Domestic Violence Protection Order

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

Mississippi requires the use of official court forms for domestic violence protection order
petitions (Petition for Domestic Abuse Protection Order). 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 forms are available from your local chancery court
clerk or at https://www.msatjc.org/legal-forms.
Do not file this document directly with the court.

[DRAFT] DOMESTIC VIOLENCE PROTECTION ORDER (MISSISSIPPI)

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Jurisdiction & Statutory Authority
4. Findings of Fact and Conclusions of Law
5. Injunctive Relief (Core Protective Provisions)
6. Ancillary Relief (Custody, Support, Firearms, Residence, Counseling)
7. Enforcement Mechanisms & Violation Penalties
8. Service, Notice, and Law-Enforcement Duties
9. Duration, Modification, and Termination
10. Full Faith and Credit & Interstate Enforcement
11. General Provisions
12. Execution Block

1. DOCUMENT HEADER

IN THE [☐ CHANCERY / [___] COUNTY / ☐ YOUTH] COURT OF [COUNTY] COUNTY, STATE OF MISSISSIPPI

CASE NO.: __[COURT-ASSIGNED]__

PETITIONER (Protected Party): __[Petitioner Full Legal Name]__

RESPONDENT (Restrained Party): __[Respondent Full Legal Name]__

DOMESTIC VIOLENCE PROTECTION ORDER
(☐ Ex Parte Temporary Order – Effective Upon Service / ☐ Final Order After Hearing)

Effective Date: __[MM/DD/YYYY]__
Expiration Date: __[MM/DD/YYYY | “Until Modified”]__

2. DEFINITIONS

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

“Covered Address(es)” – Any residential, school, or employment location listed in Section 5.

“Firearm” – Any weapon that will expel a projectile by the action of an explosive or the frame or receiver of such weapon.

“Protected Person(s)” – Collectively, the Petitioner and any minor child(ren) or other household/family member(s) specifically identified in Section 5.

“Prohibited Contact” – Any direct or indirect contact whatsoever, including but not limited to in-person, telephone, text, social media, electronic messaging, third-party communication, delivery of gifts, or surveillance.

3. JURISDICTION & STATUTORY AUTHORITY

1. The Court has subject-matter jurisdiction under the Mississippi Protection from Domestic Abuse statutes .
2. Venue is proper in __[County]__ County because __[state basis: residence of Petitioner, location of abuse, etc.]__.
3. The Respondent was duly served or has waived service as reflected in the record.

4. FINDINGS OF FACT AND CONCLUSIONS OF LAW

After reviewing the verified petition, sworn testimony, and documentary evidence, and applying the preponderance-of-the-evidence standard, the Court FINDS and CONCLUDES:

a. An act(s) of domestic abuse occurred or was threatened;
b. Petitioner and Respondent are in a qualifying domestic relationship;
c. Immediate and ongoing protection is necessary to prevent further harm;
d. The Court is authorized to issue the injunctive and ancillary relief set forth herein.

5. INJUNCTIVE RELIEF (CORE PROTECTIVE PROVISIONS)

IT IS HEREBY ORDERED that Respondent shall:

5.1 No Contact. Cease and desist all Prohibited Contact with any Protected Person(s).

5.2 Stay-Away. Maintain a minimum distance of __[500]__ feet from:
i. Protected Person(s);
ii. Covered Address(es) listed below:
• [Residence] _____________________________________
• [School] ________________________________________
• [Place of Employment] ____________________________

5.3 Residence Exclusion. Immediately vacate the shared domicile located at __[Full Address]__ and surrender all keys, garage openers, and access codes to law-enforcement at time of service.

5.4 Harassment/Stalking. Refrain from stalking, surveillance, harassment, intimidation, destruction of property, or interference with the personal liberty of any Protected Person.

5.5 Third-Party Facilitation. Not cause, solicit, or permit any third party to violate the terms of this Order.

6. ANCILLARY RELIEF

6.1 Temporary Custody & Visitation
a. Sole temporary legal and physical custody of the minor child(ren) __[Name(s) & DOB]__ is awarded to Petitioner.
b. Visitation for Respondent is: ☐ Suspended ☐ Supervised at __[Location/Agency]__ ☐ As set forth in attached Parenting Schedule (Exhibit A).

6.2 Child Support / Spousal Support
Respondent shall pay temporary support of __$[Amount]__/week via the Mississippi Disbursement Unit commencing __[Date]__.

6.3 Firearms & Ammunition Surrender
Respondent shall, within __[24]__ hours of service, surrender all Firearms and ammunition to __[Designated Law-Enforcement Agency]__ and file proof of compliance with the Clerk.

6.4 Treatment / Counseling
Respondent is ordered to complete ☐ Batterer Intervention Program ☐ Substance-Abuse Assessment ☐ Anger Management within __[60]__ days and provide completion certificates.

6.5 Other Relief
☐ Vehicle possession ☐ Pet protection ☐ Payment of medical expenses ☐ Transfer of cell-phone account(s) ☐ [Specify]

7. ENFORCEMENT MECHANISMS & VIOLATION PENALTIES

7.1 Criminal Enforcement. Violation of any provision of this Order may constitute a misdemeanor and/or felony under Mississippi law, punishable by incarceration, fines, or both, and may subject the Respondent to federal prosecution under 18 U.S.C. § 2261 et seq.

7.2 Contempt Powers. The Court retains inherent and statutory contempt authority to impose coercive or compensatory sanctions for non-compliance, including but not limited to civil fines, incarceration, and attorney’s fees.

7.3 Warrantless Arrest. Any law-enforcement officer with probable cause to believe Respondent has violated this Order shall arrest Respondent without warrant.

8. SERVICE, NOTICE, AND LAW-ENFORCEMENT DUTIES

8.1 Service. The Clerk shall immediately forward a certified copy of this Order to the __[County]__ Sheriff for prompt personal service on Respondent.

8.2 NCIC Entry. Upon service, the enforcing agency shall enter the Order into the Mississippi Protection Order Registry and the National Crime Information Center (NCIC) database.

8.3 Proof of Service. The serving officer shall file a sworn Return of Service within __[72]__ hours.

8.4 Notice of Hearing Rights. Respondent is advised of the right to:
a. Request a hearing to modify or dissolve this Order;
b. Be represented by counsel;
c. Present evidence and cross-examine witnesses.

9. DURATION, MODIFICATION, AND TERMINATION

9.1 Duration. This Order remains in full force and effect until the Expiration Date stated above, unless earlier modified or dissolved by written order of this Court.

9.2 Modification. Either party may file a properly-served motion for modification. The Court may modify upon a showing of good cause after notice and hearing.

9.3 Extension. Prior to expiration, Petitioner may move to extend the Order; the Court may grant an extension for additional periods as permitted by law.

9.4 Automatic Termination. Provisions relating solely to minor children terminate upon the child(ren)’s emancipation or majority, unless otherwise ordered.

10. FULL FAITH AND CREDIT & INTERSTATE ENFORCEMENT

This Order is issued in compliance with 18 U.S.C. § 2265 and is entitled to full faith and credit in every state, tribal, and territorial jurisdiction within the United States. Any jurisdiction receiving a certified copy shall enforce it as if issued by its own court.

11. GENERAL PROVISIONS

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

11.2 Superseding Effect. This Order supersedes any prior inconsistent civil protection order between the parties. Criminal bond conditions remain in effect unless expressly modified herein.

11.3 Copies. Certified copies shall be provided at no cost to the parties, law-enforcement, schools, and child-care facilities as requested.

11.4 Electronic Signatures. Consistent with Mississippi Uniform Electronic Transactions Act, a facsimile or electronically-signed copy of this Order shall be deemed an original.

12. EXECUTION BLOCK

SO ORDERED, this ___ day of __________, 20___ at __:__ ⏲ __.m., in __[County]__ County, Mississippi.

_______________________________
[JUDGE NAME], ☐ Chancery ☐ County ☐ Youth Court Judge

My Commission Expires: N/A (Court Officer)

ACKNOWLEDGMENT OF RESPONDENT

I, __[Respondent Name]__, hereby acknowledge receipt of this Protection Order and understand that violation may result in arrest and criminal prosecution.

Signature: _________________________ Date: ___/___/20___

CERTIFICATE OF SERVICE

I certify that I personally served the foregoing Order on Respondent at ___:___ __.m. on ___/___/20___ at the following location: __[Address]__.

_______________________________
[Name & Badge No.], Serving Officer
[Agency]

Date Filed: ___/___/20___
Clerk: _________________________