FINAL PROTECTION FROM 
 ABUSE ORDER 

 Extended Order 

 Amended Order 

IN THE COURT OF COMMON PLEAS OF 

 COUNTY, PENNSYLVANIA 

NO. 

First 

            Middle 

Last 

Suffix

Plaintiff’s DOB 

Name(s) of all protected persons, including minor child/ren and DOB: 

PLAINTIFF 

V. 

DEFENDANT 

First 

Middle 

Last 

Suffix 

Defendant’s Address: 

DEFENDANT IDENTIFIERS 

DOB 
SEX 
RACE 
HAIR 
SSN 
DRIVERS 
LICENSE # 
EXP DATE 

HEIGHT 
WEIGHT 
EYES 

STATE 

CAUTION: 

Weapon Involved

Weapon Present on the Property
Weapon Ordered Relinquished 

opportunity to be heard. 

The Court Hereby Orders: 

any place where they might be found. 







The Court Hereby Finds: That it has jurisdiction over the parties and subject matter, and Defendant has been provided with reasonable notice and 

Defendant shall not abuse, harass, stalk,  threaten, or attempt or threaten to use physical force against any of the above persons in

Except as provided in Paragraph 5 of this order, Defendant shall not contact Plaintiff, or any other person protected under this

order, by telephone or by any other means, including through third persons. 

Additional findings of this order are set forth below.

Order Effective Date 

Order Expiration Date 

NOTICE TO DEFENDANT 

Defendant is hereby notified that failure to obey this order may result in arrest as set forth in 23 Pa.C.S. § 6113 and that violation of the order may 

result in a charge of indirect criminal contempt as set forth in 23 Pa.C.S. § 6114. Violation may also subject you to prosecution and criminal penalties

under the Pennsylvania Crimes Code.  A violation of this order may result in the revocation of the safekeeping permit, which will require the 

immediate relinquishment of your firearms, other weapons, or ammunition to the sheriff or the appropriate law enforcement agency. Plaintiff's 

consent to contact by Defendant shall not invalidate this order which can only be modified by further order of court. 23 Pa.C.S. § 6108(g). 

This order is enforceable in all fifty (50) States, the District of Columbia, Tribal Lands, U.S. Territories, and the Commonwealth of Puerto 

Rico under the Violence Against Women Act, 18 U.S.C. § 2265.  If you travel outside of the state and intentionally violate this order, you may be 

subject to federal criminal proceedings under that act. 18 U.S.C. §§ 2261-2262. If you possess a firearm or any ammunition while this order is in 

effect, you may be charged with a federal criminal offense even if this Pennsylvania order does not expressly prohibit you from possessing firearms 

or ammunition under 18 U.S.C. § 922(g)(8) or state criminal offenses and state criminal penalties under 18 Pa.C.S. § 6105.

CHECK ALL THAT APPLY: 

Plaintiff or Protected Person(s) is/are: 

spouse or former spouse of Defendant 
parent of a child with Defendant 
current or former sexual or intimate partner with Defendant 
child of Plaintiff 
child of Defendant 
family member related by blood (consanguinity) to Defendant 
family member related by marriage or affinity to Defendant 
sibling (person who shares parenthood) of Defendant 

Defendant was served in accordance with Pa.R.C.P. No. 1930.4 and provided

notice of the time, date, and location of the hearing scheduled in this matter. 

AND NOW, this 

 day of __________, 20 __, the court having jurisdiction over 

the parties and the subject-matter, it is ORDERED, ADJUDGED, and DECREED as 
follows: 

This order is entered by (check one) 

by agreement 

by agreement 

without an admission 
after a hearing and decision by the court  at 
which Defendant was not present, despite proper service being made 
Without regard as to how the order was entered, this is a final order of court subject to 
full enforcement pursuant to the Protection From Abuse Act. 

after a hearing 
by default. 

Note:  Space is provided to allow for 1)  the court's general findings of abuse; 2)  

inclusion of the terms under which the order was entered (e.g., that the order was 
entered with the consent of the parties, or that Defendant, though properly served,
failed to appear for the hearing, or the reasons why the plaintiff's request for a final 
PFA order was denied); or 3) information that may be helpful to law enforcement (e.g.,
whether a firearm or other weapon was involved in the incident of abuse or whether 
Defendant is believed to be armed and dangerous).

Plaintiff's request for a final protection order is denied.

OR 

Plaintiff's request for a final protection order is granted.

1.

Defendant shall not abuse, stalk, harass, threaten, or attempt or threaten
to use physical force against Plaintiff or any other protected person in any place where they might
be found

2. Defendant is completely evicted and excluded from the residence at
___________________________________________________________ or any other
residence where Plaintiff or any other person protected under this order may live.
Exclusive possession of the residence is granted to Plaintiff. Defendant shall have no
right or privilege to enter or be present on the premises of Plaintiff or any other person
protected under this order.

On _________________, Defendant may enter the residence to retrieve his/her 
clothing and other personal effects, provided that Defendant is in the company of a law
enforcement officer or sheriff when such retrieval is made and [insert any other
conditions]:

3.

Except as provided in Paragraph 5 of this order, Defendant is
prohibited from having ANY CONTACT with Plaintiff, either directly or indirectly, or any 
other person protected under this order, at any location, including but not limited to any 
contact at Plaintiff's school, business, or place of employment.  Defendant is specifically 
ordered to stay away from the following locations for the duration of this order. 

4.

Except as provided in Paragraph 5 of this order, Defendant shall not

contact Plaintiff, either directly or indirectly, or any other person protected under this 
order, by telephone or by any other means, including through third persons.

5.

Temporary custody of the minor children: [NAMES OF THE CHILDREN

SUBJECT TO THE PROVISION OF THIS PARAGRAPH] shall be as follows: 

Check all that apply:.

STATE TO WHOM PRIMARY PHYSICAL CUSTODY IS AWARDED; STATE

TERMS OF PARTIAL CUSTODY, IF ANY.

There is a current custody order as to the children of the parties:

(county court) 

(docket number) 

A custody petition is pending.

A hearing is scheduled for

(Date, time and location) 

THIS ORDER SHALL NOT SUPERSEDE THE CURRENT CUSTODY ORDER.

THIS ORDER SUPERSEDES ANY PRIOR ORDER RELATING TO CHILD


CUSTODY.

The  custody  provisions  of  Paragraph  5  of  this  order  are  temporary.  Either  party  may 
initiate  custody  proceedings  pursuant  to  the  custody  statute  at  23  Pa.C.S.  §§  5321  — 
5340.    Any  valid  custody  order  entered  after  the  final  Protection  From  Abuse  order 
supersedes the custody provisions of this order. 

FIREARMS, OTHER WEAPONS, OR AMMUNITION

6.

RESTRICTIONS

Check all that apply: 


of this order.

Defendant is prohibited from possessing or acquiring any firearms for the duration

Defendant shall relinquish to the sheriff or the appropriate law enforcement 

agency the following firearm licenses owned or possessed by Defendant:

Defendant is directed to relinquish to the sheriff or the appropriate law
enforcement agency any firearm, other weapon, or ammunition listed in Attachment A
to Final Order, which is incorporated herein by reference.

Defendant may relinquish any firearms, other weapons, or ammunition to the 
sheriff or the appropriate law enforcement agency.  As an alternative, Defendant may
either relinquish firearms, other weapons, or ammunition to a third party provided
Defendant and the third party first comply with all the requirements to obtain a
safekeeping permit, or relinquish firearms, other weapons, or ammunition to a licensed
firearms dealer for consignment sale, lawful transfer, or safekeeping pursuant to 23 
Pa.C.S. § 6108.2(e).  Defendant must relinquish any firearm, other weapon,
ammunition, or firearm license ordered to be relinquished no later than 24 hours after 

service of this order.  Failure to timely relinquish any firearm, other weapon, 
ammunition, or any firearm license ordered to be relinquished shall result in a violation 
of this order and may result in criminal conviction under the Uniform Firearms Act, 18 
Pa.C.S. § 6105. 

7.

Any firearm delivered to the sheriff or the appropriate law enforcement

agency or transferred to a licensed firearm dealer or a qualified third party, who 
satisfies the procedural and substantive requirements to obtain a safekeeping permit 
issued under 23 Pa. C.S. § 6108.3 pursuant to this order or the temporary order, 
shall not be returned to Defendant until further order of court or as otherwise provided 
by law. 

The Pennsylvania State Police, the municipal police, or the sheriff shall

accompany Plaintiff to his or her residence to retrieve personal belongings.

The following additional relief is granted as authorized by § 6108 of the
Act:

8.

9.

Defendant is prohibited from stalking, as defined in 18 Pa.C.S. §2709.1, or

harassing, as defined in 18 Pa.C.S. § 2709, the following family and household
members of Plaintiff:

Name 

Address (optional) 

Relationship to Plaintiff 

Other relief:

as follows: 

10.

Defendant is directed to pay temporary support for: _________________

This order for support shall remain in effect until a final support order is entered by 
this court. However, this order shall lapse automatically if Plaintiff does not file a 
complaint for support with the Domestic Relations Section of the court within two 
weeks of the date of this order.  The amount of this temporary order does not 
necessarily reflect Defendant’s correct support obligation, which shall be determined 
in accordance with the guidelines at the support hearing. Any adjustments in the final 
amount of support shall be credited, retroactive to this date, to the appropriate party.

11.

(a)

The costs of this action are imposed on Defendant.

Because this order followed a contested proceeding, or a

(b)
hearing at which Defendant was not present, despite being served
with a copy of the petition, temporary order and notice of the date,
time and place of the hearing, Defendant is ordered to pay an
additional $100 surcharge to the court, which shall be distributed
in the manner set forth in 23 Pa C.S. §6106(d).

Upon a showing of good cause or a finding that Defendant is

(c)
unable to pay, the costs of this action are waived.

12. 

     Defendant shall pay $

   to Plaintiff by ____________  as

compensation for Plaintiff's out-of-pocket losses, which are as follows: 

An installment schedule is ordered as follows: 

OR 

Plaintiff is granted leave to present a petition, with appropriate notice to

□
Defendant, to __________________________________________________________
requesting recovery of out-of-pocket losses. The petition shall include an exhibit 
itemizing all claimed out-of-pocket losses, copies of all bills and estimates of repair, and 
an order scheduling a hearing. No fee shall be required by the prothonotary’s office for 
the filing of this petition.

13.

THIS ORDER SUPERSEDES ANY PRIOR PROTECTION FROM ABUSE

ORDER OBTAINED BY THE SAME PLAINTIFF AGAINST THE SAME 
DEFENDANT. 

14.

All provisions of this order shall expire:

CHECK ONE 

in _______________________on _______________ 

in three years, on ____________

NOTICE TO DEFENDANT 

Defendant is hereby notified that failure to obey this order may result in arrest as set forth 
in 23 Pa.C.S. § 6113 and that violation of the order may result in a charge of indirect 
criminal contempt as set forth in 23 Pa.C.S. § 6114.  Violation may also subject
you to prosecution and criminal penalties under the Pennsylvania Crimes Code.  A 
violation of this order may result in the revocation of the safekeeping permit, which will 
require the immediate relinquishment of your firearms, other weapons, and ammunition 
to the sheriff or the appropriate law enforcement agency. Plaintiff's consent to contact by
Defendant shall not invalidate this order, which can only be modified by further order of 
court. 23 Pa.C.S. § 6108(g). 

This order is enforceable in all fifty (50) States, the District of Columbia, Tribal 

Lands, U.S. Territories, and the Commonwealth of Puerto Rico under the Violence 
Against Women Act, 18 U.S.C. § 2265.  If you travel outside of the state and intentionally 
violate this order, you may be subject to federal criminal proceedings under that act. 18 
U.S.C. §§ 2261-2262. If you possess a firearm or any ammunition while this 
order  is  in  effect,  you  may  be  charged  with  a  federal  criminal  offense  even  if  this 
Pennsylvania order does not expressly prohibit you from possessing firearms or 
ammunition under 18 U.S.C. § 922(g)(8) or state criminal offenses and state criminal 
penalties under 18 Pa.C.S. § 6105.

NOTICE TO SHERIFF, POLICE, AND LAW ENFORCEMENT OFFICIALS 

The police and sheriff who have jurisdiction over Plaintiff's residence OR any 
location where a violation of this order occurs OR where Defendant may be located, shall 
enforce this order.  The court shall have jurisdiction over any indirect criminal contempt 
proceeding, either in the county where the violation occurred or where this 
protective order was entered.  An arrest for violation of Paragraphs 1 through 7 of this 
order may be without warrant, based solely on probable cause, whether or not the 
violation is committed in the presence of the police or any sheriff. 23 Pa.C.S. § 6113. 

Subsequent to an arrest, and without the necessity of a warrant, the police officer 

or sheriff shall seize all firearms, other weapons, and ammunition in Defendant's 
possession that were used or threatened to be used during the violation of the protection 
order or during prior incidents of abuse and any other firearms in Defendant's 
possession.  The [insert the appropriate name or title] shall maintain possession of the 
firearms, other weapons, or ammunition until further order of this court. 

When Defendant is placed under arrest for violation of the order, Defendant shall 

be taken to the appropriate authority or authorities before whom Defendant is to be 
arraigned.  A "Complaint for Indirect Criminal Contempt" shall then be completed and 
signed by the police officer, sheriff, OR Plaintiff. Plaintiff's presence and signature are 

not required to file the complaint. 

If sufficient grounds for violation of this order are alleged, Defendant shall be 

arraigned, bond set, if appropriate, and both parties given notice of the date of the
hearing. 

BY THE COURT: 

Judge 

Date 

This order was entered pursuant to the consent of Plaintiff and Defendant:

Plaintiff’s Signature 

Defendant’s Signature

ATTACHMENT A TO FINAL ORDER  
FIREARMS, OTHER WEAPONS AND 
AMMUNITION INVENTORY 

It is hereby ordered that Defendant relinquish the following firearms, other 
weapons, and ammunition to the sheriff or the appropriate law enforcement agency:

Location 

Firearm/Other Weapon/Ammunition 
1. 
2. 
3. 
4. 
5. 
6. 
7. 
8. 
9. 
10. 

BY THE COURT 

□ All firearms, other weapons, and ammunition owned or possessed by Defendant.

NOTICE: 

This attachment will be withheld from public inspection in 

accordance with 23 Pa. C.S. § 6108(a)(7)(v). 

Judge 

Date: 

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