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THE SUPERIOR COURT FOR THE COUNTY OF STATE (Cherokee County, Georgia)

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ORI Number ____________________
SC-18
THE SUPERIOR COURT FOR THE COUNTY OF
STATE OF GEORGIA
,
:
Petitioner,
: Civil Action File
v. :
:
,
: No.
Respondent. :
STALKING TWELVE MONTH PROTECTIVE ORDER
A hearing was held on this matter on , 20 at which the Respondent
appeared and/or was provided with the opportunity to be heard and the Petitioner requested that the
Protective Order entered in this case be continued. Having heard the evidence presented, reviewed the
petition and the record concerning this case and for good cause shown, IT IS HEREBY ORDERED
AND ADJUDGED:
1. The Respondent has knowingly and willfully violated O.C.G.A. § 16-5-90 et seq.
[pco01] and placed the Petitioner in reasonable fear for the Petitioner’s safety.
[pco02] Respondent is hereby enjoined and restrained from doing or attempting to do, or
threatening to do any act constituting a violation of O.C.G.A. § 16-5-90 et seq. and of
harassing, interfering, or intimidating the Petitioner or Petitioner’s immediate family.
Specifically Respondent is hereby enjoined and restrained from
which is a violation of O.C.G.A. §
16-5-90 et seq. and that any future acts committed by the Respondent toward the
Petitioner which are in violation of this statute and this Protective Order can amount to
AGGRAVATED STALKING, pursuant to O.C.G.A. § 16-5-91, which is a felony. A
person convicted of Aggravated Stalking shall be punished by imprisonment for not less
than 1 nor more than 10 years and by a fine of not more than $10,000.00.
2.
Respondent is enjoined and restrained from approaching within yards of
[pco04] Petitioner and/or Petitioner’s immediate family, and/or residence, place of
employment, or school.
3.
Respondent is not to have any contact of any type, direct, indirect, or through
[pco05] another person with the Petitioner or her/his immediate family, including but not
limited to telephone, fax, e-mail, or any other type of communication.
For your convenience, this form has been designed to be completed
online. The information typed on the first page will automatically
update to the other pages. Please be sure all pertinent information is
completed before printing. Once the form is completed, select 'Print' to
print the form. Selecting 'Reset' will clear the entire form.
Print
Reset
CIVIL ACTION FILE NO.
2
4.
That these proceedings be filed in the office of the Clerk of this Court.
5. This Order shall remain in effect for up to twelve (12) months from this date. This Order
expires on , 20 .
6. That this Order applies in every county throughout the state and it shall be the duty of
every court and every law enforcement official to enforce and carry out the provisions of
this Order pursuant to O.C.G.A. §§ 16-5-94 (e) and 19-13-4 (d). Law enforcement
may use their arrest powers pursuant to O.C.G.A. §§ 16-5-91 and 17-4-20 to enforce
the terms of this Order.
7. That this Court determined that it had jurisdiction over the parties and the subject matter
under the laws of the State of Georgia and Respondent received reasonable notice and
had the opportunity to be heard before this Order was issued sufficient to protect the
Respondent’s due process rights and this Order shall be presumed valid and pursuant
to 18 U.S.C. § 2265(a) shall be accorded full faith and credit by any other state or
local jurisdiction and shall be enforced as if an Order of the enforcing state or
jurisdiction.
ONLY THE FOLLOWING THAT ARE INITIALED BY THE JUDGE SHALL APPLY:
8. Respondent is to receive appropriate psychiatric or psychological services.
9. Petitioner is awarded costs and attorney fees in the amount of $ .
10.
[pco07]
SO ORDERED this day of , 20 .
JUDGE, SUPERIOR COURT
County
Print or stamp Judge’s name
Violation of the above Order may be punishable by arrest.
CIVIL ACTION FILE NO.
3
NOTICE TO RESPONDENT
1. Violation of this Order may result in immediate arrest and criminal prosecution that may result
in jail time and/or fines and/or may subject you to prosecution and penalties for contempt of
court.
2. This Order shall remain in effect unless specifically superseded by a subsequent Order signed
and filed, by operation of law, or by Order of dismissal, whichever occurs first. Only this
Court can void, modify or dismiss this Order. Either party may ask this Court to change or
dismiss this Order.
3. If after a hearing, of which the Respondent received notice and opportunity to participate, a
protective order is issued which restrains Respondent from harassing, stalking or threatening
an intimate partner, Respondent is prohibited from possessing, receiving, or transporting a
firearm or ammunition which has been shipped or transported in interstate or foreign
commerce for the duration of the Order. 18 U.S.C. § 922(g).
4.
A person commits the offense of Aggravated Stalking when such person, in violation of a
temporary or permanent protective Order prohibiting this behavior follows, places under
surveillance, or contacts another person on public or private property for the purpose of
harassing and intimidating the other person. This activity can subject the Respondent to
arrest and prosecution for Felony Aggravated Stalking, which carries penalties of
imprisonment.
CIVIL ACTION FILE NO.
4
Pursuant to O.C.G.A. § 19-13-3,
Petitioner assisted by
Name: ______________________________
Address: ____________________________
____________________________________
Phone: ______________________________
Note to Judges: This form is promulgated as a Uniform Superior Court Rule under the auspices of O.C.G.A. §
19-13-53. To order a specific provision, please initial in the space provided. The court should delete or
otherwise make inoperative any provision in the standardized form which is not supported by the evidence in
the case and in order to comply with the court´s application of the law and facts to an individual case.
CIVIL ACTION FILE NO.
5
*REMOVE THIS PAGE FROM ORDER AND FILE SEPARATELY UNDER SEAL*
*For transmittal to the Georgia Protective Order Registry and, if applicable,
the National Crime Information Center.*
RESPONDENT’S IDENTIFYING FACT SHEET
(please complete as much as possible; one of these must be provided to have the order placed in the National Crime
Information Center registry: Respondent’s date of birth OR social security number)
Respondent’s social security number is _______________, date of birth is _________, sex ____, color of hair
__________, color of eyes ______________, height _______, weight _____. Respondent’s race is __________,
ethnic background ____________. Respondent has distinguishing marks (tattoos, scars,
etc.)_____________________. Respondent drives a __________________________, license tag
no:____________(Expires:____) and has a ____(state) driver’s license no: _____________(Expires:____).
Respondent’s home address _____________________________________________ and is employed
by__________________ at _________________________________ and works from ____ to ____ on
(days)___________. Respondent has the following known aliases: ____________________________.
PROTECTED PARTIES’ IDENTIFYING INFORMATION
Petitioner: _________________________ DOB ___________ sex _______ race ______________
Other: _________________________ DOB ___________ sex _______ race ______________
Other: _________________________ DOB ___________ sex _______ race ______________
Other: _________________________ DOB ___________ sex _______ race ______________
Other: _________________________ DOB ___________ sex _______ race ______________
Transmitted to Georgia Protective Order Registry Date __________ Clerk ___________________________
Rev’d 8/14
CONFIDENTIAL INFORMATION FORM - ATTENTION COURT STAFF:
THIS PAGE IS A RESTRICTED-ACCESS DOCUMENT.
This document is not accessible to the public or to other parties.
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THE SUPERIOR COURT FOR THE COUNTY OF STATE (Cherokee County, Georgia)

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Completed 23 June 2021

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