Domestic Violence Protection Order - New York
For preparation only: Family Court Act § 814-a calls for uniform protection-order forms statewide. Use the court's current uniform form for any order the judge will issue. Transfer applicable proposed terms from this draft to that form, or supply this draft as an attachment only if the court directs. Only a judge may issue an order of protection and determine its findings, terms, and effective date.
FAMILY COURT OF THE STATE OF NEW YORK
County of [COUNTY]
In the Matter of a Proceeding under Article 8 of the Family Court Act
[PETITIONER FULL LEGAL NAME],
Petitioner,
– against –
[RESPONDENT FULL LEGAL NAME],
Respondent.
Docket No.: [DOCKET NO.]
Index No.: [INDEX/FILE NO.]
ORDER OF PROTECTION (DOMESTIC VIOLENCE)
Effective Date: [MM/DD/YYYY]
Expiration Date: [MM/DD/YYYY] (not to exceed the statutory maximum, see N.Y. Fam. Ct. Act § 842)
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions (Court-Ordered Relief)
- Findings, Representations & Warranties
- Covenants & Restrictions
- Default & Remedies (Violation Consequences)
- Risk Allocation (N/A – informational only)
- Dispute Resolution & Governing Law
- General Provisions
- Execution Block & Service
1. DOCUMENT HEADER
A. Recitals
- On [DATE OF FILING], Petitioner filed a verified petition alleging that Respondent committed one or more family offenses as defined in N.Y. Fam. Ct. Act § 812.
- The Court has jurisdiction over the parties and subject matter pursuant to N.Y. Fam. Ct. Act §§ 812–828.
- The Court, after due inquiry and either a hearing on the record or Respondent’s default/consent, makes the findings and issues the relief set forth herein.
2. DEFINITIONS
For purposes of this Order, the following capitalized terms shall have the meanings indicated below. Undefined capitalized terms bear their plain-language meaning.
“Child(ren)” – The minor child or children of the parties, or otherwise placed under the Court’s jurisdiction, listed in Schedule A.
“Court” – The Family Court of the State of New York, County of [COUNTY].
“Firearm” – Any weapon defined in 18 U.S.C. § 921(a)(3) and N.Y. Penal Law § 265.00(3).
“Order” – This Domestic Violence Order of Protection, as amended from time to time.
“Petitioner” – [PETITIONER FULL LEGAL NAME], together with any child(ren) or guardian(s) lawfully protected hereby.
“Respondent” – [RESPONDENT FULL LEGAL NAME].
“Residence” – The dwelling(s) set forth in Schedule B or subsequently designated in writing by Petitioner and approved by the Court.
3. OPERATIVE PROVISIONS (COURT-ORDERED RELIEF)
IT IS HEREBY ORDERED, pursuant to N.Y. Fam. Ct. Act § 842, that Respondent shall comply immediately and continuously with each of the following provisions:
3.1 Stay-Away. Respondent shall stay at least [SPECIFY] feet away from Petitioner, the Child(ren), Petitioner’s Residence, place of employment, school, and any other location listed in Schedule C.
3.2 No Contact. Respondent shall have no direct or indirect contact with Petitioner or the Child(ren), including but not limited to in-person, telephone, text, e-mail, social media, or third-party communication, except:
(a) as expressly permitted in Paragraph 3.4 (visitation), or
(b) for bona-fide counsel by attorneys of record concerning this action.
3.3 Exclusive Possession of Residence. Respondent is excluded from Petitioner’s Residence. Respondent shall not enter or attempt to enter the Residence or any surrounding curtilage.
3.4 Custody & Visitation. Temporary legal and physical custody of the Child(ren) is awarded to Petitioner. Supervised visitation for Respondent shall occur only:
• at [VISITATION CENTER NAME],
• on [DAYS/TIMES],
• under supervision by [QUALIFIED SUPERVISOR].
3.5 Child and/or Spousal Support. Respondent shall pay temporary support of $[AMOUNT] per [WEEK/MONTH] beginning [MM/DD/YYYY] via the Support Collection Unit. This provision is without prejudice to any final determination under Article 4 of the Family Court Act.
3.6 Surrender of Firearms & Licenses. If the Court orders surrender under N.Y. Fam. Ct. Act § 842-a, Respondent shall surrender the firearms, rifles, or shotguns identified by the Court at [PLACE DESIGNATED BY COURT] by [COURT-SPECIFIED DATE AND TIME]. The Court shall specify the place, date, and time in the order and direct the receiving authority to notify the Court immediately of surrender. Any license suspension, revocation, or ineligibility is as separately ordered by the Court. Continued possession in violation of this Order may have criminal consequences.
3.7 Treatment Programs. Respondent shall enroll in and complete, at Respondent’s expense, a certified [BATTERER’S INTERVENTION PROGRAM / SUBSTANCE-ABUSE PROGRAM] and shall file proof of enrollment within [10] days.
3.8 Law-Enforcement Entry & Registry. Pursuant to N.Y. Fam. Ct. Act § 168, the Clerk shall file a copy of this Order with the sheriff's office or police department in the county (or city) where Petitioner resides, and the Order shall be entered in the statewide computerized registry of orders of protection maintained under N.Y. Executive Law § 221-a (accessible via NYSPIN/NCIC). Any police officer is authorized and directed to arrest Respondent upon probable cause of a violation hereof.
3.9 Compliance Monitoring. Respondent shall appear for compliance reviews on [DATES] or as otherwise directed by the Court.
4. FINDINGS, REPRESENTATIONS & WARRANTIES
4.1 Findings of Fact. The Court finds that Respondent committed the following family offense(s): [ASSAULT / MENACING / HARASSMENT / STALKING / CRIMINAL MISCHIEF / OTHER].
4.2 Best-Interests Determination. The relief granted herein is necessary to ensure the safety and welfare of Petitioner and the Child(ren).
4.3 Material Disclosure. Each party affirmed on the record that all material facts relevant to risk assessment were fully disclosed to the Court.
5. COVENANTS & RESTRICTIONS
Respondent shall:
(a) obey all conditions of this Order;
(b) immediately update the Court and Petitioner’s counsel of any change in residence, telephone number, or employment; and
(c) not commit any further family offense against Petitioner or the Child(ren).
If the Court has authorized address confidentiality under N.Y. Fam. Ct. Act § 154-b(2), Petitioner shall provide address changes for service to the court clerk or the disinterested person designated by the Court, not to Respondent. The Court determines any needed change to the Order's geographic terms without requiring Petitioner to disclose a confidential address to Respondent.
6. DEFAULT & REMEDIES (VIOLATION CONSEQUENCES)
6.1 Civil & Criminal Contempt. A knowing violation of this Order may subject Respondent to immediate arrest, prosecution for criminal contempt under N.Y. Penal Law § 215.50 (a class A misdemeanor punishable by up to 364 days in jail under § 70.15(1)), and/or commitment to jail for up to six months for each violation under the Family Court's contempt power in N.Y. Fam. Ct. Act § 846-a. Aggravated or repeat violations may be charged as felony criminal contempt under N.Y. Penal Law §§ 215.51–215.52.
6.2 Notice to Respondent. YOU ARE HEREBY NOTIFIED that violating this Order is a crime, even if the protected person invites or permits contact. Only the Court can modify or terminate this Order.
7. RISK ALLOCATION
8. DISPUTE RESOLUTION & GOVERNING LAW
8.1 Governing Law. This Order is governed by the laws of the State of New York, including but not limited to N.Y. Fam. Ct. Act §§ 812–846 and applicable federal statutes.
8.2 Court Proceedings. A request to modify or extend this Family Court order should be directed to the issuing court under applicable procedure. N.Y. Fam. Ct. Act § 812 recognizes concurrent Family Court and criminal court jurisdiction over covered family offenses; this Order does not bar criminal proceedings concerning a violation.
8.3 Arbitration & Jury Trial. Arbitration is unavailable, and jury trial is not applicable in Family Court protection-order proceedings.
9. GENERAL PROVISIONS
9.1 Modification / Termination. Either party may, upon written motion and notice, seek to modify, extend, or vacate this Order pursuant to N.Y. Fam. Ct. Act § 842.
9.2 Severability. If any provision of this Order is held invalid, the remaining provisions shall remain in full force and effect.
9.3 Full Faith & Credit. This Order shall be accorded full faith and credit in all U.S. jurisdictions under 18 U.S.C. § 2265.
9.4 Electronic Signatures. An electronic or facsimile signature of the Court shall have the same force and effect as an original.
10. EXECUTION BLOCK & SERVICE
IT IS SO ORDERED.
DATED: [MM/DD/YYYY]
[CITY], New York
_______________________________________
HON. [NAME OF JUDGE]
Judge of the Family Court
[COURT SEAL]
ACKNOWLEDGMENT OF RECEIPT BY RESPONDENT
I, [RESPONDENT NAME], acknowledge receipt of a certified copy of this Order on [MM/DD/YYYY] at [TIME].
Signature: ________________________
CERTIFICATE OF SERVICE
I, [NAME], certify that on [MM/DD/YYYY] I personally served a true copy of this Order upon Respondent by [METHOD], in accordance with N.Y. Fam. Ct. Act § 153-b.
Signature: ________________________ Title: [PROCESS SERVER / LAW ENFORCEMENT] Date: _________
SCHEDULE A – Child(ren) Covered by This Order
| Name | Date of Birth | Relationship |
|---|---|---|
| [NAME] | [DOB] | Child |
SCHEDULE B – Residence(s) Under Protection
| Address | Type (Home/Work/School) |
|---|---|
| [COURT-APPROVED LOCATION OR CONFIDENTIAL REFERENCE] | Home |
SCHEDULE C – Additional Stay-Away Locations
(List any daycare, relative’s home, or other location requiring protection.)
About this template
- Last updated
- October 26, 2026
- Jurisdiction
- New York
- Category
- Family Law
Legal authority
- N.Y. Fam. Ct. Act Art. 8 (§§ 812–847) (Family Offense Proceedings)
- N.Y. Fam. Ct. Act § 812 (Procedures for family offense proceedings — concurrent jurisdiction & definitions)
- N.Y. Fam. Ct. Act § 828 (Temporary order of protection)
- N.Y. Fam. Ct. Act § 842 (Order of protection — conditions & duration: 2 years, or 5 years on aggravating circumstances)
- N.Y. Fam. Ct. Act § 842-a (Suspension/revocation of firearm license; order to surrender firearms)
- N.Y. Fam. Ct. Act § 814-a (Uniform protection-order forms)
- N.Y. Fam. Ct. Act § 846-a (Powers on failure to obey order — commitment up to six months)
- N.Y. Fam. Ct. Act § 168 (Notice of order of protection; filing with police & arrest authority)
- N.Y. Fam. Ct. Act § 153-b (Service of process)
- N.Y. Executive Law § 221-a (Statewide computerized registry of orders of protection)
- N.Y. Penal Law § 215.50 (Criminal contempt in the second degree — class A misdemeanor)
- N.Y. Penal Law § 70.15(1) (Class A misdemeanor maximum sentence)
- N.Y. Penal Law § 265.00(3) (Definition of firearm)
- N.Y. Penal Law § 265.01-b (Criminal possession of a firearm — class E felony)
- 18 U.S.C. § 921(a)(3) (Federal definition of firearm)
- 18 U.S.C. § 2265 (Full faith and credit for protection orders)
Family law covers the paperwork that shapes divorce, custody, child support, adoption, guardianship, and other family matters. These filings are emotional and high-stakes, and they also have to meet strict procedural rules for service, financial disclosure, and parenting plans. Clean, accurate paperwork keeps the focus on getting a workable outcome for the family instead of getting derailed by technical problems that delay hearings or force amended filings.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
The statutes this template relies on are listed under Legal authority.
N.Y. Fam. Ct. Act § 842-a(5)(a) (checked October 25, 2026): "the temporary order of protection or order of protection shall specify the place where such weapons shall be surrendered, shall specify a date and time by which the surrender shall be completed"
N.Y. Fam. Ct. Act § 812(1) (checked October 25, 2026): "The family court and the criminal courts shall have concurrent jurisdiction over any proceeding concerning acts which would constitute"
N.Y. Fam. Ct. Act § 812(5) (checked October 25, 2026): "Only a judge can issue an order of protection. The judge does that as part of a criminal or family court case against the person who harmed you."
N.Y. Fam. Ct. Act § 154-b(2)(d) (checked October 25, 2026): "the party whose address is to remain confidential shall inform the clerk of the court or disinterested person designated by the court of any change in address"
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