Domestic Violence Protection Order

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

The District of Columbia requires the use of the official Petition and Affidavit for
Civil Protection Order form for domestic violence civil protection order petitions
under D.C. Code §§ 16-1003 to 16-1005. 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.dccourts.gov/court-resources/search-forms/petition-and-affidavit-civil-protection-order.
Do not file this document directly with the court.

Superior Court of the District of Columbia

Family Court—Domestic Violence Division

Civil Protection Order (CPO) Template

(Draft for Attorney Customization)

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions (Injunctive Relief)
IV. Representations & Warranties (Court Findings & Respondent Acknowledgments)
V. Covenants & Restrictions
VI. Default & Remedies (Violation Penalties & Enforcement)
VII. Risk Allocation (Intentionally Omitted—Not Applicable)
VIII. Dispute Resolution & Governing Law
IX. General Provisions
X. Execution Block
XI. Mandatory Notices & Law-Enforcement Information Sheet (Attachment A)

I. DOCUMENT HEADER

1. Case Caption
   • Court: Superior Court of the District of Columbia, Family Court—Domestic Violence Division
   • Case No.: [CASE NUMBER]
   • Petitioner / Protected Party: [PETITIONER FULL LEGAL NAME]
   • Respondent / Restrained Party: [RESPONDENT FULL LEGAL NAME]

2. Effective Date
   This Civil Protection Order (“Order”) is entered and effective as of [EFFECTIVE DATE] pursuant to D.C. Code § 16-1005.

3. Jurisdiction & Venue
   The Court has subject-matter jurisdiction under D.C. Code § 16-1005 and personal jurisdiction over the Respondent because [BASIS FOR PERSONAL JURISDICTION—e.g., residence, service within D.C., minimum contacts].

4. Recitals
   A. On [DATE OF PETITION], Petitioner filed a Verified Petition alleging that Respondent committed or threatened to commit an intrafamily offense as defined in D.C. Code § 16-1001(8).
   B. A hearing was held on [HEARING DATE(S)], at which the Court received testimony and evidence.
   C. The Court finds good cause to believe that Respondent has committed or threatened to commit a criminal offense against Petitioner (or an animal Petitioner owns, possesses, or controls), which is the standard for issuance of a civil protection order under D.C. Code § 16-1005(c).

II. DEFINITIONS

For purposes of this Order, the following capitalized terms shall have the meanings set forth below:

1. “Court” means the Superior Court of the District of Columbia, Family Court—Domestic Violence Division.
2. “Petitioner” or “Protected Party” means [PETITIONER FULL LEGAL NAME] and any minor child or other person specifically protected herein.
3. “Respondent” or “Restrained Party” means [RESPONDENT FULL LEGAL NAME].
4. “Minor Child(ren)” means the following individuals under 18 years of age: [LIST OF CHILDREN]
5. “Proscribed Conduct” means any act prohibited by Section III of this Order, including but not limited to threats, harassment, stalking, assault, or any intrafamily offense enumerated in D.C. Code § 16-1001(8).
6. “Firearm” includes any weapon defined as a “firearm” under D.C. Code § 7-2501.01(9).
7. “Law-Enforcement Agency” means the Metropolitan Police Department (“MPD”) or any other agency with jurisdiction to enforce this Order.

III. OPERATIVE PROVISIONS (INJUNCTIVE RELIEF)

Pursuant to D.C. Code § 16-1005(c), IT IS HEREBY ORDERED THAT:

1. No Contact
   Respondent shall not assault, threaten, harass, follow, interfere with, or contact Petitioner, directly or indirectly, by any means—including in person, telephone, electronic communication, social media, or through third parties—except as expressly permitted herein.

2. Stay-Away
   Respondent shall stay at least [100] feet from:
   a. Petitioner;
   b. Petitioner’s residence at [ADDRESS] (if confidential, state “confidential address on file”);
   c. Petitioner’s workplace at [ADDRESS];
   d. The Minor Child(ren)’s school(s) and/or daycare(s) at [ADDRESSES]; and
   e. Any other location where Petitioner is known to frequent, including [SPECIFY].

3. Vacate Order
   Respondent shall immediately vacate and remain away from the shared residence located at [ADDRESS] no later than [TIME, DATE] and may remove personal belongings only under law-enforcement escort at a date and time arranged through MPD.

4. Temporary Custody / Visitation (select if applicable)
   a. Temporary legal and physical custody of the Minor Child(ren) is awarded to Petitioner.
   b. Supervised visitation, if any, shall occur [TERMS, LOCATION, SUPERVISING AGENCY].
   c. Respondent shall not remove the Minor Child(ren) from the District of Columbia without prior written Court approval.

5. Financial Relief (select if applicable)
   a. Respondent shall pay temporary child support in the amount of $[AMOUNT] per [week/month] commencing [DATE] in accordance with D.C. Child Support Guidelines.
   b. Respondent shall pay emergency household expenses in the amount of $[AMOUNT] as listed in Attachment [#].

6. Counseling / Treatment
   Respondent is ORDERED to enroll in and complete [BATTERER INTERVENTION PROGRAM / SUBSTANCE ABUSE TREATMENT] approved by the Court and shall provide proof of enrollment within [7] days and proof of completion within [X] days of program end.

7. Firearms Surrender
   Pursuant to D.C. Code § 16-1005(c)(10), Respondent shall relinquish possession of all Firearms and ammunition and is prohibited from possessing, controlling, purchasing, or receiving any Firearm or ammunition while this Order is in effect. Respondent shall surrender all Firearms, ammunition, and firearm registration certificates to MPD no later than [TIME/DEADLINE SET BY COURT—e.g., within 24 hours of service] and shall file proof of surrender (or an affidavit of non-possession) with the Court by [DATE/TIME SET BY COURT].

8. Duration
   This Order shall remain in effect for [SPECIFY PERIOD—NOT TO EXCEED TWO YEARS] from the Effective Date, unless modified, extended, or vacated by further Court order.

9. Full Faith & Credit
   This Order is enforceable throughout the United States pursuant to 18 U.S.C. § 2265.

IV. REPRESENTATIONS & WARRANTIES (Court Findings & Respondent Acknowledgments)

1. Findings of Fact
   The Court incorporates by reference the findings stated on the record at the hearing held on [HEARING DATE].

2. Capacity
   The Court finds Respondent was present in person / by counsel, was afforded due process, and is competent to understand the terms of this Order.

3. Respondent Acknowledgment
   Respondent acknowledges receipt of this Order in open court and understands that violation of any provision may result in arrest and criminal prosecution.

V. COVENANTS & RESTRICTIONS

1. Affirmative Covenants
   a. Respondent shall comply with all counseling, treatment, and support obligations set forth herein.
   b. Respondent shall return or transfer to Petitioner any essential personal property specified in Attachment [#] no later than [DATE], under MPD escort if requested.

2. Negative Covenants
   Respondent shall not:
   a. Engage in Proscribed Conduct;
   b. Possess any Firearm or ammunition;
   c. Access, attempt to access, or disrupt Petitioner’s digital accounts, utilities, or financial instruments;
   d. Incur joint debt or cancel utilities or insurance covering Petitioner without Court approval.

3. Notice & Cure (Limited)
   No cure period applies to any violation involving personal safety. For all other violations, Respondent must strictly comply within [24] hours of written notice from Petitioner or law enforcement.

VI. DEFAULT & REMEDIES (VIOLATION PENALTIES & ENFORCEMENT)

1. Criminal Penalties
   Violation of this Order is punishable as criminal contempt under D.C. Code § 16-1005(f) and is separately chargeable as a misdemeanor under D.C. Code § 16-1005(g). Upon conviction under either, the penalty is imprisonment for not more than 180 days, a fine of not more than the amount set forth in D.C. Code § 22-3571.01 (currently $1,000 for an offense punishable by up to 180 days’ imprisonment), or both. No person may be found to have violated this Order unless personally served with or given actual notice of it (D.C. Code § 16-1005(g-1)).

2. Civil Contempt
   The Court retains jurisdiction to enforce this Order through civil contempt proceedings, fines, or additional injunctive relief.

3. Warrantless Arrest Authority
   A law-enforcement officer may arrest Respondent without a warrant where the officer has probable cause to believe Respondent has committed an intrafamily offense, pursuant to D.C. Code § 23-581(a-1). Where the intrafamily offense resulted in physical injury (including physical pain or illness) or caused or was intended to cause reasonable fear of imminent serious physical injury or death, arrest is mandatory under D.C. Code § 16-1031(a).

4. Attorney’s Fees
   Upon motion and showing of a willful violation, the Court may award reasonable attorney’s fees and costs to the prevailing party.

VII. RISK ALLOCATION

Intentionally omitted. Indemnification provisions, limitation of liability, and insurance requirements are not applicable to a court-issued protection order.

VIII. DISPUTE RESOLUTION & GOVERNING LAW

1. Governing Law
   This Order is governed by, and interpreted in accordance with, the laws of the District of Columbia and applicable federal law.

2. Exclusive Forum
   Any motion to modify, extend, or enforce this Order shall be filed exclusively in the Superior Court of the District of Columbia, Family Court—Domestic Violence Division.

3. Arbitration & Jury Trial
   Arbitration is not available, and jury trial is not applicable to proceedings to modify or enforce this Order.

4. Injunctive Relief Preservation
   The equitable and injunctive remedies provided herein are cumulative and not exclusive of any other remedy available at law.

IX. GENERAL PROVISIONS

1. Modification
   Upon motion of any party to the original proceeding, the Court may extend, modify, or vacate this Order for good cause shown, pursuant to D.C. Code § 16-1005(d-1)(1). A finding that the Order has been violated is not necessary for a finding of good cause to modify or extend it.

2. Severability
   If any provision of this Order is held invalid, the remaining provisions shall remain in full force and effect.

3. Integration
   This Order constitutes the entire civil protection order between the parties and supersedes all prior oral or written rulings on the same relief, except as incorporated by reference.

4. Service & Dissemination
   The Clerk shall:
   a. Provide certified copies to Petitioner, Respondent, MPD, and the National Crime Information Center (NCIC) Protection Order File; and
   b. Maintain the original Order in the Court file.

5. Electronic Signatures & Counterparts
   This Order may be signed electronically by the Judge and issued in counterpart originals.

X. EXECUTION BLOCK

Entered this ___ day of __________, 20___.

____________________________________
[JUDGE’S PRINTED NAME]
Judge, Superior Court of the District of Columbia
Family Court—Domestic Violence Division

XI. ATTACHMENT A

Mandatory Notices & Law-Enforcement Information Sheet

1. Notice to Respondent
   “You have been served with a Civil Protection Order. Possession of a firearm or ammunition while this Order is in effect is a criminal offense under D.C. and federal law. Violation of any term of this Order may result in immediate arrest.”

2. Law-Enforcement Identifiers
   • Respondent’s DOB: [MM/DD/YYYY]
   • Respondent’s SSN (last 4 digits): [XXXX]
   • Respondent’s Physical Description: [HEIGHT/WEIGHT/HAIR/EYE]
   • Known Firearms: [MAKE/MODEL/SERIAL]
   • NCIC Order Number: [TO BE ASSIGNED BY CLERK/MPD]

Prepared by: [ATTORNEY NAME], D.C. Bar No. [BAR NUMBER]
Address: [FIRM ADDRESS] • Phone: [PHONE] • Email: [EMAIL]