Oregon Revised Statutes Crimes and Punishments § 163.735

OFFICER:___________________________________________________________________________________________

AGENCY:____________________________________________________________________________________________

PETITIONER:________________________________________________________________________________________

PERSON TO BE PROTECTED IF OTHER THAN PETITIONER:___________________________________________________

RESPONDENT:________________________________________________________________________________________

  On behalf of petitioner, I affirm that I am a law enforcement officer in the State of Oregon.

  You, the respondent, must appear at _________________________ (name and location of court at which respondent is to appear) on ____________ (date and time respondent is to appear in court). At this hearing, you must be prepared to establish why the court should not enter a court's stalking protective order which shall be for an unlimited duration unless limited by law or court order. If you fail to appear at this hearing, the court shall immediately issue a warrant for your arrest and shall enter a court's stalking protective order.

  If the court issues a stalking protective order at this hearing, and while the protective order is in effect, federal law may prohibit you from:

  Traveling across state lines or tribal land lines with the intent to violate this order and then violating this order.

  Causing the person protected by the order, if the person is your spouse or intimate partner, to cross state lines or tribal land lines for your purpose of violating the order.

  Possessing, receiving, shipping or transporting any firearm or firearm ammunition.

  Whether or not a stalking protective order is in effect, federal law may prohibit you from:

  Traveling across state lines or tribal land lines with the intent to injure or harass another person and during, or because of, that travel placing that person in reasonable fear of death or serious bodily injury to that person or to a member of that person's immediate family.

  Traveling across state lines or tribal land lines with the intent to injure your spouse or intimate partner and then intentionally committing a crime of violence causing bodily injury to that person.

  Causing your spouse or intimate partner to travel across state lines or tribal land lines if your intent is to cause bodily injury to that person or if the travel results in your causing bodily injury to that person.

  It has been alleged that you have alarmed or coerced the petitioner, or person to be protected if other than the petitioner. If you engage in contact that alarms or coerces the petitioner, or person to be protected if other than the petitioner, in violation of ORS 163.732, you may be arrested for the crime of stalking.

Date: _______________ Time: _______________

Signed: __________________________________________________

        (Respondent)

Signed: __________________________________________________

        (Law enforcement officer).