )           OF ELDERLY PERSONS

vs.                                            )           OR PERSONS WITH

                                                )           DISABILITIES

                                                )

                                                )           NO. ________

_________,                             )

Respondent                             )

(person to be restrained)         )

                                                )

 

TO THE RESPONDENT:

VIOLATION OF THIS RESTRAINING ORDER

MAY RESULT IN YOUR ARREST AND IN

CIVIL AND/OR CRIMINAL PENALTIES.

REVIEW THIS ORDER CAREFULLY.

EACH PROVISION MUST BE OBEYED.

SEE YOUR RIGHTS TO A HEARING.

      The Court, having reviewed the petition, makes the following findings:

Judge’s Initials

      __  Petitioner has been abused by respondent as defined by ORS 124.005;

      __  The abuse of petitioner by respondent occurred within the last 180 days as provided in ORS 124.010;

      __  There is an immediate and present danger of further abuse to petitioner.

IT IS HEREBY ORDERED that:

Petitioner’s Request                                                                            Judge’s Initials

[ ]   1.   Respondent is restrained (prohibited) from intimidating,            _____

            molesting, interfering with or menacing petitioner, or

            attempting to intimidate, molest, interfere with or menace

            petitioner.

[ ]   2.   Respondent is restrained (prohibited) from entering, or               _____

            attempting to enter:

      (Include names and address unless withheld for safety reasons.)

      [ ]   Petitioner’s residence.                                                                   _____

      [ ]   Petitioner’s business or place of employment.                              _____

      [ ]   Petitioner’s school.                                                                        _____

      [ ]   Other locations.                                                                             _____

[ ]   3.   Respondent is restrained (prohibited) from:

      [ ]   Contacting, or attempting to contact, petitioner by telephone.    _____

      [ ]   Contacting, or attempting to contact, petitioner by mail.             _____

[ ]   4.   Respondent shall move from and not return to the re-                 _____

            sidence located at ____________ except with a

            peace officer in order to remove essential personal effects

            of the respondent, including, but not limited to:

            clothing, toiletries, medications, Social Security cards,

            birth certificates, identification and tools of the trade.

[ ]   5.   A peace officer shall accompany the petitioner to the                  _____

            parties’ residence in order to remove essential personal

            effects of petitioner, including, but not limited to:

            clothing, toiletries, medications, Social Security cards,

            birth certificates, identification and tools of the trade.

[ ]   6.   Beginning on a date not less than 150                                          _____

            days from the date of this order, the respondent shall

            not mail the petitioner any further sweepstakes promotions.

[ ]   7.   Respondent shall remove the petitioner from                               _____

            the respondent’s sweepstakes promotion mailing list or

            shall place the petitioner on the respondent’s list of

            persons to whom sweepstakes promotions may not be mailed.

[ ]   8.   Respondent shall refund any payment received                           _____

            in any form from the petitioner after the date

            this order is entered by the court.

[ ]   9.   Other relief:________________________                                   _____

            ______________________________

            ______________________________

[ ]   10. No further service is necessary because respondent