Request Restraining OrderCal. Super. - 6th Dist.October 10, 2017Re uest for Civil Harassment crr1oo q .. Restraining Orders Read Can a Civil Harassment Restraining Order Help Me? 022m: CH-100- INFO) before completing this form. Also fill out Confidential CLETS Information (form CLETS-OOI) with as much information as you know. (D Person Seeking Protection 21. Your Full Name: , - Mfl#///< fifl/qfl we Age: 57 Your Lawyer (ifyou have one for this case): Name: SeIf.ReQresented State Bar No.: Firm Name: Self-Represented b. Your Address (If you have a lawyer, give your lawyer ‘s information. If you do not have a lawyer and want to keep your home address private, you may give a different mailing address instead You do not have to give telephone, fax, or e-mail.): Address: 630 Sflfl/ flare/”'0 (0/ fl/GC/ ." ' Clerk stamps date here when form ls tiled. F" C. m II\V. .ll Zflll OCT it) A Q: 02 Fill in court name and street address: Superior Court of California, County of Santa Clara 191 North First Street San Jose, CA 95113 Downtown Courthouse - Civil Court fills in case number when form IS filed. City Fflé 6/70 State: (27 Zip: iyfid Telephone: ¢pg 79/7» 25 Fax: /1///7 E- Mail Address: 2 g E 29?. : éE‘ZQ db: ‘ Com Person From Whom Protection is Sought mmmenb;sguz77" youn/67 Addressfl‘fknown) [2° (:qfl/ [fin/fry}; flo/ Case Number: 17CH007779 50 047A. gf #204 City flflfi fl/XZ/fl can / State 07 Zip: eq/eag @ Additional Protected Persons a. Are you asking for protection for any other family or household members? El Yes |Z]/No Ifyes, list them: Full Name m Age Lives with vou? How are they related to you? A//,4 El Yes E] No " ’ ’ [:1 Yes [:1 No El Yes E] No |:| Yes [:1 No El Check here if there are more persons. Attach a sheet of paper and write ”Attachment 3aiAdditional Protected Persons ”for a title. You may useform MC-025, Attachment. b. Why do these people need protection? (Explain below): El Check here if there is not enough space for your answer. Put your complete answer on the attached sheet of paper or form MC- 025 and write 'Attachment 3b-Why Others Need Protection' for a title m e 6rd 64~ la; ' . ‘ 1 . , .r 0 "if err Mayhem (wt/1 inf/(”El “rhea/earner” ‘04" I“ “ / inf M/anoVEKS‘ts fun/drakv me, [riff 6N Ae- mu flew Mkw"! 4”" 67nd hflI/Ifgdu M ' This Is not a Court Order. gue‘cgzgfigggg‘wiéggmnmemW Request for Civil Harassment Restraining Orders “-100. P8931 0f 5 0069010” Procedure §§ 5175md5179 (Civil Harassment Prevention) ROHC/ 9 PVERN Case Number: ~~ Relationship of Parties How do you know the person in ® ? (Explain below): El Check here if there is not enough space for your answer. Put your complete answer an the attached sheet of paper or form MC- 025 and wrt e”Attachment 4-Relationship of Parties " for a title. lie / Case Number: ~~ Check the orders you want. [2| 0 N Personal Conduct Orders /’ G) I ask the court to order the person in @ not to do any ofthe following things to me or to any person to be protected listed in @2 a. m Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy personal property of, or disturb the peace of the person. b. Contact the person, either directly or indirectly, in any way, including, but not limited to, in person, by telephone, in writing, by public or private mail, by interoffice mail, by e-mail, by text message, by fax, or by other electronic means. c. C! Other specify).- |:l Check here if there is not enough space for your answer. Put your complete answer on the attached sheet of paper or form MC-025 and write “Attachment 8cv0ther Personal Conduct Orders, " for a title. The person in Q) will be ordered no! to take any action to get the addresses or locations of any protected person \ nless the court finds good cause not to make the order. Stay-Away Orders 1 as th; court to order the person in (1D to stay at least am yards away from (check all that apply): (1) Me (8) [:I My vehicle (2) CI The other persons listed in © (9) [:| Other (specifi): (3) My home -- [O (4) y job or workplace (5) El My school (6) El My children’s school (7) El My children’s place ofchild care b. If the court orders the person in ® to stay away from all the places listed above, will he or she still be able to get to his or her home, school, orjob? El YES El NO (If '10. explain below): El Check here if there is not enough space for your answer. Put your complete answer on the attached sheet of paper or form MC-025 and write “Attachment 9b-Stay-Away Orders, ” for a title. Guns or Other Firearms and Ammunition Does the person in ® own or possess any guns or other firearms? I] Yes [:l No [:l I don't know If the judge grants a protective order, the person in ® will be prohibited from owning, possessing, purchasing, receiving, or attempting to purchase or receive a gun, other firearm, and ammunition while the protective order is in eflect. The person in ® will also be ordered to turn in to law enforcement, or sell to or store with a licensed gun dealer, any guns or firearms within his or her immediate possession or control. This is not a Court Order. “W‘s“mm "2°” Request for Civil Harassment Restraining Orders CH-1001P399 4 076 (Civil Harassment Prevention) 9 Case Number: i7CHQU7F7© ~~ @ Immediate Orders Do you want the court to make any of these orders now that will last until the hearing without notice to the person in (2). ‘7 Yes 1:] No (If you answered yes explain why below): El Chec here if there Is not enough space for your answer. Put your complete answer on the attached sheet of paper or form MC-025 and write "Attachment II-Immediate Orders " for a title. 0 7"- /9 ema se ,L a/e IQQ / ’7/eg/ §%//€ / are” M Fern/ed 0w e a find a 7‘ / no/Tc’ law/é/Ker- I min/fey? 7704“ 6M Me A ear/:57 e0 éfl/f’KKS/Vé fl (WC/ ”4 wf‘ . M ‘ Kt 0/ ‘ - ' ‘ f D Request to Give Less Than Five Days' Notice You must have your papers personally served on the person in ® at least five days before the hearing, unless the court orders a shorter time for service. (F orm» CH-ZOO-UVF 0 explains What Is “Proof of Personal Service”? Form CH-200, Proof of Personal Service, may be used to show the court that the papers have been served.) If you want there to be fewer than five days between service and the hearing, explain why below: El Check here i there is not enough space or our answer. Put your cam lete answer on the attached sheet 0 y P paper or form MC-025 and write "Attachment 12-Request to Give Less Than Five Days'Notice " for a title. Z/No Fee for Filing or Service a. El There should be no filing fee because the person in ® has used or threatened to use violence against me, has stalked me, or has acted or spoken in some other way that makes me reasonably fear violence. b. Z/T he sheriff or marshal should serve (notify) the person in @ about the orders for free because my request for orders is based on unlawful violence, a credible threat of violence, or stalking. c. E, There should be no filing fee and the sheriff or marshal should serve the person in @for free because I -am entitled to a fee waiver. (You must complete and file form F W 001, Application for Waiver of Court Fees and Costs.) 2 _ _ i N Lawyer's Fees and Costs I ask the court to order payment of my: a. El Lawyer’s fees b. m Court costs The amounts requested are: m Amount m Amount " Filing Fee(ifrequired)’ ‘ $ 435.00 $ $ $ s E $ D Check here if there are more items. Put the items and amounts on the attached sheet of paper or form MC-025 and write "Attachment 14-Lawyer ’s Feels and Costs" for a title. This is not a Gourt Order. "EV‘S“J“"”‘"Y"2°" Request for Civil Harassment Restraining Orders CH-1001Page 5 °f6 (Civil Harassment Prevention) 9 Case Number: ~ ~ CI Possession and Protection of Animals I ask the court to order the following: a. El That I be given the sole possession, care, and control of the animals listed below, which I own, possess, lease, keep, or hold, or which reside in my household. (Identifi' animals by, e.g., type, breed, name, color, sex.) Mr? I request sole possession of the animals because (specifi/ good cause for granting order): El Check here if there is not enough space for your answer. Put your complete answer an the attached sheet of paper or form MC-025 and write "Attachment Uzi-Possession of Animals ”. for a title. we b. E] That the person in®must stay at least yards away from, and not take, sell, transfer, encumber, conceal, molest, attack, strike, threaten, harm, or otherwise dispose of, the animals listed above. I] Additional Orders Requested I ask the court to make the following additional orders (specify): El Check here if there is not enough space for your answer. Put your complete answer on the attached sheet of paper or form MC-025 and write “Attachment 16-Addz'tional Orders Requested, "for a title. @ Number of pages attached to this form, if any: Date: Self-Represented Self-Represented ' Self-Represented Lawyer ’s name (ifany) Lawyer 's signature I declare under penalty of perjury under the laws of the State of California that the information above and on all attachments is true and correct. Date: V/O’ é Z’/7’ . Mfléfi/Z /€fl/;/}fm< p flflflzb’, Type or print your name Sign your name This is not a Court-Order. Revise‘Januam-m’ > Request for Civil Harassment Restraining Orders Cid-10°: P3995 °f6 (Civil Harassment Prevention) MC-OZO SHORT TITLE. c1 . JVIBER: _ / 20¢ Kflr Lést/iame and Last Name ”up; n 7 I? 7 9 1 1/4.; L221 Q’oas on §¢flf§§ (”(6% «Z: a/éffléés’m 2 gfi/afiiI/A flw- a/z/voia/s’ fiflA/ll fluo- JAIL/(VA /00/( £27,977m 3 fs/U/ ML- £ M” /(I// Voa #412/ /0/a;4 Voa/ 0/ 4 He MQn/e fiarficres reward mg @207 knot/ad 5 [’HZ [1%a (71/4 ‘1 Lia/790,77-Q/ Mofizn 46/955 LL13 6 name W/rI/p/e Al- Wfl/ éOfii'n‘ d/f me. 7 36m flé/fy/cé/ly céafldnfl/o/ 5170/ Mm/ fan s 771214; Jar/£27K?! / 4944/ £444 [766“ Q/(dflhasiS 9 _ 4.4 f’ffi (finger-UM QC, {V/M fl/ fizé/WV 7:? 10 Main» flimfllfl/Z/ Miéfibnd fle/flp/ Larry-14%??? 11 flMI/ faygr/ 0740/ I’lfiéa/ fl flé {f/e 4221/ AQVL 12 “1467* Lunar/S . £1,272, 14L /( Ia C’Q/a/eazr 92 0/ '13 4/&/ mfl/anfl éflCaSS/I/a 140/545 fl/ér /4/€/L 14 [mars I, } flag/0 @flar/Zo/ my @flzxfl/flxh 4/1/9 ¢7L 15 Mi». 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