Domestic Violence Protection Order

IMPORTANT: THIS IS A PREPARATION GUIDE — NOT THE OFFICIAL COURT FORM

Connecticut requires the use of official court form JD-FM-137 (Application for Relief
from Abuse) for domestic violence restraining order applications under Conn. Gen. Stat.
§ 46b-15. This template provides the substantive legal content to help you prepare — but
you must transfer your content to the official form before filing. The official form is
available at https://www.jud.ct.gov/webforms/default.aspx.
Do not file this document directly with the court.

Connecticut Superior Court – Family Division

Domestic Violence Protection Order

(Civil Restraining Order – Relief From Abuse Pursuant to Conn. Gen. Stat. § 46b-15)

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1. Title.
   DOMESTIC VIOLENCE PROTECTION ORDER (CIVIL RESTRAINING ORDER – RELIEF FROM ABUSE)

2. Court and Docket Information.
   Issuing Court: Connecticut Superior Court – Family Division, [JUDICIAL DISTRICT]
   Docket No.: [DOCKET_NUMBER]

3. Parties.
   a. Petitioner/Protected Party: [PETITIONER FULL LEGAL NAME], date of birth [DOB], residing at [ADDRESS].
   b. Respondent/Restrained Party: [RESPONDENT FULL LEGAL NAME], date of birth [DOB], last known address [ADDRESS].

4. Effective Date & Term.
   a. Effective Date: [MM/DD/YYYY] (“Effective Date”).
   b. Expiration: This Order shall remain in full force until [MM/DD/YYYY] (not to exceed one year from issuance) unless earlier modified, extended, or dissolved by the Court pursuant to Section VIII(2).

5. Jurisdiction & Statutory Authority.
   This Order is issued under Conn. Gen. Stat. § 46b-15. Violation of this Order is enforced as a family violence crime under Conn. Gen. Stat. § 53a-223b, and arrest for such a violation is governed by the family violence arrest procedure of Conn. Gen. Stat. § 46b-38b. This Order is enforceable statewide and, consistent with the full faith and credit provisions of 18 U.S.C. § 2265 and the firearms prohibition of 18 U.S.C. § 922(g)(8), nationally under the Violence Against Women Act (VAWA).

II. DEFINITIONS

For purposes of this Order, capitalized terms have the meanings set forth below and apply throughout, whether singular or plural.

“Court” – The Connecticut Superior Court, Family Division, issuing this Order.
“Firearm” – Any weapon as defined in Conn. Gen. Stat. § 53a-3(19) (any sawed-off shotgun, machine gun, rifle, shotgun, pistol, revolver or other weapon, whether loaded or unloaded, from which a shot may be discharged).
“Minor Child” – Any child under eighteen (18) years of age identified in Schedule A.
“Order” – This Domestic Violence Protection Order, inclusive of all attachments and schedules.
“Prohibited Conduct” – Any act enumerated in Section III(1).
“Protected Address” – Each location listed in Schedule B.
“Protected Party/Parties” – Petitioner and each Minor Child or household member named in Schedule A.
“Respondent” – The individual in Section I(3)(b) against whom this Order is entered.

III. OPERATIVE PROVISIONS

1. Prohibited Conduct. Respondent SHALL NOT, directly or indirectly (including through third parties):
   a. Assault, threaten, harass, stalk, follow, or otherwise abuse any Protected Party;
   b. Contact any Protected Party by telephone, text, email, social media, or other electronic means;
   c. Enter, approach within [100] yards of, or surveil any Protected Address or place of employment, education, or childcare attended by a Protected Party;
   d. Possess or control any Firearm, ammunition, or deadly weapon;
   e. Interfere with the care, custody, or control of any Minor Child except as expressly permitted in Section III(3).

2. Exclusive Use of Residence.
   a. [ADDRESS] is awarded to Petitioner for exclusive use and occupancy.
   b. Respondent shall vacate immediately and may return only once, in the presence of law enforcement, to retrieve personal effects within [24] hours of service of this Order.

3. Temporary Custody & Parenting Time.
   a. Petitioner is granted temporary legal and physical custody of the Minor Child(ren) listed in Schedule A.
   b. Respondent’s parenting time is:
   i. [SUSPENDED / SUPERVISED at [LOCATION] under agency-approved supervision]; or
   ii. [As otherwise ordered herein].
   c. Any visitation in violation of this subsection is prohibited and subject to arrest.

4. Firearms, Ammunition, and Permit Surrender.
   a. Pursuant to Conn. Gen. Stat. § 29-36k(b), immediately, but in no event more than twenty-four (24) hours after notice of this Order has been provided, Respondent SHALL either:
   i. Transfer all Firearms and ammunition to a federally licensed firearms dealer; or
   ii. Deliver or surrender all Firearms and ammunition to the Commissioner of Emergency Services and Public Protection (a local police department may accept them on the Commissioner’s behalf).
   b. Any permit to carry a pistol or revolver, eligibility certificate, long gun eligibility certificate, or ammunition certificate held by Respondent is subject to revocation as a result of this Order (Conn. Gen. Stat. §§ 29-32, 29-36i). Respondent should retain the receipt or other written proof of surrender or transfer provided by the receiving dealer or agency.
   c. Respondent may request the return of surrendered Firearms and ammunition only upon expiration of this Order or issuance of a subsequent court order rescinding it (Conn. Gen. Stat. § 29-36k(c)).

5. Counseling / Treatment. As the Court deems necessary for the protection of the Protected Parties, Respondent is ORDERED to enroll in and complete:
   a. [A family violence intervention, batterer’s intervention, or counseling program] commencing within [14] days; and
   b. [Substance abuse / mental health] evaluation and treatment as recommended.

6. Law Enforcement Service & Registry Entry.
   a. A state marshal or other proper officer shall serve this Order forthwith.
   b. Upon service, this Order shall be entered into the Connecticut Protective Order Registry and the National Crime Information Center (NCIC) database.

IV. REPRESENTATIONS & WARRANTIES

1. Respondent acknowledges, upon service, that:
   a. Respondent has read, understands, and will comply with this Order;
   b. Violation constitutes a separate criminal offense under Conn. Gen. Stat. § 53a-223b; and
   c. Respondent may be arrested without warrant upon probable cause to believe a violation occurred.

2. Petitioner represents that the statements in the Verified Application are true to the best of Petitioner’s knowledge, information, and belief, subject to penalties of false statement under Conn. Gen. Stat. § 53a-157b.

3. Survival. The acknowledgments herein survive any expiration or modification of this Order with respect to conduct occurring during its term.

V. COVENANTS & RESTRICTIONS

1. Change of Address. Respondent shall provide the Court and Petitioner’s counsel with written notice of any change in residence within forty-eight (48) hours.

2. Notification of Service Barriers. Each party shall promptly inform the Court of any circumstance impeding compliance, including incarceration or hospitalization.

3. Mutual Non-Disparagement. Both parties shall refrain from disparaging or intimidating communications that could be viewed by Minor Children.

VI. DEFAULT & REMEDIES

1. Events of Default. Any breach of Section III constitutes a default and a criminal offense.

2. Enforcement Mechanisms.
   a. Immediate Arrest. Law enforcement SHALL arrest the Respondent upon probable cause of a violation.
   b. Criminal Penalties. Under Conn. Gen. Stat. § 53a-223b, criminal violation of a restraining order is a class D felony — punishable by up to five (5) years’ imprisonment, a fine of up to $5,000, or both — for a violation described in subparagraph (A) or (B) of § 53a-223b(a)(2) (failing to stay away, or contacting a person, in violation of the order). A violation described in subparagraph (C) or (D) (imposing any restraint on a person’s liberty, or threatening, harassing, assaulting, molesting, sexually assaulting or attacking a person, in violation of the order) is a class C felony, punishable by up to ten (10) years’ imprisonment, a fine of up to $10,000, or both.
   c. Civil Contempt. Upon a motion for contempt for violation of this Order, the Court shall hold an expedited hearing and may impose such sanctions as the Court deems appropriate (Conn. Gen. Stat. § 46b-15(j)).
   d. Extension or Modification. This Order shall not exceed one (1) year, but the Court may extend it upon motion of the Petitioner for such additional time as the Court deems necessary (Conn. Gen. Stat. § 46b-15(g)).

3. Costs & Fees. The Court may award attorney’s fees and costs incurred in enforcement proceedings to the prevailing party.

VII. RISK ALLOCATION

Indemnification, liability caps, and insurance provisions are not applicable to this judicial Order. Nothing herein limits statutory or common-law rights of any Protected Party to seek civil damages arising from Respondent’s conduct.

VIII. DISPUTE RESOLUTION

1. Governing Law. This Order shall be governed by and construed in accordance with the laws of the State of Connecticut.

2. Modification or Dissolution. Only the Connecticut Superior Court may modify, extend, or dissolve this Order upon:
   a. Written motion filed by either party; and
   b. Notice and opportunity to be heard consistent with Conn. Gen. Stat. § 46b-15.

3. Arbitration & Jury Trial. Arbitration is unavailable, and jury trial is not applicable in Family Division protective-order proceedings.

4. Preservation of Injunctive Relief. Nothing herein limits the Court’s inherent authority to issue further equitable or injunctive relief.

IX. GENERAL PROVISIONS

1. Severability. If any provision of this Order is determined invalid, the remaining provisions remain fully enforceable.

2. Integration. This Order, together with all schedules, constitutes the entire protective relief granted; all prior temporary or ex parte orders are superseded as of the Effective Date.

3. Amendment & Waiver. No provision may be waived except in a written order of the Court. The failure to enforce any provision is not a waiver of future enforcement.

4. Service of Process. Certified copies of this Order shall be provided to:
   a. Petitioner and counsel;
   b. Respondent;
   c. Designated law-enforcement agencies;
   d. Department of Children and Families, if applicable.

5. Electronic Filing & Signatures. Electronic filing and service in this matter are governed by the Judicial Branch’s E-Services Procedures and Technical Standards, as referenced in Conn. Practice Book § 4-4. The Court may execute and issue this Order electronically.

X. EXECUTION BLOCK

SO ORDERED.

DATED at [CITY], Connecticut on [MM/DD/YYYY].

_____________________________________
Judge of the Superior Court
Name: __________________________________
Juris No.: _______________________________

Attest: __________________________________
Clerk / Assistant Clerk

Acknowledged:

Petitioner: _______________________________ Date: ___________

Respondent (upon service): ________________ Date: ___________

Schedule A – Minor Children Protected

1. Name: __________________ DOB: __________ Relationship: ________
   [Add additional lines as necessary]

Schedule B – Protected Addresses

1. ________________________________________
   [Add additional lines as necessary]

Sources and References

• Conn. Gen. Stat. § 46b-15 — Relief for victim of domestic violence (application, court orders, one-year duration, service, expedited contempt hearing).
• Conn. Gen. Stat. § 46b-15(f)(1)(B) — required order language reciting § 53a-223b penalty tiers.
• Conn. Gen. Stat. § 53a-223b — Criminal violation of a restraining order (class D / class C felony).
• Conn. Gen. Stat. § 29-36k(b)–(c) — 24-hour firearm/ammunition surrender by persons subject to a restraining order; return upon expiration/rescission.
• Conn. Gen. Stat. § 53a-3(19) — definition of “firearm.”
• Conn. Gen. Stat. § 53a-157b — False statement (class A misdemeanor).
• Conn. Gen. Stat. § 46b-38b — Family violence arrest procedure.
• 18 U.S.C. §§ 922(g)(8), 2265 — federal firearms prohibition; full faith and credit for protection orders.
• Official application: CT Judicial Branch Form JD-FM-137 (https://www.jud.ct.gov/webforms/default.aspx).