(TO BE USED FOR VIOLATION OF ORDER OFPROTECTION PROCEEDINGS)

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NOTICE: YOURFAILURE TO APPEAR IN COURT MAY RESULT IN YOUR IMMEDIATE ARREST. YOU HAVE THERIGHT TO BE REPRESENTED BY A LAWYER. IF YOU CANNOT AFFORD A PRIVATE LAWYER,YOU HAVE THE RIGHT TO ASK THE JUDGE TO ASSIGN A LAWYER. IF, AFTER HEARING,THE JUDGE FINDS THAT YOU WILLFULLY FAILED TO OBEY THE ORDER, YOU MAY BE IMPRISONEDFOR A TERM NOT TO EXCEED SIX MONTHS FOR EACH VIOLATION, FOR CONTEMPT OF COURT.

IN THE NAME OF THE PEOPLE OF THESTATE OF NEW YORK TO THE ABOVE-NAMED RESPONDENT: __________ WHORESIDES OR IS FOUND AT: _________________.

A petition having been filed inthis Court alleging that you have failed to obey the (Temporary) Order ofProtection dated __, 19 , made bythis Court under Article __ of the Family Court Act, ofa copy of the petition being annexed hereto;

YOU ARE HEREBY SUMMONED to appearbefore this Court at _____, New York on __,19 , at __ o'clock in the __ noon of the date to answer the petition and show cause why youshould not be dealt with in accordance with Section __ofthe Family Court Act.

Dated: ____,19 . BY ORDER OF THE COURT

Clerk of the Court

NOTICE: FamilyCourt Act § 154(c) provides that support, paternity, custody, family offenseand child abuse and neglect petitions, in which an order of protection issought or in which a violation of an order of protection is alleged, may beserved outside the State of New York upon a Respondent who is not a residentor domiciliary of the State of New York. In such instance, the exercise ofpersonal jurisdiction over the Respondent is limited to the issue of the requestfor, or alleged violation of, the order of protection, unless other groundsexist for the exercise of personal jurisdiction over the Respondent. Wherethe Respondent has been served with this summons and petition and does notappear, the Family Court may proceed to a hearing with respect to issuanceor enforcement of the order of protection.