[Globally replace (A) with Applicant s name and (B) with
Respondent s name]

NO. _____________

) IN THE ______ COURT
_____________ )
)
AND )
___ _________ ________ )
) TRAVIS COUNTY, TEXAS

PROTECTIVE ORDER

On _______________, 1999, the Court heard the application of
(A) for a Protective Order.
I. Appearances
Applicant, (A), appeared in person and by attorney,
_______________ of Legal Aid of Central Texas, and announced
ready.
( ) Respondent, (B), did not appear and wholly made
default.
( ) Respondent (B), appeared in person and by and through
counsel (___________________) and announced ready.
( ) Respondent, (B), appeared pro se and announced ready.
II. Findings
The Court, having considered the pleadings and heard the
evidence and argument of counsel, finds that all necessary
prerequisites of the law have been legally satisfied and that
this Court has jurisdiction over the parties and subject matter
of this cause.
( ) The testimony was duly recorded.
( ) The making of a record of testimony was waived.
The Court also finds that:
(A) and (B) are husband and wife.

The parties have agreed to the following protective orders.

( ) Family violence has occurred and is likely to occur in
the foreseeable future.

( ) Respondent, who is a party to these proceedings
committed family violence. Applicant has been the
victim of family violence.

( ) Respondent poses a threat to the physical safety of the
Applicant.

( ) Respondent, because there are pending criminal charges
or criminal charges may be filed, has requested that
the Court defer a finding of family violence in this
matter at this time.

( ) Respondent violated a previous protective order.

( ) Respondent has a duty to support
______________________________________________________
______________________________________________________.

III. Orders
The Court finds that the following orders are in the best
interests of the Applicant.
IT IS THEREFORE ORDERED THAT RESPONDENT, (B), BE AND
HEREBY IS PROHIBITED FROM:
( ) committing family violence against (A) or any member of
the Applicant s family or household, and not to use any
force that would cause injury to the Applicant.

( ) Communicating nor attempting to communicate with the
(A) or any member of the Applicant s family or
household in a threatening or harassing manner.

The Court finds that good cause exists to order
Respondent not to communicate with Applicant in
any manner whatsoever except through attorneys,
and it is so ordered.

( ) communicating a threat nor attempting to communicate a
threat to the (A) or any member of the Applicant s
family or household through any other person.

( ) damaging, transferring, encumbering, or otherwise
disposing of property mutually owned or leased by the
parties, except when in the ordinary course of
business.

( ) going within 200 yards of those persons or locations
listed on this page or any locations where Respondent
knows Respondent s child(ren) to be, except where such
is necessary:

( ) to carry out visitation policies as set out
in the attached schedule of visitation;

( ) to attend court proceedings;

[list persons]
___________________________;
___________________________;
___________________________;

( ) going to or near the residences or places of employment
or business of (A). Respondent is specifically to
maintain AT LEAST 200 YARDS from (A) at any time;

( ) engaging in conduct directed specifically toward (A),
including following (A) that is reasonably likely to
harass, annoy, alarm, abuse, torment, or embarrass (A);

IT IS FURTHER ORDERED that Respondent:
[Travis County usually gives the Respondent 1 month to enter the
program and 4 months to complete the program.]

( ) enter, meet attendance requirements, pay costs and
complete the 12 week Domestic Violence Prevention
Program, 1030 South Lamar, Suite H, Austin, Texas (326-
1717). Respondent is ordered to enter the program no
later than __________________________ and to complete
the program by _________ _________________. Respondent
is ordered to comply with any recommendation/referral
for additional or alternate counseling within 7 (seven)
days of the recommendation being made and ordered to
complete the program as recommended. Respondent is
ordered to sign a waiver for release of information
upon registration so that Legal Aid of Central Texas
may monitor his participation in the program.

( ) enter, meet attendance requirements, pay costs and
complete the Domestic Violence Threat Containment
Intensive Treatment Program (DVTC), 1030 South Lamar,
Suite H, Austin, Texas (326-1717). Respondent is
ordered to contact and enter the program no later than
_________________________, to submit himself/herself
for two (2) intake interviews, to begin participation
in the program by ______________________, and to attend
at least 34 sessions of the program by
_________________________________. Respondent is
ordered to comply with any recommendation/referral for
additional or alternate counseling within 7 (seven)
days of the recommendation being made and ordered to
complete the program as recommended. Respondent is
ordered to sign a waiver for release of information
upon registration so that Legal Aid of Central Texas
may monitor his/her participation in the program.

( ) enter, meet attendance requirements, pay costs and
complete the 21 week counseling course offered by the
Family Violence Diversion Network at Lifeworks, 2001
Chicon, Austin, Texas, (512) 478-1648. Respondent is
ordered to enter the program no later than
______________ and complete the program by the ____ day
of ________________, 19_____. Respondent is ordered to
comply with any recommendation/referral for additional
or alternate counseling within 7 (seven) days of the
recommendation being made and ordered to complete the
program as recommended. Respondent is ordered to sign
a waiver for release of information upon registration
so that Legal Aid of Central Texas may monitor his/her
participation in the program.

( ) submit himself for an alcohol and drug evaluation to
Substance Abuse Counseling and Assessments (SACA) of
Travis County (473-9540) 411 W. 13th Street, Suite 700,
Austin, Texas by _________________________. Respondent
is ordered to enter all programs recommended by the
counselors within seven (7) days of the recommendation
being made, is ordered to complete all programs and is
ordered to pay all costs connected with all of the
programs he attends. Respondent is ordered to sign a
waiver for release of information upon registration so
that Legal Aid of Central Texas may monitor his
participation in the program.

( ) contact Alcoholics Anonymous, either the Twenty Four
Hours Group (473-0569) 49 East Avenue, Austin, Texas,
or the group of his/her choice by _________
______________________. Respondent is ordered to
attend a minimum of _______ meeting(s) per week for the
duration of this order and is ordered to mail proof of
his/her attendance in writing every 90 days to Legal
Aid of Central Texas.

( ) contact Narcotics Anonymous (465-8124) by
______________. Respondent is ordered to attend a
minimum of __________ meeting(s) per week for the
duration of this order and is ordered to mail proof of
his/her attendance in writing every 90 days to Legal
Aid of Central Texas.

( ) contact Parents Anonymous of Austin (478-9922) by
____________________. Respondent is ordered to attend
a minimum of _________ meeting(s) per week for the
duration of this order and is ordered to mail proof of
his/her attendance in writing every 60 days to Legal
Aid of Central Texas.

( ) submit to an evaluation by the Rio Grande Counseling
Center, located at 1605-B West Avenue, Austin, Texas
78701 (465-5342). The Respondent is ordered to submit
himself for the initial evaluation by
________________________. Respondent is ordered to
comply with and complete any commendations/referrals
for counseling and for treatment programs recommended
by the counselor and is ordered to enter the
recommended program or counseling within ten (10) days
of the recommendation being made. Respondent is
ordered to pay all costs incurred in participation with
the program or any programs recommended by the
counselors and attended by Respondent and is ordered to
report his attendance in writing every six weeks to
Legal Aid of Central Texas. Respondent is ordered to
sign a waiver for release of information upon
registration so that Legal Aid of Central Texas may
monitor his/her participation in the program.

( ) enter and participate in counseling with the Family
Development Program by ___________________________.
Respondent is ordered to comply with any
recommendations made by the Family Development Program
counselors within ten (10) days of the recommendation
being made, is ordered to pay all costs, and is ordered
to report his attendance in writing every 6 weeks to
Legal Aid of Central Texas. Respondent is ordered to
sign a waiver for release of information upon
registration so that Legal Aid of Central Texas may
monitor his/her participation in the program.
Respondent is ordered to contact Randy Moncebaaiz,
Program Coordinator at 459-5490.

( ) enter, meet attendance requirements, pay costs, and
complete the 20 hour (10 week) Child Abuse Prevention
Program at 1030 South Lamar, Suite H, Austin, Texas
(326-1717). Respondent is ordered to enter the program
no later than ______________ and to complete the
program by ________________. Respondent is ordered to
comply with any recommendation/referral for additional
or alternate counseling within 7 (seven) days of the
recommendation being made and ordered to complete the
program as recommended. Respondent is ordered to sign
a waiver for release of information upon registration
so that Legal Aid of Central Texas may monitor his/her
participation in the program.

Respondent may enter and complete similar programs as above
in his jurisdiction.

( ) and Applicant will not willfully nor intentionally
damage, transfer, encumber, or otherwise dispose of any
property owned or leased by the parties except in the
ordinary course of business.

( ) pay the Applicant named herein $_______ per
_____________ as current child support, said payments
to begin ______________ and continue each
___________________ thereafter for the term of this
Order or until further order of the Court, whichever
event first occurs. The Respondent is ordered to make
all payments for child support payable to the Applicant
as named in this order and pay all payments for child
support through the Travis County Domestic Relations
Office, P. O. Box 1495, Austin, Texas 78767. The
Respondent is further ordered to keep the Domestic
Relations Office informed of Respondent s residence and
work addresses. On this date the Court signed an
income withholding order ordering the employer and any
subsequent employer of Respondent to withhold the
above-ordered child support from Respondent s earnings.
THE EXISTENCE OF THE ORDER FOR WITHHOLDING FROM
EARNINGS FOR CHILD SUPPORT DOES NOT EXCUSE RESPONDENT
FROM PERSONALLY MAKING ANY CHILD SUPPORT PAYMENT
ORDERED HEREIN, EXCEPT TO THE EXTENT RESPONDENT S
EMPLOYER ACTUALLY MAKES THE PAYMENT ON BEHALF OF
RESPONDENT.

( ) pay the sum of $91.00/$158.00 (money order only) to the
Clerk of this Court, said sum being the costs of
service, the actual costs of court, the costs incurred
by the clerk but not paid by Applicant, and all other
fees, charges or expenses incurred in connection with
the protective order. Said sum is ordered to be paid
by ____________________ to the Travis County District
Clerk s Office, P. O. Box 1748, Austin, Texas 78767,
for which let execution lie.

( ) Pursuant to §85.007 of the Texas Family Code, the Court
grants Applicant s request for exclusion of the address and
telephone number of his/her residence and place of employment,
and the children s schools and child care facilities, and orders
the clerk to strike said information from the public records of
the Court and maintain a confidential record of same.
Nothing in this order shall be construed to allow Respondent
to:
( ) to go to the residence of the Applicant.

( ) remain at the residence of the Applicant longer
than 10 minutes and only for the express purpose
of exchanging the child(ren) pursuant to
visitation as set forth herein.

( ) Respondent may have possession of the child(ren) listed
on the second page of this order pursuant to Schedule A (Schedule
B), attached hereto and incorporated herein by this reference.
For purposes of visitation, Applicant is to deliver the
child(ren) to Respondent at
_____________________________________________________________;
Respondent is to pick up the child(ren) at
_______________________________________________ at the
commencement of his/her visitation and is to return the
child(ren) to _________________________________________________
at the termination of the visitation. The visitation schedule
shall begin on the date this order is signed. Applicant must
make the child(ren) available to Respondent at the commencement
of each period of Respondent s possession. Respondent is ordered
to return the child(ren) to Applicant at the termination of
Respondent s designated period of possession.
A copy of this order shall be forwarded by the Clerk to the Chief of Police of the
City of Austin, Texas, and to the Travis County Sheriff, Austin, Travis County, Texas.
WARNING:
A PERSON WHO VIOLATES THIS ORDER MAY BE PUNISHED FOR
CONTEMPT OF COURT BY A FINE OF AS MUCH AS $500.00 OR BY
CONFINEMENT IN JAIL FOR AS LONG AS SIX MONTHS, OR BOTH.
A VIOLATION OF THIS ORDER BY COMMISSION OF AN ACT
PROHIBITED BY THIS ORDER MAY BE A FELONY PUNISHABLE BY A FINE OF
AS MUCH AS $4,000.00 OR BY CONFINEMENT IN PRISON FOR AS LONG AS ONE
YEAR, OR BOTH. AN ACT THAT RESULTS IN FAMILY VIOLENCE MAY BE
PROSECUTED AS A SEPARATE MISDEMEANOR OR FELONY OFFENSE. IF THE
ACT IS PROSECUTED AS A SEPARATE FELONY OFFENSE, IT IS PUNISHABLE BY
CONFINEMENT IN PRISON FOR AT LEAST TWO YEARS.
NO PERSON, INCLUDING A PERSON WHO IS PROTECTED BY THIS
ORDER, MAY GIVE PERMISSION TO ANYONE TO IGNORE OR VIOLATE ANY
PROVISION OF THIS ORDER. DURING THE TIME IN WHICH THIS ORDER IS
VALID, EVERY PROVISION OF THIS ORDER IS IN FULL FORCE AND EFFECT
UNLESS A COURT CHANGES THE ORDER.
A RESPONDENT ORDERED INTO COUNSELING OR INTO BATTERER S
TREATMENT PROGRAM SHALL FILE AN AFFIDAVIT WITH THE COURT THAT
HE HAS BEGUN THE PROGRAM OR THAT THE PROGRAM IS NOT AVAILABLE
WITHIN A REASONABLE DISTANCE TO THE RESPONDENT S RESIDENCE NO
LATER THAN 60 DAYS AFTER THE PROTECTIVE ORDER IS SIGNED BY THE
JUDGE. FURTHER, NOT LATER THAN THE 30TH DAY BEFORE THE EXPIRATION
OF THE PROTECTIVE ORDER, RESPONDENT SHALL FILE A STATEMENT THAT
HE COMPLETED THE PROGRAM. AN AFFIDAVIT MUST BE ACCOMPANIED BY
A LETTER, NOTICE, OR CERTIFICATE FROM THE PROGRAM OR COUNSELOR
THAT VERIFIES COMPLETION OF THE PROGRAM OR COUNSELING. FAILURE
TO SUBMIT THE AFFIDAVITS MAY BE PUNISHED FOR CONTEMPT OF COURT
BY A FINE IN THE AMOUNT NOT TO EXCEED $500.00 OR BY CONFINEMENT IN
JAIL FOR A TERM NOT TO EXCEED SIX MONTHS, OR BOTH.
All said Protective Orders contained herein shall continue in full force and effect
until one year after the date of entry.
SIGNED this day of , 1999

___________________________________
Presiding Judge

APPROVED AS TO FORM:

LEGAL AID OF CENTRAL TEXAS
205 West 9th Street, Suite 200
Austin, Texas 78701
Phone: (512) 476-7244
Facsimile: (512) 476-3940

______________________________
Name:________________________
State Bar No. __________________

SCHEDULE A

Parents who Reside 100 Miles or Less Apart
(Only those items checked refer to this case)

Respondent is to have possession of the child(ren) during the following periods:

( ) On Saturday/Sunday of each week from ________ until ________ the same day.

( ) On the first, third, and fifth weekends of each month from 6:00 p.m. on Friday until the
Sunday immediately following at 6:00 p.m. The first, third, and fifth weekends of a month are those that
begin on the first, third, and fifth Fridays of the month.

( ) On Wednesday of each week during school from 6:00 p.m. until 8:00 p.m.

( ) If a weekend visit with the Respondent coincides with a school holiday during the regular
school term or with a federal, state, or local holiday during the summer months when school is not in
session, such weekend visit shall extend until 6:00 p.m. on the Monday holiday, or shall begin at 6:00 p.m.
Thursday for a Friday holiday or school holiday.

The following provisions of this order will determine possession of the child(ren) for holidays and
vacations, even if such a holiday or vacation provision conflicts with the weekend and Wednesday visitation
set out above.

( ) The Respondent shall have possession of the child(ren) from noon on December 26th until
6:00 p.m. on the day before school resumes.

( ) The Respondent shall have possession of the child(ren) from 6:00 p.m. on the Wednesday
before Thanksgiving until 6:00 p.m. on the following Sunday.

( ) The Respondent shall have possession of the child(ren), if he/she gives the Applicant
written notice by May 1st specifying an extended period or periods of summer possession, for 30 days
beginning not earlier than the day after school is dismissed for summer vacation and ending not later than
seven days before school resumes, to be exercised in no more than two separate periods of at least seven
consecutive each.

( ) On Father s Day, the child(ren) shall visit the father from 9:00 a.m. until 6:00 p.m.

( ) On Mother s Day, the child(ren) shall visit the mother from 9:00 a.m. until 6:00 p.m.

( ) At any other reasonable times as may be agreed upon by the parties in advance in writing.

( ) Respondent is ordered not to consume any alcoholic beverages or illegal drugs within 24
hours prior to or at any time during a period of visitation.

( ) Respondent is ordered not to remove the child(ren) from Travis County without
Applicant s prior written consent.

( ) Respondent is ordered not to use corporal punishment in disciplining the child(ren).

( ) Other: ________________________________________________________________________________________________________________________________________________________________________________________________________________________

SCHEDULE B

Parents who reside over 100 Miles Apart
(Only those items checked refer to this case)

Respondent is to have possession of the child(ren) during the following periods:

( ) One weekend per month of the Respondent s choice if the Respondent gives the
Applicant 14 days written or telephonic notice preceding a designated weekend and provided that
Respondent gives written notice to Applicant within 90 days after Applicant and Respondent begin to
reside more than 100 miles apart.

( ) Respondent shall have possession of the child(ren) from noon on December 26th until 6:00
p.m. on the day before school resumes.

( ) Respondent shall have possession of the child(ren) from 6:00 p.m. on the Wednesday
before Thanksgiving until 6:00 p.m. on the following Sunday.

( ) Respondent shall have possession of the child(ren) every spring school vacation from 6:00
p.m. on the day school recesses until 6:00 p.m. on the day before school resumes after that vacation.

( ) On Father s Day, the child(ren) shall visit the father from 9:00 a.m. until 6:00 p.m.

( ) On Mother s Day, the child(ren) shall visit the mother from 9:00 a.m. until 6:00 p.m.

( ) The Respondent shall have possession of the child(ren), if he/she gives the Applicant
written notice by May 1st specifying an extended period or periods of summer possession, for 42 days
beginning not earlier than the day after school is dismissed for summer vacation and ending not later than
seven days before school resumes, to be exercised in no more than two separate periods of at least seven
consecutive days each.

( ) At any other reasonable times as may be agreed upon by the parties in advance in writing.

( ) Respondent is ordered not to consume any alcoholic beverages or illegal drugs within 24
hours before or at any time during a period of visitation.

( ) Respondent is ordered not to use corporal punishment in disciplining the child(ren).

( ) Other: ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________