Domestic Violence Protection Order

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

New Hampshire requires the use of official court forms from the Domestic Violence Order of
Protection Petition Packet 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 forms are available at
https://www.courts.nh.gov/our-courts/circuit-court/district-division/forms/domestic-violence-forms.
Do not file this document directly with the court.

DOMESTIC VIOLENCE PROTECTIVE ORDER

State of New Hampshire – Circuit Court, Family Division

Issued Pursuant to N.H. Rev. Stat. Ann. § 173-B

I. DOCUMENT HEADER

1. Caption
   1.1 Court: State of New Hampshire – Circuit Court, Family Division – [COUNTY]
   1.2 Docket No.: [DOCKET NUMBER]
   1.3 Title: “Domestic Violence Protective Order” (☐ Ex Parte ☐ Final)

2. Parties
   2.1 Petitioner (“Protected Party”): [FULL LEGAL NAME], DOB [MM/DD/YYYY]
   2.2 Respondent (“Restrained Party”): [FULL LEGAL NAME], DOB [MM/DD/YYYY]

3. Effective Date & Duration
   3.1 Effective Date: [DATE]
   3.2 Expiration Date: [DATE] (not to exceed one year from the date of issuance per N.H. Rev. Stat. Ann. § 173-B:5, I)

II. DEFINITIONS

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

“Abuse” means the commission or attempted commission of any act described in N.H. Rev. Stat. Ann. § 173-B:1, I.

“Contact” includes, without limitation, in-person interaction, telephone calls, text or instant messages, e-mail, social media interaction, third-party communication, delivery of gifts, or surveillance.

“Court” means the New Hampshire Circuit Court – Family Division hearing this matter.

“Firearm” has the same meaning as in 18 U.S.C. § 921(a)(3).

“Protected Person(s)” means the Petitioner and the following additional individuals, if any: [LIST NAMES / DOBs OF MINOR CHILDREN OR OTHER HOUSEHOLD MEMBERS].

“Residence” means [STREET ADDRESS, CITY/TOWN, NH], including any curtilage, outbuildings, and vehicles located thereon.

III. OPERATIVE PROVISIONS

Pursuant to N.H. Rev. Stat. Ann. §§ 173-B:3–5, the Court HEREBY ORDERS:

1. No Abuse
   Respondent shall refrain from abusing, harassing, stalking, or threatening any Protected Person.

2. No Contact
   Respondent shall have no Contact with any Protected Person, directly or indirectly, except as explicitly permitted in Section 3 (Limited Communications).

3. Limited Communications (if applicable)
   ☐ Not applicable
   ☐ Respondent may communicate with Petitioner only for the limited purpose of [CHILD-EXCHANGE / OTHER], exclusively through [METHOD], and only between the hours of [TIME RANGE] with at least [HOURS] advance written notice.

4. Stay-Away & Exclusion
   Respondent shall stay at least [300] feet from:
   a. The Residence;
   b. Petitioner’s place of employment [ADDRESS];
   c. [CHILD’S] school or daycare [ADDRESS]; and
   d. Any other location where a Protected Person is reasonably believed to be.

5. Vacate Residence
   Respondent shall immediately vacate the Residence and may remove personal belongings only with law-enforcement escort arranged through the [LOCAL POLICE DEPARTMENT] within [5] days of service of this Order.

6. Firearms & Dangerous Weapons
   a. Respondent shall relinquish to [LAW-ENFORCEMENT AGENCY] all Firearms, ammunition, and other deadly weapons in Respondent’s possession, custody, or control within [24] hours of service of this Order.
   b. Law enforcement shall hold said items until further order of the Court pursuant to N.H. Rev. Stat. Ann. § 173-B:5, II.

7. Temporary Custody & Parental Rights (if applicable)
   ☐ Not applicable
   ☐ Temporary decision-making responsibility and residential responsibility for the minor child(ren) listed below is awarded to Petitioner until the earlier of the Order’s expiration or further Court order:
   • Child 1: [NAME, DOB]
   • Child 2: [NAME, DOB]

8. Support & Financial Relief (if applicable)
   ☐ Not applicable
   ☐ Respondent shall pay to Petitioner temporary child support/spousal support in the amount of $[AMOUNT] per [WEEK/MONTH], commencing [DATE], pursuant to N.H. Rev. Stat. Ann. § 173-B:5, IV.

9. Care of Animals
   ☐ Not applicable
   ☐ Exclusive care, custody, or control of the following animal(s) is awarded to Petitioner: [DESCRIPTION]. Respondent shall not harm or interfere with said animal(s).

10. Additional Relief
    ☐ [DESCRIBE COURT-ORDERED RELIEF CONSISTENT WITH RSA 173-B:5]

IV. REPRESENTATIONS & WARRANTIES

Not Applicable

V. COVENANTS & RESTRICTIONS

1. Respondent’s Covenants
   a. To comply fully and promptly with every provision of this Order.
   b. To appear at all scheduled hearings and participate in any court-ordered programming (e.g., batterers’ intervention).

2. Petitioner’s Covenants
   a. To refrain from aiding, abetting, or facilitating Respondent’s violation of this Order.
   b. To notify the Court in writing of any material change in circumstance relevant to the protections herein.

VI. DEFAULT & REMEDIES

1. Events of Default
   Any knowing violation of this Order by Respondent constitutes a criminal offense pursuant to N.H. Rev. Stat. Ann. § 173-B:9 and may also constitute contempt of court.

2. Law-Enforcement Response
   Upon probable cause to believe Respondent has violated this Order, law-enforcement officers shall arrest Respondent without warrant in accordance with N.H. Rev. Stat. Ann. § 173-B:9, III.

3. Criminal Penalties
   A first offense is punishable as a class A misdemeanor; subsequent offenses may constitute a class B felony. See N.H. Rev. Stat. Ann. § 173-B:9, I–II.

4. Civil/Contempt Sanctions
   The Court retains continuing jurisdiction to impose civil contempt sanctions, including incarceration until compliance, fines, and any other remedy authorized by law.

VII. RISK ALLOCATION

Not Applicable

VIII. DISPUTE RESOLUTION

1. Governing Law
   This Order is governed by the laws of the State of New Hampshire.

2. Forum Selection
   Exclusive jurisdiction lies with the issuing Family Division of the New Hampshire Circuit Court.

3. Modification & Dissolution
   Either party may file a written motion pursuant to N.H. Rev. Stat. Ann. § 173-B:4, VII to modify or vacate this Order. The Court shall hold a hearing within 30 days of filing unless good cause is shown for a later date.

4. Appeals
   Any final order may be appealed to the New Hampshire Supreme Court in accordance with Supreme Court Rule 7.

5. Injunctive Relief
   The injunctive nature of this Order is primary and ongoing. Monetary damages are inadequate to remedy violations.

IX. GENERAL PROVISIONS

1. Full Faith & Credit
   This Order shall be accorded full faith and credit by all United States jurisdictions pursuant to 18 U.S.C. § 2265.

2. Service & Entry
   a. The Clerk shall cause certified copies of this Order to be served promptly on Respondent.
   b. A copy shall be forwarded to the New Hampshire Domestic Violence Protective Order Registry and to the National Crime Information Center (NCIC) Protection Order File forthwith.

3. Severability
   Should any provision of this Order be held invalid, the remaining provisions shall remain in full force and effect.

4. Integration
   This document constitutes the complete protective order; any prior protections not contained herein are superseded.

5. Electronic & Facsimile Copies
   Certified electronic or facsimile copies of this Order are legally enforceable.

X. EXECUTION BLOCK

IN WITNESS WHEREOF, and based upon the statutory findings announced on the record, it is SO ORDERED.

Acknowledgment of Receipt (Optional – Not Required for Enforceability)

I, ____________________________ (Respondent), acknowledge receipt of a certified copy of this Protective Order on ____________, 20____, at ____ ☐ am ☐ pm.
Signature: ______________________________________