Domestic Violence Protection Order

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

Indiana requires the use of official court form PO-0100 (Petition for an Order for
Protection) for domestic violence protection order petitions. 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.in.gov/courts/iocs/publications/po-forms/.
Do not file this document directly with the court.

INDIANA DOMESTIC VIOLENCE PROTECTION ORDER

(Template for Court Use under Ind. Code § 34-26-5-1 et seq.)

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Findings of Fact and Representations
4. Operative Injunctive Provisions
5. Respondent Obligations & Restrictions
6. Enforcement, Default & Remedies
7. Risk Allocation & Miscellaneous Provisions
8. Dispute Resolution & Jurisdiction
9. General Provisions
10. Execution & Certification Block

1. DOCUMENT HEADER

CAUSE NO.: [COURT-ASSIGNED]
IN THE [NAME OF COUNTY] [CIRCUIT/SUPERIOR] COURT, FAMILY DIVISION
STATE OF INDIANA

DOMESTIC VIOLENCE PROTECTION ORDER
(☐ Ex Parte ☐ Final After Hearing)

Petitioner/Protected Person(s): [PETITIONER FULL LEGAL NAME(S)]
Date of Birth: [MM/DD/YYYY]

v.

Respondent: [RESPONDENT FULL LEGAL NAME]
Date of Birth: [MM/DD/YYYY]

Effective Date: [DATE OF ISSUANCE]
Expiration Date: [DATE—NOT TO EXCEED TWO (2) YEARS WITHOUT SPECIFIC FINDINGS]

Jurisdictional Basis: Ind. Code § 34-26-5-2; acts of domestic or family violence alleged to have occurred in [COUNTY], Indiana.

2. DEFINITIONS

For purposes of this Order, the following capitalized terms have the meanings set forth below. Defined terms apply singularly or plurally, as the context requires.

“Act of Domestic or Family Violence” means an act as defined in Ind. Code § 34-26-5-2(a), including but not limited to battery, stalking, or harassment.

“Court” means the [NAME OF COUNTY] [CIRCUIT/SUPERIOR] Court, Family Division, State of Indiana.

“Excluded Location(s)” means any physical location listed in Section 4.2 from which Respondent is barred.

“Firearm” has the meaning ascribed in Ind. Code § 35-47-1-5.

“No-Contact Provision” refers to the prohibition in Section 4.1.

“Petitioner” includes any “Protected Person(s)” identified in Section 1.

“Respondent” means the individual identified in the Document Header against whom this Order is entered.

3. FINDINGS OF FACT AND REPRESENTATIONS

The Court, having reviewed the verified petition, supporting evidence, and (if applicable) testimony presented at hearing, FINDS:

3.1 Relationship. The parties are (check one): ☐ spouses ☐ former spouses ☐ persons who have a child in common ☐ current/former co-habitants ☐ persons in a dating relationship, within the meaning of Ind. Code § 34-26-5-2.

3.2 Jurisdiction & Venue. The Court has subject-matter jurisdiction under Ind. Code § 34-26-5-3, and venue is proper in [COUNTY], Indiana.

3.3 Immediate Danger. ☐ The Court finds by a preponderance of the evidence that Petitioner and/or the minor child(ren) face an immediate and present danger of domestic or family violence.

3.4 Service/Notice. ☐ Respondent was served with notice and an opportunity to be heard on [DATE] (or) ☐ Proceeding is ex parte per Ind. Code § 34-26-5-9.

3.5 Necessity. The relief granted herein is necessary to bring about the cessation of the violence or threat thereof.

4. OPERATIVE INJUNCTIVE PROVISIONS

IT IS THEREFORE ORDERED, ADJUDGED, AND DECREED that:

4.1 No-Contact Provision. Respondent shall not directly or indirectly contact, molest, harass, threaten, follow, or communicate with Petitioner and the Protected Person(s) by any means, including in-person, telephone, electronic, social media, or through third parties.

4.2 Stay-Away Provision. Respondent shall remain at least [500] feet from:
a. Petitioner’s residence at [ADDRESS];
b. Petitioner’s place of employment at [ADDRESS];
c. The minor child(ren)’s school/daycare at [ADDRESS]; and
d. Any other Excluded Location(s): [LIST].

4.3 Exclusive Possession of Residence. ☐ Respondent shall immediately vacate the shared residence located at [ADDRESS] and is prohibited from re-entering without Court authorization.

4.4 Firearms & Deadly Weapons. Respondent shall:
a. Surrender all Firearms and ammunition in Respondent’s possession to [LAW ENFORCEMENT AGENCY] within [24] hours;
b. File a receipt of surrender with the Court within [48] hours.

4.5 Parenting Time. ☐ Parenting time is temporarily suspended. ☐ Parenting time shall occur only as ordered: [DETAILS OR REFER TO SEPARATE ORDER].

4.6 Counseling/Treatment. Respondent is ordered to complete (☐ batterers’ intervention ☐ substance-abuse counseling) and file proof of enrollment within [30] days.

4.7 Duration. This Order shall remain in full force and effect until [EXPIRATION DATE] unless earlier modified or dissolved by the Court.

5. RESPONDENT OBLIGATIONS & RESTRICTIONS

5.1 Identification & Compliance. Respondent shall at all times keep a certified copy of this Order in Respondent’s possession and immediately present it to any law-enforcement officer upon request.

5.2 Transfer of Utilities/Leases. If ordered to vacate a residence, Respondent shall cooperate in transferring utilities, leases, or tenancy obligations as necessary to effectuate exclusive possession.

5.3 Prohibited Acts. Respondent shall not commit or attempt to commit any Act of Domestic or Family Violence, stalking, or harassment against Petitioner or Protected Person(s).

6. ENFORCEMENT, DEFAULT & REMEDIES

6.1 Criminal Penalties. Violation of this Order constitutes the criminal offense of invasion of privacy under Ind. Code § 35-46-1-15.1 (Class A misdemeanor; Level 6 felony for a prior conviction).

6.2 Civil Contempt. Any violation also subjects Respondent to civil contempt sanctions, including incarceration, fines, and attorney’s fees.

6.3 Law-Enforcement Entry. This Order shall be entered into the Indiana Data and Communications System (IDACS) and the National Crime Information Center (NCIC) pursuant to federal and state law.

6.4 Warrantless Arrest. Law-enforcement officers shall arrest Respondent without a warrant upon probable cause to believe Respondent has violated any provision of this Order.

6.5 Attorney Fees. The Court may award reasonable attorney’s fees to Petitioner for enforcement proceedings.

7. RISK ALLOCATION & MISCELLANEOUS PROVISIONS

7.1 Hold Harmless for Reporting. Any individual who in good faith reports a violation of this Order shall be immune from civil liability to the fullest extent permitted by law.

7.2 Force Majeure. No provision herein shall obligate Petitioner to facilitate contact or parenting time during emergencies rendering compliance impossible or unsafe.

8. DISPUTE RESOLUTION & JURISDICTION

8.1 Governing Law. This Order is governed exclusively by the laws of the State of Indiana, including Ind. Code § 34-26-5-1 et seq.

8.2 Exclusive Forum. The [NAME OF COUNTY] [CIRCUIT/SUPERIOR] Court retains exclusive jurisdiction over all matters arising from or relating to this Order.

8.3 Arbitration & Jury Trial. Arbitration is not available. Issues shall be adjudicated by the Court; no jury trial is available in protection-order proceedings.

8.4 Injunctive Relief Preservation. Nothing herein limits the Court’s inherent authority to modify or extend injunctive relief as justice requires.

9. GENERAL PROVISIONS

9.1 Modification & Termination. Either party may move to modify or dissolve this Order pursuant to Ind. Code § 34-26-5-14 by filing a verified petition and serving the opposing party.

9.2 Severability. If any provision of this Order is found unenforceable, the remaining provisions shall remain in full force.

9.3 Integration. This document constitutes the entire Protection Order. No oral representations or other writings shall modify its terms absent further Court order.

9.4 Copies & Electronic Signatures. Certified copies and electronically signed versions of this Order shall have the same force and effect as an original.

10. EXECUTION & CERTIFICATION BLOCK

SO ORDERED this ____ day of __________, 20____, at ____ [a.m./p.m.].

______________________________________________
[JUDGE’S NAME], Judge
[NAME OF COUNTY] [CIRCUIT/SUPERIOR] Court

Attest:
______________________________________________
[COURT CLERK NAME], Clerk

Service:
☐ Petitioner in open court
☐ Respondent in open court
☐ Sheriff of [COUNTY]
☐ Indiana State Police (IDACS/NCIC entry)
☐ Other: ______________________________

[SEAL]