TEMPORARY PROTECTION 
 FROM ABUSE ORDER 

 Amended Order 

 Continued 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: 

place where they might be found. 

The Court Hereby Finds: That it has jurisdiction over the parties and subject matter, and Defendant will be 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 any 

  Except for such contact with the minor child/ren as may be permitted under 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.  Consent of Plaintiff to Defendant's return to the 

residence shall not invalidate this order, which can only be changed or modified through the filing of appropriate court papers for that purpose. 

23 Pa.C.S. § 6108 (g). If Defendant is required to relinquish any firearms, other weapons, ammunition, or any firearm license, those items must 

be relinquished to the sheriff or the appropriate law enforcement agency within 24 hours of the service of this order. As an alternative, Defendant 

may relinquish any firearm, other weapon, or ammunition listed herein to a third party provided Defendant and the third party first comply with all 

requirements to obtain a safekeeping permit. If, due to their current location, firearms, other weapons, or ammunition cannot reasonably be 

retrieved within the time for relinquishment, Defendant shall provide an affidavit to the sheriff or the appropriate law enforcement agency listing 

the firearms, other weapons, or ammunition and their current location no later than 24 hours after the service of this order. Defendant is further 

notified that violation of this order may subject him/her to state charges and penalties under the Pennsylvania Crimes Code under 18 Pa.C.S. § 

6105 and to federal criminal charges and penalties under 18 U.S.C. § 922(g)(8) and the Violence Against Women Act, 18 U.S.C. §§ 2261-2262.

AND NOW, this 

 day of _______, 20__, upon consideration of the attached 

Petition for Protection From Abuse, the court hereby enters the following Temporary 
Order: 

Plaintiff's request for a Temporary Protection Order is denied.
Plaintiff's request for a Temporary Protection Order is granted.

1. Defendant shall not abuse, harass, stalk,  threaten, or attempt or threaten


to use physical force against any of the above persons in any place where 
they might be found. 

2. Defendant is evicted and excluded from the residence at

_______________________________________________________________ or any 
other permanent or temporary residence where Plaintiff or any other person protected
under this order may live. Plaintiff is granted exclusive possession of the residence.
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.

3.

Except for such contact with the minor child/ren as may be permitted


under Paragraph 5 of this order, Defendant is prohibited from having ANY CONTACT
with Plaintiff, or any other person protected under this order, either directly or indirectly,
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 for such contact with the minor child/ren as may be permitted


under 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. 



5. CUSTODY.



There is a current custody order as to the child/ren of the parties:

(county court) 

(docket number) 





THIS ORDER SHALL NOT SUPERSEDE THE CURRENT CUSTODY
ORDER.

THIS ORDER SUPERSEDES ANY PRIOR ORDER RELATING TO
CHILD CUSTODY.











Until the final hearing, all contact between Defendant and the child/ren
shall be limited to the following:

Pending the outcome of the final hearing in this matter, Plaintiff is awarded
temporary custody of the following minor child/ren:

The local law enforcement agency in the jurisdiction where the child/ren are 

located shall ensure that the child/ren are placed in the care and control of the Plaintiff 
in accordance with the terms of this order. 

6. FIREARMS, OTHER WEAPONS, OR AMMUNITION

RESTRICTIONS

Check all that apply. 

Defendant is prohibited from possessing or acquiring any firearms for the
duration of this order.
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 Temporary Order, which is incorporated herein by
reference, under Defendant’s control or in Defendant’s possession.

Defendant may relinquish any firearms, other weapons, or ammunition to the

sheriff or the appropriate law enforcement agency. As an alternative, Defendant may 
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. 
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. If, due to 
their current location, firearms, other weapons, or ammunition cannot reasonably be 
retrieved within the time for relinquishment, Defendant shall provide to the sheriff or the 
appropriate law enforcement agency an affidavit listing the firearms,

other weapons, or ammunition and their current location no later than 24 hours after 
service of this order. Failure to timely relinquish any firearm, other weapon, ammunition, 
or any firearm license 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.

The following additional relief is granted:

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:

8. The Pennsylvania State Police, the municipal police, or the sheriff
shall accompany Plaintiff to his or her residence to retrieve personal belongings or 
accompany Plaintiff while the petition or order is served on Defendant.

9. A certified copy of this order shall be provided to the sheriff or police

department where Plaintiff resides and any other agency specified hereafter: 
______________________________________________________________________

10. THIS ORDER SUPERSEDES ANY PRIOR PROTECTION FROM ABUSE

ORDER OBTAINED BY THE SAME PLAINTIFF AGAINST THE SAME DEFENDANT.

11. THIS ORDER APPLIES IMMEDIATELY TO DEFENDANT AND

SHALL REMAIN IN EFFECT UNTIL _____________________ OR UNTIL
OTHERWISE MODIFIED OR TERMINATED BY THIS COURT AFTER NOTICE 
AND HEARING. 

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.  Consent of
Plaintiff to Defendant's return to the residence shall not invalidate this order, which 
can only be changed or modified through the filing of 

appropriate court papers for that purpose. 23 Pa.C.S. § 6108(g). If Defendant is required to 
relinquish any firearms, other weapons, ammunition, or any firearm license, those items 
must be relinquished to the sheriff or the appropriate law enforcement agency within 24 
hours of the service of this order. As an alternative, Defendant may relinquish any firearm, 
other weapon, or ammunition listed herein to a third party provided Defendant and the third 
party first comply with all requirements to obtain a safekeeping permit. If, due to their 
current location, firearms, other weapons, or ammunition cannot reasonably be retrieved 
within the time for relinquishment, Defendant shall provide an affidavit to the sheriff or the 
appropriate law enforcement agency listing the firearms, other weapons, or ammunition and
their current location no later than 24 hours after the service of this order. Defendant is 
further notified that violation of this order may subject him/her to state charges and 
penalties under the Pennsylvania Crimes Code under 18 Pa.C.S. § 6105 and to federal
criminal charges and penalties under 18 U.S.C. § 922(g)(8) and the
Violence Against Women Act, 18 U.S.C. §§ 2261-2262.  

NOTICE TO SHERIFF, POLICE AND LAW ENFORCEMENT OFFICIALS 

This order shall be enforced by the police department or sheriff who has jurisdiction 
over Plaintiff's residence OR any location where a violation of this order occurs OR where 
Defendant may be located. If Defendant violates Paragraphs 1 through 6 of this order, 
Defendant shall be arrested on the charge of indirect criminal contempt. An arrest for 
violation of this order may be made without warrant, based solely on probable cause, 
whether or not the violation is committed in the presence of a police officer or sheriff. 

Subsequent to an arrest, the law enforcement officer or sheriff shall seize all 

firearms, other weapons, or ammunition in Defendant's possession which 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. Any firearm, other weapon, 
ammunition, or any firearm license must be delivered to the sheriff or the appropriate law 
enforcement agency, which sheriff or agency shall maintain possession of the firearms, 
other weapons, or ammunition until further order of this court, unless the
weapon(s) are evidence of a crime, in which case, they shall remain with the law 
enforcement agency whose officer or sheriff made the arrest. 

BY THE COURT: 

Judge 

Date 

ATTACHMENT A TO TEMPORARY ORDER 
FIREARMS, OTHER WEAPONS, OR 
AMMUNITION INVENTORY 

It is hereby ordered that Defendant relinquish the following firearms, other 

weapons, or 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. 

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

BY THE COURT 

Judge 

Date: 

NOTICE: 

This attachment will be withheld from public inspection in 

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