VERMONT FAMILY COURT

DOMESTIC VIOLENCE PROTECTION ORDER

(a/k/a “Relief-From-Abuse Order” under 15 V.S.A. § 1101 et seq.)

Case No.: [DOCKET NUMBER]
County: [COUNTY]
Division: Family

Petitioner (Protected Party): [PETITIONER FULL LEGAL NAME]
Respondent (Restrained Party): [RESPONDENT FULL LEGAL NAME]

Effective as of [EFFECTIVE DATE] (“Effective Date”)
Expires on [EXPIRATION DATE – MAX 1 YEAR UNLESS EXTENDED]

[// GUIDANCE: Confirm local court form numbers and filing‐fee waivers, if any, before finalizing.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1. Recitals
   1.1 On [FILING DATE], Petitioner filed a sworn Complaint/Petition for Relief-From-Abuse pursuant to 15 V.S.A. § 1103.
   1.2 The Court, having reviewed the pleadings, evidence, and testimony, makes the findings below and issues this Domestic Violence Protection Order (“Order”).
   1.3 Jurisdiction and venue are proper in this Court under Vermont law.

2. Consideration
   2.1 No contractual consideration is required; this Order is issued pursuant to statutory authority and the Court’s equitable powers.

II. DEFINITIONS

For purposes of this Order:

“Abuse” means conduct defined in 15 V.S.A. § 1101(1).

“Contact” includes in-person, telephone, text, email, social media, third-party, or any other direct or indirect communication.

“Court” means the Vermont Family Division of the Superior Court issuing this Order.

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

“Protected Address” means [STREET ADDRESS OR ‘ANYPLACE PETITIONER MAY RESIDE OR BE PRESENT’].

“Protected Parties” means Petitioner and the following minors or household members: [LIST FULL NAMES & DOBs].

“Respondent” means [RESPONDENT FULL LEGAL NAME & DOB].

III. OPERATIVE PROVISIONS

1. Prohibited Conduct
   1.1 Respondent SHALL NOT abuse, harass, stalk, threaten, intimidate, or interfere with the personal liberty of any Protected Party.
   1.2 Respondent SHALL NOT contact any Protected Party, directly or indirectly, except as expressly permitted in Section III.4.

2. Stay-Away Requirement
   2.1 Respondent SHALL remain at least 100 feet from any Protected Party, the Protected Address, place of employment, school, childcare, or any other location where a Protected Party is known to be.
   2.2 Lawful brief contact through counsel in active litigation is excepted.

3. Exclusive Possession of Residence
   3.1 Petitioner is awarded exclusive temporary possession of the residence located at [ADDRESS].
   3.2 Law enforcement SHALL assist in the orderly removal of Respondent’s personal effects within [X] hours of service of this Order, if requested.

4. Limited Communication for Parenting Time (if applicable)
   4.1 Except for communication strictly necessary to effectuate parenting time or exchanges of the minor child(ren) [NAMES], all contact is prohibited.
   4.2 Communication shall occur only via [COURT-APPROVED APP / EMAIL / THIRD-PARTY] and solely regarding the child(ren).
   4.3 Exchange location: [POLICE STATION / SUPERVISED CENTER].

5. Temporary Custody & Support (if sought and granted)
   5.1 Petitioner is awarded temporary sole legal and physical custody of [CHILDREN NAMES].
   5.2 Respondent shall pay temporary child/spousal support in the amount of $[AMOUNT] per [WEEK/MONTH], beginning [DATE], per Vermont Child Support Guidelines.
   [// GUIDANCE: Attach guideline worksheet; coordinate with Office of Child Support.]

6. Firearms, Dangerous Weapons, and Licenses
   6.1 Respondent SHALL immediately surrender all Firearms, dangerous weapons, and any firearms-related permits to [LOCAL LAW ENFORCEMENT AGENCY] within 24 hours of service of this Order.
   6.2 Law enforcement is authorized to accompany Respondent to facilitate surrender.

7. Mental-Health / Substance-Abuse Conditions (if ordered)
   7.1 Respondent SHALL undergo [EVALUATION / COUNSELING] at [FACILITY] and provide proof of enrollment within [X DAYS].

8. Duration
   8.1 This Order remains in full force until the Expiration Date unless modified, extended, or vacated by further Court order.

IV. REPRESENTATIONS & WARRANTIES

1. Jurisdiction & Service
   1.1 The Court finds it has subject-matter jurisdiction and personal jurisdiction over the parties.
   1.2 Respondent was personally served or had actual notice of the hearing in compliance with Vt. R. Fam. P. 4.

2. Findings of Abuse
   2.1 Based on a preponderance of evidence, the Court finds Respondent committed Abuse against Petitioner, satisfying the statutory predicate for relief.

3. Disclosure of Firearms
   3.1 Respondent represents under oath that all Firearms and permits have been fully disclosed to the Court.

[// GUIDANCE: Include Form TA-1 Firearms Surrender acknowledgement, if required in your county.]

V. COVENANTS & RESTRICTIONS

1. Affirmative Covenants of Respondent
   (a) Obey all terms herein and any subsequent enforcement directives of law enforcement.
   (b) Appear at all scheduled review hearings.
   (c) Notify the Court in writing within 24 hours of any change of address or telephone number.

2. Negative Covenants of Respondent
   (a) Do not possess, purchase, or attempt to purchase Firearms or ammunition during the pendency of this Order.
   (b) Do not remove minor child(ren) from Vermont without written Court permission.

VI. DEFAULT & REMEDIES

1. Events of Default
   1.1 Any violation of Sections III–V constitutes an “Event of Default.”

2. Notice & Cure
   2.1 No notice or cure period is required; violations are subject to immediate civil or criminal enforcement.

3. Graduated Remedies
   (a) Civil contempt proceedings;
   (b) Criminal prosecution for violation of an abuse prevention order (13 V.S.A. § 1030);
   (c) Immediate arrest without warrant under 15 V.S.A. § 1106;
   (d) Extension of this Order for additional terms up to lifetime duration upon repeated violations.

4. Attorney’s Fees & Costs
   4.1 The prevailing party in any contempt or enforcement action may recover reasonable attorney’s fees and costs.

VII. RISK ALLOCATION

1. Indemnification
   1.1 Not applicable to this judicial Order.

2. Limitation of Liability
   2.1 Nothing herein imposes civil liability upon Petitioner for actions taken by law enforcement pursuant to this Order.

3. Force Majeure
   3.1 Not applicable.

VIII. DISPUTE RESOLUTION

1. Governing Law
   1.1 This Order is governed by Vermont’s Relief-From-Abuse Statute, 15 V.S.A. § 1101 et seq., and related rules.

2. Forum Selection
   2.1 Exclusive jurisdiction for modification, enforcement, or contempt lies with the Vermont Family Division, [COUNTY].

3. Arbitration & Jury Trial
   3.1 Arbitration is unavailable.
   3.2 Jury trial is not available in relief-from-abuse proceedings.

4. Injunctive Relief
   4.1 The equitable injunctive relief granted herein is the primary remedy; all criminal remedies are concurrent.

IX. GENERAL PROVISIONS

1. Amendment & Waiver
   1.1 Only the Court may amend, vacate, or dismiss this Order. Oral modifications are VOID.
   1.2 Waiver by Petitioner of any violation is ineffective unless the Court so orders.

2. Assignment
   2.1 Rights conferred upon Protected Parties are personal and non-assignable.

3. Severability
   3.1 If any provision is held invalid, the remainder shall remain enforceable.

4. Integration
   4.1 This Order, together with any attachments (Firearms Surrender Order, Parenting Plan, Support Order), constitutes the entire relief granted.

5. Service & Entry
   5.1 The Clerk SHALL transmit copies to:
   (a) Petitioner;
   (b) Respondent;
   (c) [LOCAL POLICE DEPARTMENT];
   (d) Vermont Abuse Prevention Database.
   5.2 Proof of service SHALL be filed within [X] days.

6. Electronic Signatures
   6.1 Consistent with V.R.E.F. 11, this Order may be signed electronically and shall have the same force as an original.

X. EXECUTION BLOCK

Issued at [CITY], Vermont on [DATE].

[JUDGE NAME], Superior Court Judge
Vermont Superior Court, Family Division

ATTEST:

[CLERK NAME], Docket Clerk

ACKNOWLEDGMENT OF RECEIPT BY RESPONDENT
I, [RESPONDENT NAME], acknowledge personal service of this Order and understand its terms and the penalties for violation.

Signature: ___ Date: __

[// GUIDANCE: If Respondent is not personally present, omit acknowledgment and ensure Sheriff/Constable completes return of service.]

NOTARIZATION (if locally required)
State of Vermont, County of [COUNTY], ss.
Subscribed and sworn before me on [DATE].

Notary Public
My Commission Expires: _______

[// GUIDANCE:
1. File certified copies with the Vermont Crime Information Center within 24 hours.
2. Calendar an extension review 14 days prior to Expiration Date.
3. For interstate enforcement, provide certified copy to Petitioner for carrying across state lines under 18 U.S.C. § 2265.]