NOTICETO RESPONDENT

You are notified that under Section 455.050 and 455.523 RSMoifthecourt finds in favor of the petitioner or you default. the court may grant any of the
following forms of relief to the petitioner: .
(I) Order the respondent not to stalk, abuse, threaten to abuse, molest or disturb the peace of the petitioner and/or childrea petitioner and/or
childrCl may be; (2) Order the respondent not to enter upon the premises of the dwelling unit of the petitioner and/or children and restrain the respondent
from communicating with the petitioner in any manner or through any medium; (3) Order the any contact with the child(ren).
except as specifically authorized by the court; (4) Order the respondent not to transfer, encumber or otherwise dispose 9fthe, mUtlJaHy o,wned or leased ,.
property; (5) Grant temporary possession of property as specified; (6) Order respondent to participate in court approvedcounseIing:1'oir batterers
substance abuse treatment; (7) Award custody of minor children; (8) Establish a visitation schedule; (9) Award maintenance and! onmild support in
accordance with supreme court rule 88.01 and Chapter 452, RSMo to the petitioner; (10) Order the respondent to make an assignment of earnings or
other income; (II) Order the respondent to pay petitioner's rent or mortgage, or to pay for housing or other services provided to the petitioner by a
shelter; (12) Order the respondent to pay,CGurtcosts, aU..Q.mey fees and/or petitioner's costs for maintaining or defending the action; (13)
Order the respondent to pay for medical treatment and/or services provided to petitioner for injuries sustained by an act of domestiG, committed
by the respondent .: . ......! i ," ,
DEFINITION OF ABUSE
You are notified that under Section 455.010 RSMo, the term "abuse" todo,.Qrthreatstodo any
of the following acts against the petitioner: (I) purposely or knowingly placing or 10 place peUt\P.Icr,il)l harm; . (npurposely
or knowingJy clWsing physical harm to petitioner with or without a deadly weapon; (3) compelling petitioner by force or threat of force' to engage in
conduct ffom which the petitioner has /l condu?t has a .dgl}t. (4) engaging in a
purposeful or knowing course of condtiet oneill . .. t that alliirrfs or dwlses disiressto petitioner"aid serves no legitimate purpose.
The course of conduct must be such as to cause a reasonable person'io distress and must actually cause substantial emotional
distress to the petitioner. Such conduct might include but is not limited to: (a) following petitioher aboutinn public place peering in a
window or lingering outside the residence of the petitioner; (5) causing or attempting to cause petitioner to engage involuntarily in any sexual act by
force, threat of force,(Jr hl)iding, confining,. detaining or wiIl. You under
Sec.tion (I) RSMo, dIe. seem is defined as. any . ,'Pm', on a child other .than by
aCCidental meafl$ by ail member, or stalk,mg of Ii child. PI_sclplme mc1l,ldmg spankmg, tered In a reasonable manner shall not be
construed to be abuse. 7,,;;" -, . - . '-'1""- - " ,-""
L., DEFINttIb'ttf. STALKING'
You are notified that under Section 455.0 I 0 (10) and Section 455.50 I(t 0) RSMo, the term "stalking" is when a person purposely and repeatedly harasses
or follows with intent of harassing another person or child. As used in this subdivision, "harass" means to engage in a course of conduct directed at a
specific person or child that serves no legitimate purposc, that would cause a reasonable person or a'reasooobldldUlt to bbfieveai:bildwould sufter
substantial emotional distress. As<usedia conduct" means a paUern ofoonduet composed of a.seAes,t)facts over 11 period of
time, however short, evidencing a continuity of purpose. ='';Ji'
NOTICE REGARDING FIREARMS RESTRICTION
Pursuant to,18 USC 922(g) it shall be unlawful for any person (8) c:stilf! '[lg of which, such person
received acillal notice, and at which such ( .'arasSlng,st lng, or tlireatening an
intimate partner of such person or child of such intimate partner or person or ptaee an intil'mlte partner in
fear of bodily injury to the partner or child; and (c) (i) includes a finding that such person represents tl credible threat to the physica1 force against sud
intimate partner or child; or (ii) by its terms explicitly prohibits the use, attempted use, or threatened use of physical force against such intimate partner '"
child that would reasonably be expected to cause bodily injury, to ship or transport in interstate or foreign commerce or possess in or affecting commerce.
;:my firearm or i.lmmunition; or to receive any firearm or ammunition which has been shipped or transported in interstate or foreign commerce
INSTRUCTIONS TO CLERK
I. The Ex Parte,Order L'Opy of the petition m.ust be BerSQnalI), served upon respondent forthwith and than three (3) working
days prior to the date of the hearing. '.-' ' . '''' .., . .... .
2. A, copy of the Ex Parte Order of Protection and Full Order of Protection shall be issued/delivered at the time of ils'entt)i to petitioner. respondent, and
to the local law enforcement agency (police ouherifi)in the city or county where petitioner resides.
3. The clerk shall also issue a copy of any ofprqtection to the local. law enforcement agency re'sponsihle for lhafntaining the Missouri UnitbJin
Law Enforcement System or any comparable faw system the same daythe order is granted.:nfe'Wlawenforcemcnt agency responsible
for maintaining MU!t'SrSil"a'tfwttcryinformatiol'! the order for purposes ofverificatio'n within hours from the time the order is
'. A.. M'tce df.. .. . : #iO.Q,P.f1ap., .<orf4:. ,., r of protection shall be issued to the local law enforcement agcncy and to the law enforcement
orahj;;oth' comparable law entbrcementsystem,,.: ' . "
4. If time of entry of this order, a copy shall be personally served or mailed by ccrtincd mail to the respondent at
his last known address -. - ':h'-,.,. . '. .
, ":.'" \- SHERIFF'S OR SERVER'S RETURN' .'
I hereey _____. ___ County. Missouri by II copy of the order and"
copy of the petition (0 the-rcspondent..; . . .' .'. .
Served at (address) _______._._. ..... ---------.__--.---.-...... ......"".__..____.___.
on (date) ____...._____.__._____.,;",,_at

\
SWORN Mi'-OREA"NOTARY PUBLIC IF NOT S:t:RVED BY AN AI1THORlZED OFFICER
' .
Subscribed and swom to me on
(Seal)
..",
lvly Commission Expires: fV
Onee completed, a COP} ofthis service return should be immediately to the applicable Jackson County Courthouse, "
Department. of Civil Records, Adult/Child Abuse Section. ""\ rj
CIRCT 1432A 1101