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In the District Court of Utah

__________ Judicial District ________________ County

Court Address ______________________________________________________

_____________________________________
Petitioner

_____________________________________
Respondent

Sexual Violence Protective Order
(Utah Code 78B-7-501 et seq.)

_______________________________
Case Number

_______________________________
Judge

_______________________________
Commissioner

A hearing was held on ___________________________ (date). Respondent was given
notice and an opportunity to be heard at the hearing.

The following people were present at the hearing:

[ ] Petitioner

[ ] Respondent

[ ] Petitioner’s attorney __________________________________________ (name).

[ ] Respondent’s attorney ________________________________________ (name).

The court reviewed the Request for Sexual Violence Protective Order and (Choose all that
apply.):

[ ] received argument and evidence

[ ] accepted the stipulation of the parties

[ ] entered the default of respondent for failure to appear

[ ] finds that sexual violence has occurred.

and makes the orders initialed below.

The court finds by a preponderance of the evidence:

(Choose one.)
[ ] Petitioner is 18 or older, or

1203POF Approved May 13, 2019 /
Revised by Forms Committee July 1,
2020

Sexual Violence Protective Order

Page 1 of 5

[ ] Petitioner is under 18 and has been emancipated by marriage or court order.

It has jurisdiction over the parties in this case.

Respondent and petitioner are not cohabitants or dating partners.

Petitioner has been subjected to sexual violence by the respondent.

The court orders:

Respondent must obey all provisions initialed below.

This protective order expires in three years, on

________________________ (date)

Petitioner can file a motion to extend the order before it
expires. (Utah Code 78B-7-505)

Violation of this order is a criminal Class A Misdemeanor, punishable by up to 364 days
in jail and a fine.

[ ] Personal conduct

Respondent may not commit, try to commit, or threaten to commit any form of
sexual violence against the petitioner or any person listed below.

Other people protected by this section (Relatives or people who live with petitioner.):

Name

Age

Relationship to petitioner

[ ] No contact order

Respondent may not contact, phone, text, mail, e-mail, or communicate in any
way with the Petitioner and the people listed in paragraph 5 of this order either
directly or indirectly.

[ ] Stay away order

1203POF Approved May 13, 2019 /
Revised by Forms Committee July 1,
2020

Sexual Violence Protective Order

Page 2 of 5

[ ] a. Stay at least ______________________ (distance) from petitioner.

[ ] b. Stay away from petitioner's

_________________________________________________

[ ] c. Must comply with the following restrictions while at respondent's

[ ] home

[ ] work

[ ] school

[ ] place of worship

[ ] other:

and petitioner's

Work:

School:

Place of worship:

[ ] d. Stay away from the people listed in paragraph 5 at their home,

work, school, and place of worship and the following other places:

[ ] e. Must comply with the following restrictions while at the work,

school, and place of worship that respondent and the people in
paragraph 5 have in common:

[ ]

f. Other (specify):

1203POF Approved May 13, 2019 /
Revised by Forms Committee July 1,
2020

Sexual Violence Protective Order

Page 3 of 5

[ ] The court finds there is clear and convincing evidence that

respondent’s use or possession of a firearm poses a serious threat
of harm to the petitioner and the people listed in paragraph 5.
Respondent cannot possess, have, or buy a firearm.

[ ] The court finds that respondent’s use or possession of a weapon

poses a serious threat of harm to petitioner and the people listed in
paragraph 5. Respondent cannot possess, have, or buy any of
these weapons:

_____________________________________________________.

Respondent may be subject to state or federal law making it a crime to
possess, transport, ship or receive any firearm or ammunition, including a
hunting weapon.

[ ] No weapons

espondent was afforded both notice and opportunity to be heard in the hearing that
gave rise to this order. Pursuant to the Violence Against Women Act of 1994, P.L. 103-
322, 108 Stat. 1796, 18 U.S.C. Sec. 2265, this order is valid in all the United States, the
District of Columbia, tribal lands, and United States territories. This order complies with
the Uniform Interstate Enforcement of Domestic Violence Protection Orders Act.

— The court completes this section —

Judge or commissioner’s signature may instead appear at the top of the first page of this document.

Signature ►

Commissioner

Signature ►

Judge

1203POF Approved May 13, 2019 /
Revised by Forms Committee July 1,
2020

Sexual Violence Protective Order

Page 4 of 5

Date

— Respondent completes this section —

By signing here, respondent approves the form, and accepts service of this
Protective Order and waives the right to be personally served.

Respondent’s Address

espondent’s Signature ► __________________________________________________________

1203POF Approved May 13, 2019 /
Revised by Forms Committee July 1,
2020

Sexual Violence Protective Order

Page 5 of 5

Sexual Violence Protective Order

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from legacy.utcourts.gov (2023-03)
Page(s): 5
Fields(s): 125
Average fields per page: 25
Reading Level: Grade 11
LIST Grouping(s): GO-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

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page_field__68 was page_4_field_7 (0.36 conf)
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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Sexual Violence Protective Order

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02