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Deborah A. Oliva, :IN THE COURT OF COMMON PLEAS
Plaintiff
:OF CUMBERLAND COUNTY, PENNSYLVANIA
VS.
Daniel A. Bateman,
Defendant
:NO. 99 - 3/G CIVIL TERM
:PROTECTION FROM ABUSE
NOTICE OF HEARING AND ORDER
YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set,
forth in the following papers, you must appear at the hearing scheduled herein. If
you fail to do so, the case may proceed against you and a FINAL Order may be entered
against you granting the relief requested in the Petition. In particular, you may be
evicted from your residence and lose other important rights.
A hearing on this matter is scheduled for the A Ai day of ?%7L4 / L
1999, at /P00 A m., in Courtroom No. of the Cumberland County
Courthouse, Carlisle, Pennsylvania.
You MUST obey the order that is attached until it is modified or terminated by
the court after notice and hearing. If you disobey this order, the police may arrest
you. Violation of this order may subject you to a charge of indirect criminal
contempt which is punishable by a fine of up to $1,000.00 and/or up to six months in
jail under 23 Pa.C.S. §6114. Violation may also subject you to prosecution and
criminal penalties under the Pennsylvania Crimes Code. Under federal law, 1S U.S.C.
§2265, this Order is enforceable anywhere in the United States, tribal lands, U.S.
Territories and the Commonwealth of Puerto Rico. If you travel outside of the state
and intentionally violate this Order, you may be subject to federal criminal
proceedings under the Violence Against Women Act, 1S U.S.C. §2261-2262.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. YOU HAVE THE RIGHT TO HAVE
A LAWYER REPRESENT YOU AT THE HEARING. THE COURT WILL NOT, HOWEVER, APPOINT A LAWYER
FOR YOU. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELD. IF YOU CANNOT FIND
ALAWYER, YOU MAY HAVE TO PROCEED WITHOUT ONE.
CUMBERLAND COUNTY BAR ASSOCIATION
2 LIBERTY AVENUE
CARLISLE, PENNSYLVANIA 17013
TELEPHONE NUMBER: (717) 249-3166
AMERICANS WITH DISABILITIES ACT OF 1990
The Court of Common Pleas of Cumberland County is required by law to comply with
the Americans with Disabilities Act of 1990. For information about accessible
facilities and reasonable accommodations available to disabled individuals having
business before the court, please contact our office. All arrangements must be made
at least 72 hours prior to any hearing or business before the court. You must attend
the scheduled conference or hearing.
Deborah A. Oliva,
Plaintiff
VS.
Daniel A. Bateman,
Defendant
:IN THE COURT OF COMMON PLEAS
:OF CUMBERLAND COUNTY, PENNSYLVANIA
:NO. 99 CIVIL TERM
:PROTECTION FROM ABUSE
TEMPORARY PROTECTION FROM ABUSE ORDER
Defendant's Name: Daniel A. Bateman
Defendant's Date of Birth: 11/30/53
Defendant's Social Security Number: 210-40-3982
Name of Protected Person: Deborah A. Oliva
AND NOW, this ao?? day of May, 1999, upon consideration of
the attached Petition for Protection from Abuse, the court hereby
enters the following Temporary Order:
® 1. Defendant shall not abuse, harass, stalk or threaten any
of the above persons in any place where they might be found.
? 2. Defendant is evicted and excluded from Plaintiff's
residence located at , Cumberland County, Pennsylvania, (a
residence which is jointly owned/leased by the parties;
owned/leased by the entireties; owned/leased solely by
Plaintiff/Defendant to which Plaintiff and the minor child/ren
moved to avoid abuse, which is not owned or leased by the
Defendant, or any other permanent or temporary residence where
Plaintiff may live. Plaintiff is granted exclusive possession of
the residence. Defendant shall have no right or privilege to
enter or be present on the premises, except for the limited
purpose of transferring custody of the parties' child/ren.
Defendant shall remain in his vehicle at all times during the
transfer of custody.)
® 3. Defendant is prohibited from having ANY CONTACT with
Plaintiff at any location, including, but not limited to any
contact at Plaintiff's place of employment. Defendant is
specifically ordered to stay away from the following locations
for the duration of this Order: Plaintiff's residence located at
1137 Columbus Avenue, Apartment 6, Lemoyne, Cumberland County,
Pennsylvania, a residence which is leased solely by Plaintiff,
and any other residence Plaintiff may establish.
® 4. Defendant shall not contact Plaintiff by telephone or by
any.other means, including through third persons.
? 5. Pending the outcome of the final hearing in this matter.
Plaintiff is awarded temporary custody of the following minor
child/ren:
Until the final hearing, all contact between Defendant and the
child/ren shall be limited to the following:
The local law enforcement agency in the jurisdiction where the
child/ren are located shall ensure that the child/ren are placed
in the care and control of Plaintiff in accordance with the terms
of this order.
? 6. Defendant shall immediately relinquish the following
weapons to the Sheriff's Office or a designated local law
enforcement agency for the delivery to the Sheriff's Office:
Defendant is prohibited from possessing; transferring or
acquiring any other weapons for the duration of this order.
® 7. The following additional relief is granted:
The Cumberland County Sheriff's Department shall attempt to
make service at Plaintiff's request and without pre-payment of
fees, but service may be accomplished under any applicable Rule
of Civil Procedure.
This Order shall be docketed in the office of the
Prothonotary and forwarded to the Sheriff for service. The
Prothonotary shall not send a copy of this order to Defendant by
mail.
This Order shall remain in effect until modified or
terminated by the Court and can be extended beyond its original
expiration date if the Court finds that Defendant has committed
another act of abuse or has engaged in a pattern or practice that
indicates continued risk of harm to Plaintiff.
Defendant is enjoined from damaging or destroying any
property owned solely by Plaintiff.
Defendant is to refrain from harassing Plaintiff's
relatives.
® 8. A certified copy of this order shall be provided to the
police department where Plaintiff resides and any other agency
specified hereafter: Lower Allen Police Department.
? 9. THIS ORDER SUPERSEDES D ANY PRIOR PFA ORDER AND O ANY
PRIOR ORDER RELATING TO CHILD CUSTODY
10. THIS ORDER APPLIES IMMEDIATELY TO DEFENDANT AND SHALL REMAIN
IN EFFECT UNTIL MODIFIED OR TERMINATED BY THIS COURT AFTER NOTICE
AND HEARING.
NOTICE TO DEFENDANT
Defendant is hereby notified that violation of this Order
may result in arrest for indirect criminal contempt, which is
punishable by a fine of up to $1,000.00 and/or up to six months
in jail. 23 Pa.C.S. 56114. Consent of Plaintiff to Defendant's
return to the residence shall not invalidate this Order, which
can only be changed or modified through the filing of appropriate
court papers for that purpose. 23 Pa.C.S. 56113. Defendant is
further notified that violation of this Order may subject him/her
to state charges and penalties under the Pennsylvania Crimes Code
and to federal charges and penalties under the Violence Against
Women Act, 18 U.S.C. 55 2261-2262. Any protection order granted
by a court may be considered in any subsequent proceedings.
including child custody proceedings under title 23 (Domestic
Relations) of the Pennsylvania Consolidated Statutes.
NOTICE TO LAW ENFORCEMENT OFFICIALS
This order shall be enforced by the police who have
jurisdiction over Plaintiff's residence OR any locations where a
violation of this order occurs OR where Defendant may be located.
If Defendant violates Paragraphs 1 through 6 of this order,
Defendant may be arrested on the charge of indirect Criminal
Contempt. An arrest for violation of this Order may be made
without warrant, based solely on probable cause, whether or not
the violation is committed in the presence of law enforcement.
Subsequent to an arrest, the law enforcement officer shall
seize all weapons used or threatened to be used during the
violation of this order OR during prior incidents of abuse.
Weapons must forthwith be delivered to the Sheriff's office of
the county which issued this order, which office shall maintain
possession of the weapons until further order of this Court,
unless the weapon/s are evidence of a crime, in which case, they
shall remain with the law enforcement agency whose officer made
the arrest.
BY THE COURT
Judge
Joan Carey
Attorney for Plaintiff
? z? E d 1o ;5P
Deborah A. Oliva, :IN THE COURT OF COMMON PLEAS
Plaintiff
OF CUMBERLAND COUNTY, PENNSYLVANIA
VS.
:NO. 99 - 3/6/ CIVIL TERM
Daniel A. Bateman,
Defendant :PROTECTION FROM ABUSE
PETITION FOR PROTECTION FROM ABUSE
1. Plaintiff's name is Deborah A. Oliva.
2. The name of the person, who seeks protection from abuse is
Deborah A. Oliva.
3. Plaintiff's address is 1137 Columbus Avenue, Apartment 6,
Lemoyne, Pennsylvania.
4. Defendant is believed to live at the following address 113
Heather Drive, Harrisburg, Pennsylvania 17112.
Defendant's Social Security Number is 210-40-3982.
Defendant's date of birth is 11/30/53.
Defendant's place of employment is Consolidated Freight, New
Kingstown, Pennsylvania.
5. Defendant is Plaintiff's former intimate partner.
6. Defendant has been involved in the following criminal
court action: in December 1998, Defendant received a summons with
a fine for harassment against Plaintiff, and on May 15,1999,
Defendant was given a citation for defiant trespass because of
another incident with Plaintiff.
7. The facts of the most recent incident of abuse are as
follows:
On or about May 9, 1999, Plaintiff prepared a defiant
trespass letter warning Defendant to stay away from
her. On May 10, 1999, Lower Allen Police hand-delivered
the letter to Defendant. A copy of that letter and a receipt
signed by Defendant is attached and marked Exhibit A. On or
about may 15, 1999, Defendant followed Plaintiff for
approximately three miles to her apartment complex, and parked
at another building close enough to see her causing Plaintiff
to fear for her safety and call the police. Police saw
Defendant leaving Plaintiff's apartment complex, stopped him,
and gave him a citation for defiant trespass.
8. Defendant has committed the following prior acts of abuse
against Plaintiff:
a. On or about May 10, 1999, Plaintiff saw Defendant
driving on a. highway near her apartment, and fearing
for her safety, she called Lower Allen Police
Department. After the police arrived, they saw
Defendant drive out of the complex. The police
stopped Defendant and gave him a copy of a defiant
trespass letter which was written by Plaintiff.
b. On or about May 8, 1999, Defendant called Plaintiff
to tell her to come pick up her house key.
Plaintiff told him to leave it on his porch for her
to pick up. When she arrived to get the key,
Defendant opened the door, grabbed her by the arm,
and told her to talk to him. Defendant grabbed
Plaintiff's hand and put an engagement ring on her i
finger begging her to marry him. When Defendant
eventually gave Plaintiff her key, Plaintiff ran out
of the house. Defendant repeatedly called Plaintiff
and left several messages on her answering machine,
exacerbating her fear.
c. On or about May 3, and May 4, 1999, Defendant
repeatedly harassed Plaintiff by coming to her
residence, knocking on her door, throwing pebbles at
her window, and putting notes under her door. j
Plaintiff refused to answer the door and put a towel j
by the door to prevent any further written contact.
d. In or about March 1999, Defendant forcefully grabbed
Plaintiff's arms and shook her.
e. on several occasions between approximately January
and May 1999, Defendant constantly checked up on
Plaintiff's whereabouts, badgered Plaintiff about her
whereabouts, and got close to her face calling her
vile names causing her to fear for her safety. On
one occasion during this period of time, Defendant
screamed at Plaintiff and slammed his fist down on a
stove in front of Plaintiff.
f. In or about December 1998, Defendant came toward
Plaintiff in a threatening manner. Fearing for her
safety, Plaintiff tried to get to a telephone to call
for help. Defendant grabbed the telephone, threw it,
and grabbed Plaintiff's arm twisting it behind her
back causing her pain. Plaintiff's daughter called
Lower Allen Police who gave Defendant a citation for
harassment.
g. On several occasions from December 1998 to January
1999, after Plaintiff and Defendant had ended their
relationship, Defendant repeatedly drove past
Plaintiff's residence and sent her letters.
Defendant later told Plaintiff that he had been
watching her and that he knew when she was in and out
of her residence, and Defendant also repeated
conversations she had in her apartment.
9. The following police department or law enforcement agency)
in the area in which Plaintiff lives should be provided with a
copy of the Protection Order: Lower Allen Police Department.
10. There is an immediate and present danger of further abuse
from Defendant.
11. Plaintiff is asking the Court to order Defendant to stay
away from the residence at 1137 Columbus Avenue, Apartment 6,
Lemoyne, Pennsylvania, which is rented by Plaintiff.
WHEREFORE, PLAINTIFF REQUESTS THAT THE COURT ENTER A TEMPORARY
ORDER, AND AFTER HEARING, A FINAL ORDER THAT WOULD DO THE
FOLLOWING:
A. Restrain Defendant from abusing, threatening, harassing, or
stalking Plaintiff in any place where Plaintiff may be found.
B. Order Defendant to stay away from Plaintiff's residence and
prohibit Defendant from attempting to enter any temporary or
permanent residence of Plaintiff.
C. Prohibit Defendant from having any contact with Plaintiff
either in person, by telephone, or in writing, personally or
through third persons, including, but not limited to any contact
at Plaintiff's place of employment.
D. Order Defendant to pay the costs of this action, including
filing fees, service fees, and surcharge of $25.00.
E. Order Defendant to pay $250.00 to reimburse one of Legal
Services, Inc.'s funding sources for the cost of litigation in
this case.
F. Order the following additional relief, not listed above:
a. Defendant is enjoined from damaging or destroying any
property owned solely by Plaintiff.
b. Defendant is to refrain from harassing Plaintiff's
relatives.
H. Grant such other relief as the court deems appropriate. ?.
Order the police or other law enforcement agency to serve
Defendant with a copy of this Petition, any Order issued, and the
Order for Hearing. Plaintiff will inform the designated
authority of any addresses, other than Defendant's residence,
where Defendant can be served.
Plaintiff prays for such other relief as may be just and
proper.
Respectfully submitted,
Dated: 5
( o n Carey
Attorney for Plaintiff
LEGAL SERVICES, INC.
8 Irvine Row
Carlisle, PA 17013
(717) 243-9400,
VERIFICATION
I verify that I am the Plaintiff as designated in the present
action and that the facts and statements contained in the above
Petition are true and correct to the best of my knowledge. I
understand that any false statements are made subject to the
penalties of 18 Pa.C.S. §4904, relating to unsworn falsification
to.authorities.
Dated • ? ???- nt? ? /
J{?6!(-t^ 7 1
Deborah A. Oliva
May 9, 1999
Daniel Bateman
113 Heather Drive
Harrisburg, PA 17112
W Bateman:
This letter will confirm my regtiasCOf May 1999 that you leap a me alone
As you have spent this past week: knocking of my door. Which I would not answer,
throwing rocks at my front windows, and sliding
has become necessary:, notes under the door. this warning
Stay away, Do not attempt tb.call. stop over. or mail armhinc• Am•thine ?•ou do
to get my attention will be considered harassment.
Funher, should we be in the mo. same establishment. you are not welcome to approach
Go about you life without me in. it and govern vour actions accordingly.
Deborah Oliva
cc: Lower Allen Police Dept,
cc: Lower Allen Police Dept.
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Deborah A. Oliva,
Plaintiff
V8.
Daniel A. Bateman,
Defendant
:IN THE COURT OF COMMON PLEAS
:OF CUMBERLAND COUNTY, PENNSYLVANIA
:NO. 99 - 3161 CIVIL TERM
:PROTECTION FROM ABUSE
FINAL ORDER OF COURT
Defendant's Name: Daniel A. Bateman
Defendant's Date of Birth: 11/30/53
Defendant's Social Security Number: 210-40-3982
Name of Protected: Deborah A. Oliva
AND NOW, this ? day of ? ? f , 1999, the
court having jurisdiction ove the parties and the subject-
matter, it is ORDERED, ADJDDGED, and DECREED as follows:
Plaintiff is represented by Joan Carey of LEGAL SERVICES, INC.;
Defendant is unrepresented but is aware of his right to have an
attorney. The parties agree that the following may be entered as
an Order of Court. Defendant, although agreeing that an Order
may be entered, does not admit to the allegation made in the
Petition.
? Plaintiff's request for a Final Protection Order is denied OR
N Plaintiff's request for a Final Protection Order is granted.
N 1. Defendant shall not abuse, stalk, harass, threaten
Plaintiff or, any other protected person in any place where they
might be found.
? 2. Defendant is Completely evicted and excluded from the
residence at *[NONCONFIDENTIAL ADDRESS FROM WHICH DEFENDANT IS
EXCLUDED] or any other residence where Plaintiff may live.
Exclusive possession of the residence is granted to Plaintiff.
Defendant shall have no right or privilege to enter or be present
on the premises.
? On (Insert date and time], Defendant may enter the residence
to retrieve his/her clothing and other personal effects, provided
that Defendant is in the company of a law enforcement officer
when such retrieval is made.
® 3. Defendant is prohibited from having ANY CONTACT with
Plaintiff at any location, including, but not limited to any
contact at Plaintiff's place of employment. Defendant is
specifically ordered to stay away from the following locations
for the duration of this Order: Plaintiff's residence located at
1137 Columbus Avenue, Apartment 6, Lemoyne, Cumberland County,
Pennsylvania, and any other residence Plaintiff may establish.
® 4. Defendant shall not contact plaintiff by telephone or by
any other means, including third parties.
? 5. Custody of the minor children, (names of the children
subject to the provision of this paragraph] shall be as follows;
[state to whom primary physical custody awarded; state terms of
partial custody or visitation, if any] (or see attached Custody
Order)
? 6. Defendant shall immediately turn over to the Sheriff's
Office, or to a local law enforcement agency for delivery to the
Sheriff's office, the following weapons used or threatened to be
used by Defendant in an act of abuse against Plaintiff and/or the
minor child/ren:
? 7. Defendant is prohibited from possessing, transferring or
acquiring any other weapons for the duration of this Order. Any
weapons delivered to the sheriff under Paragraph 6 of this Order
or under Paragraph 6 of the Temporary order shall not be returned
until further Order of Court.
08. The following additional relief is granted as authorized
by 56108 of this Act:
a. This Order shall remain in effect until modified or
terminated by the Court and can be extended beyond its original
expiration date if the Court finds that Defendant has committed
another act of abuse or has engaged in a pattern or practice that
indicates continued risk of harm to Plaintiff.
b. Defendant is enjoined from damaging or destroying any
property owned solely by Plaintiff.
c. Defendant is to refrain from harassing Plaintiff's
relatives.
d. The court costs and fees are waived.
? 9. Defendant is directed to pay temporary support for [insert
the names of the persons for whom support is to be paid]
as follows: [insert amount,
frequency and other terms and conditions of the support order]
This Order for support shall remain in effect
until a final support order is entered by this Court. However,
this order shall lapse automatically if Plaintiff does not file a
complaint for support with the Court within fifteen days of the
date of this order. The amount of this temporary order does not
necessarily reflect Defendant's correct support obligation, which
shall be determined in accordance with the guidelines at the
support hearing. Any adjustments in the final amount of support
shall be credited, retroactive to this date, to the appropriate
party.
? 10. The costs of this action are waived as to Plaintiff and
imposed on Defendant.
? il. Defendant shall pay $* to Plaintiff as compensation for
Plaintiff's out-of-pocket losses, which are as follows:
OR
? Plaintiff is granted leave to present a petition, with
appropriate notice to Defendant, to [insert the name of the judge
or court to which the petition should be presented] requesting
recovery of out-of-pocket losses. The petition shall include an
exhibit itemizing all claimed out-of-pocket losses, copies of all
bills and estimates of repair, and an order scheduling a hearing.
No fee shall be required by the Prothonotary's office for the
filing of this petition.
? 12. BRADY INDICATOR
1.0 Plaintiff or protected person(s) is a spouse, former spouse,
a person who cohabitates or has cohabited with Defendant, a
parent of a common child, a child of that person, or a child of
Defendant.
2.0 This order is being entered after a hearing of which
Defendant received actual notice and had an opportunity to be
heard.
3.0 Paragraph 1 of this Order has been checked to restrain
Defendant from harassing, stalking, or threatening Plaintiff or
protected person(s).
4.0 Defendant represents a credible threat to the physical
safety of Plaintiff or other protected person(s) OR
? The terms of this Order prohibit Defendant from using,
attempting to use, or threatening to use physical force against
Plaintiff or protected person that would reasonably be expected
to cause bodily injury.
® 13. THIS ORDER SUPERCEDES ® ANY PRIOR PFA ORDER AND ? ANY
PRIOR ORDER RELATING TO CHILD CUSTODY.
14. All provisions of this Order shall expire in one year.
NOTICE TO DEFENDANT
VIOLATION OF THIS ORDER MAY RESULT IN YOUR ARREST ON THE
CHARGE OF INDIRECT CRIMINAL CONTEMPT WHICH IS PUNISHABLE BY A
FINE OF UP TO $1,000 AND/OR A JAIL SENTENCE OF UP TO SIX MONTHS.
23 PA.C.S. 86114. VIOLATION MAY ALSO SUBJECT YOU TO PROSECUTION
AND CRIMINAL PENALTIES UNDER THE PENNSYLVANIA CRIMES CODE. THIS
ORDER IS ENFORCEABLE IN ALL FIFTY (50) STATES, THE DISTRICT OF
COLUMBIA, TRIBAL LANDS, U.S. TERRITORIES, AND THE COMMONWEALTH OF
PUERTO RICO UNDER THE VIOLENCE AGAINST WOMEN ACTION, 18 U.S.C.
82265. IF YOU TRAVEL OUTSIDE OF THE STATE AND INTENTIONALLY
VIOLATE THIS ORDER, YOU MAY BE SUBJECT TO FEDERAL CRIMINAL
PROCEEDINGS UNDER THAT ACT. 18 U.S.C. 88 2261-2262. IF
PARAGRAPH 12 OF THIS ORDER HAS BEEN CHECKED, YOU MAY BE SUBJECT
TO FEDERAL PROSECUTION AND PENALTIES UNDER THE "BRADY" PROVISIONS
OF THE GUN CONTROL ACTION, 18 U.S.C. 8922(0), FOR POSSESSION,
TRANSPORT OR RECEIPT OF FIREARMS OR AMMUNITION.
NOTICE TO LAW ENFORCEMENT OFFICIALS
The police who have jurisdiction over Plaintiff's residence
OR any location where a violation of this Order occurs OR where
Defendant may be located, shall enforce this Order. An arrest
for violation of Paragraphs 1 through 7 of this order may be
without warrant, based solely on probable cause, whether or not
the violation is committed in the presence of the police. 23
Pa.C.S. 96113:
Subsequent to an arrest, the police officer shall seize all
weapons used or threatened to be used during the violation of the
Protection order or during prior incidents of abuse. The [insert
the appropriate name or title] shall maintain possession of the
weapons until further Order of this Court. When Defendant is
placed under arrest for violation of the Order, Defendant shall
be taken to the appropriate authority or authorities before whom
Defendant is to be arraigned. A "Complaint for Indirect Criminal
Contempt" shall then be completed and signed by the police
officer OR Plaintiff, Plaintiff's presence and signature are not
required to file the complaint.
If sufficient grounds for violation of this Order are
alleged, Defendant shall be arraigned, bond set and both parties
given notice of the date of the hearing.
BY THE CO
s
Edward E. Guido, Judge
If entered pursuant to the consent of Plaintiff and Defendant:
ik 0
Deborah A. Oliva
Plaintiff
oan Carey /
Attorney for Plaintiff
Danie A Bateman
Pro Se Defendant
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SHERIFF'S RETURN - REGULAR
CASE NO: 1999-03161 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
OLIVA DEBORAH A
VS.
BATEMAN DANIEL A
RICHARD SMITH , Sheriff or Deputy Sheriff of
CUMBERLAND County, Pennsylvania, who being duly sworn according
to law, says, the within PROTECTION FROM ABUSE was served
upon BATEMAN DANIEL A the
defendant, at 19:25 HOURS, on the 26th day of May
1999 at CONSOLIDATED FREIGHT
NEW KINGSTON PA 17072 CUMBERLAND
County, Pennsylvania, by handing to DANIEL A. BATEMAN
a true and attested copy of the PROTECTION FROM ABUSE
together with NOTICE OF HEARING AND ORDER, TEMPORARY PROTECTION
FROM ABUSE ORDER
and at the same time directing His attention to the contents thereof.
Sheriff's Costs:
Docketing
Service
Affidavit
Surcharge
18.00 So answers:
3.10
tiles
.00
8 .00 s
05/27/199
by
Sworn and subscribed to before me
this ; 7 tr?' day of 11
19 91 A.D.