esckþIbgÁab; 
    ehIy\LÚvenH edayPaBv½yqøat éf¶TI ______ Ex ________ 
qñaM 20______, RtUv)anbgÁab; nigRbkasfa esckþIbgÁab;karBar 
RtUv)ancUlCaFrmanenAeRkam 18 Pa.C.S. §4954 edaytMNag[ 
__________________________________________. 
   tamry³enH RtUv)anbgÁab;fa cugecaT 
________________________________ RtUvQb;TMnak;TMng 
b¤KRmamkMEhgbuKÁlEdlmaneQµaHdUcerobrab;xagelIedaypÞal; b¤ 
tamry³RKYsar mitþPkþi Pñak;garepSg² b¤mnusSsÁal;Kña ehIyfacugecaT 
minRtUvmanTMnak;TMngNamYyedaypÞal; b¤edayRbeyalkþI CamYybuKÁl 
EdlmaneQµaHdUc)anerobrab;xagelI elIkElgEttamry³emFavI . 

   

 

 

 

:            

TERM (ry³eBl) : _____________ 

 

 

: 
 

OMMONWEALTH OF PENNSYLVANIA   
                  xum:unEvlGhVepnsuIlv:aeno 
    
 
                            Tl;nwg                 
________________________________________ 
                  

                V.              

      
 
 

 
 

 

 

ORDER  

 

 

 

    AND NOW, to wit, this ______ day of 
___________________, 20______, it is  
ORDERED AND DECREED that a 
PROTECTIVE ORDER is entered under 18 
Pa.C.S. §4954 on behalf of 
________________________________________. 

   It is HEREBY ORDERED that the defendant, 
________________________________ 
refrain from contacting or intimidating the above 
mentioned person(s), either personally or by 
family, friends, agents or acquaintances, and that 
the defendant have no communication 
whatsoever, directly or indirectly, with the 
person(s) above named, except through an 
attorney. 

   This ORDER is effective from 
__________________________________ until 
this case is finally disposed. 

    esckþIbgÁab;enHcUlCaFrmancab;BIéf¶TI 
_____________________ rhUtdl;erOgkþIenH RtUvbiTecal .  

arbMBaneTAelIesckþIbgÁab;enH nwgRtUvTTYleTasBin½yedaysßiteRkam 
18 Pa.C.S. §4955 ³ 
   1.  GñkGacRtUv)ancab;xøÚn BIbTKRmamkMEhgsakSI b¤CnrgeRKaH 
nig¼b¤eFVIkarsgswkeTAelIsakSI b¤CnrgeRKaH EdlTaMgBIrenHCa 
karecaTRbkan;BIbT]RkidækRmitF¶n; .  
    2.  GñkGacRtUv)anecaTRbkan;fa mineKarBtamtulakar .  

   

   3.  eTasBin½yTaMgenH GacRtUv)anecaTRbkan; minfaEtkarbMBan 
EdlRtUv)anbwþgenH RtUv)anRbRBwtþieLIgedayxøÜnGñkpÞal; b¤Gñk)anbgá 
b¤CMruj[mankarbMBanenHekItmaneLIgenaHeLIy.  
 

iolation of this ORDER carries the following 

penalties under 18 Pa.C.S §4955: 

   1.  You may be arrested for intimidation of 
witnesses or victims and/or retaliation against a 
witness or victim, both felony charges. 

   2.  You may be held in contempt by this 
COURT. 
 

3.  These penalties may be imposed 

whether the violation complained of has been 
committed by you personally or caused or 
encouraged by you. 
 

                                                                        

         __________________________________________ 
Judge (ecARkm) 
                                                      
          
 
DATE ENTERED (kalbriecäTcUlCaFrman) :______________ 

 

 

 

 

 

 

11-300 (Rev. 9/06) Khmer/Cambodian 

 

 

 

 

 

 

 

 

[Quantum 2009] 

  COMPLAINING WITNESS  (sakSIbNþwg) 

 

   

                                                               

   

 k

   

  

  C

  

  

  

  

  V

Magisterial District Court No. __________ of ____________________, County, Pennsylvania 
tulakarDI®sÞIkemCIsþWerolelx __________ énexanFI ____________________ epnsuIlva:eno