ONE copy to court, ONE copy to restrained person, ONE copy to protected person, ONE copy to issuing agency

EPO-001
EMERGENCY PROTECTIVE ORDER (See reverse for important notices.)
1. PROTECTED PERSONS (insert names of all persons protected by this Order):

LAW ENFORCEMENT CASE NUMBER:

2. RESTRAINED PERSON (name):
Wt.:

Hair color:

Ht.:

3. TO THE RESTRAINED PERSON: 

Eye color:

Race:

Age:

Date of birth:

Gender:

M

F

X

a.

b.

c.

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.
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. 

YOU MUST

stay away at least:

yards from each person named in item 1. 

stay away at least:

yards from

move out immediately from:

(address):

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):
minor children of the parties (names and ages):

is given temporary care and control of the following

5. Order Expires on (date):

at (time):

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 (date):

at (time):

9. 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):

APPLICATION

10.

11.

12.

By:

Agency:

Firearms or ammunition were (check all that apply):

 observed

 reported

physically searched for

seized

The persons in 1 and 2 live together. The person in 1 asks that the person in 2 immediately move out from the address in item 3c.

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 not exist.

  does exist.

(PRINT NAME OF LAW ENFORCEMENT OFFICER)

Telephone No.:

(SIGNATURE OF LAW ENFORCEMENT OFFICER)
Badge No.:

13. I personally delivered (served) copies of this Order to the person named in 2 on: (date):

at (time):

PROOF OF SERVICE

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.
15. My name, address, and telephone number are (this does not have to be server's home telephone number or address):

  I am a California law enforcement officer.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:

(TYPE OR PRINT NAME OF SERVER)

(SIGNATURE OF SERVER)

Form Adopted for Mandatory Use 
Judicial Council of California 
EPO-001 [Rev. January 1, 2023] 
Approved by DOJ

EMERGENCY PROTECTIVE ORDER (CLETS–EPO) 
(Domestic Violence, Child Abuse, Elder or Dependent Adult Abuse, or Stalking) 

Page 1 of 2

Family Code, §§ 6240-6275, 6389; 
Penal Code, § 646.91 

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EMERGENCY PROTECTIVE ORDER 
WARNINGS AND INFORMATION

EPO-001

TO THE RESTRAINED PERSON: VIOLATION OF THIS ORDER IS A MISDEMEANOR PUNISHABLE BY A $1,000 FINE, 
ONE YEAR IN JAIL, OR BOTH, OR IT MAY BE  PUNISHABLE AS A FELONY. THIS PROTECTIVE ORDER MUST BE ENFORCED 
BY ALL LAW  ENFORCEMENT OFFICERS IN THE STATE OF CALIFORNIA WHO ARE AWARE OF OR SHOWN A COPY OF THE 
ORDER. THE TERMS AND CONDITIONS OF THIS ORDER REMAIN ENFORCEABLE REGARDLESS OF THE ACTS OF THE 
PARTIES; IT MAY BE CHANGED ONLY BY ORDER OF THE COURT (PENAL CODE SECTION 13710(b)). 

OU ARE PROHIBITED FROM OWNING, POSSESSING, PURCHASING, RECEIVING, OR ATTEMPTING TO PURCHASE OR 
RECEIVE ANY ITEM LISTED IN 3e. (PENAL CODE SECTIONS 29825(a), 30305(a).) A VIOLATION IS SUBJECT TO A $1,000 
FINE AND IMPRISONMENT OR BOTH. YOU MUST IMMEDIATELY SURRENDER THE ITEMS IN 3e IF ASKED BY LAW 
ENFORCEMENT. IF NOT ASKED BY LAW ENFORCEMENT TO SURRENDER, YOU MUST TURN IN THE ITEMS IN 3e TO LAW 
ENFORCEMENT, OR SELL THEM TO, OR STORE THEM WITH, A LICENSED GUN DEALER WITHIN 24 HOURS OF RECEIVING 
THIS ORDER. PROOF OF SURRENDER, SALE, OR STORAGE MUST BE FILED WITH THE COURT WITHIN 48 HOURS OF 
RECEIPT OF THIS ORDER.

  Y

To the restrained person: This order will last until the date 
and time in item 5 on the reverse. The protected person may, 
however,   obtain a more permanent restraining order from the 
court. You may seek the advice of an attorney on any matter 
connected with this  order. The attorney should be consulted 
promptly so that the attorney may assist you in responding to 
the order.

To the protected person: This order will last only until the 
date and time noted in item 5 on the reverse. If you wish to 
seek continuing   protection, you will have to apply for an order 
from the court at the address in item 6. You may apply for a 
protective order free of charge. In the case of an endangered 
child, you may also apply for a more permanent order at the 
address in item 6, or if there is a juvenile dependency action 
pending, you may apply for a more permanent order under 
section 213.5 of the Welfare and Institutions Code. In the case 
of a child being abducted, you may apply for a Child Custody 
and Visitation Order from the court. You may seek the advice 
of an attorney on any matter connected with your application 
for any future court orders. The attorney should be consulted 
promptly so that the attorney may assist you in making your 
application. You do not have to have an attorney to get the 
protective order.

If a child is in danger of being abducted: This order will last 
only until the date and time noted in item 5 on the reverse. You 
may apply for a child custody order from the court.

A la persona bajo restricción judicial: Esta orden durará hasta 
la fecha y hora indicada en el punto 5 al dorso. La persona 
protegida puede, sin embargo, obtener una orden de entredicho 
(restricción judicial) más permanente de la corte. Usted puede 
consultar a un abogado en conexión con cualquier asunto 
relacionado con esta orden. Debe consultar al abogado 
inmediatamente para que él o ella le pueda ayudar a responder 
a la orden.

A la persona protegida: Esta orden durará sólo hasta la fecha y 
hora indicada en el punto 5 al dorso. Si usted desea que la 
protección continúe, tendrá que solicitar una orden de la corte en 
la dirección indicada en el punto 6. La solicitud de la orden de 
protección es gratis. En el caso de que un niño o una niña se 
encuentre en peligro, puede solicitar una orden más permanente 
en la dirección indicada en el punto 6, o si hay una acción legal 
pendiente de tutela juvenil, puede solicitar una orden más 
permanente conforme a la sección 213.5 del código titulado en 
inglés Welfare and Institutions Code. En el caso del secuestro 
de un niño o una niña, usted puede solicitar de la corte una orden 
para la guarda del niño o de la niña (Child Custody and Visitation 
Order). Puede consultar a un abogado en conexión con cualquier 
asunto relacionado con las solicitudes de órdenes de la corte que 
usted presente en el futuro. Debe consultar un abogado 
inmediatamente para que él o ella le pueda ayudar a presentar 
su solicitud. Para obtener la orden de protección no es necesario 
que un abogado le represente.

En el caso de peligro de secuestro de un niño o de una 
niña: Esta orden será válida sólo hasta la hora y fecha indicada 
en el punto 5 al dorso. Usted puede solicitar de la corte una 
orden para la guarda del niño o de la niña (Child Custody and 
Visitation Order).

To law enforcement: The emergency protective order shall be served upon the restrained person by the officer, if the restrained person 
can reasonably be located, and a copy shall be given to the protected person. A copy shall be filed with the court as soon as practicable 
after issuance. Also, the officer shall have the order entered into CLETS (CARPOS). The availability of an emergency protective order 
shall not be affected by the fact that the endangered person has vacated the household to avoid abuse. A law enforcement officer shall 
use every reasonable means to enforce an emergency protective order. A law enforcement officer who acts in good faith to enforce an 
emergency protective order shall not be held civilly or criminally liable.

This emergency protective order is effective when made. This order shall expire on the date and time specified in item 5 on the reverse. 
The provisions of this emergency protective order take precedence in enforcement over provisions of other existing protective orders  
between the same protected and restrained persons to the extent the provisions of this order are more restrictive. In other words, the  
provisions in this emergency protective order take precedence over the provisions in any other protective order, including a criminal  
protective order, if (1) the person to be protected is already protected by the other protective order, (2) the person to be restrained is  
subject to that other order, and (3) the provisions in this emergency order are more restrictive than the provisions in that other order. 
The  provisions in another existing protective order remain in effect and take precedence if they are more restrictive than the provisions 
in this emergency protective order.

EPO-001 [Rev. January 1, 2023]

EMERGENCY PROTECTIVE ORDER (CLETS–EPO) 
(Domestic Violence, Child Abuse, Elder or Dependent Adult Abuse, or Stalking) 

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