Request Restraining OrderCal. Super. - 6th Dist.January 4, 2021‘ CH 100 Request for Civil Harassment Clerk stamps date here when formis filed. Restraining Orders Read C'un u Civil llurussmcm Restraining Order Help Me? (form CH-l ()0- INFO) before completing this form. Also fill out Confidential CLETS I L E Infonnan’on (form CLETS-OOI) with as much information as you know. JAN - 4 2021 f the Court A County of Santa Ctata CD Person Seeking Protection a. You ul Name: Age: Y DEPUTY Your Lawyer (ifyou have onefor this case) Name: State Bar NO; Fill in court name and street address: Firm Name: -“- Superior Court of California, County of Santa Clara b. Your Address ([fyou have a lauyer. giveyour lanyer's Civil Division information. lfyou d0 not have a lawyer and want t0 keep y(mr 191 North First Street home address private, you may give a diflerent mailing address San Jose, CA 951 13 instead. You do not have t0 give telephone, fax, 0r e-mail.) Address: Court fills in case number when form is filed. City: tate: Zip: case Number: Telephone: Fax: - 2 1 C H 0 0 9 7 9 2 E-Mail Address: Address if/mou n) City: WW NV:\M WW‘V V ® Additional Protected Persons a. Are you asking for protection for any other family or household members? Yes D N0 Ifyes, list them: '1 e A06 iv swith ethe relate Shag §§lfln§ :EH: SE(IEE“ jjfi‘ D YCSENO G Yes D No D Yes D No B Yes D N0 D Check here iftlzcre are more persons. Attach a sheet ofpaper and write “Attachment 3a-Additi0na1 Protected Persons "for a title. You may useform MC-025, Attachment. b. Why d0 these people need protection? (Erplain below): D Check here iftlzcre is not enough spaccforyour answer. Put your complete answer 0n the attached sheet 0f paper orform MC-025 and write "Attachment 3b-Why Others Need Protection "for a title. This is not a Court Order. Jud: lCou 1| fCal'f I. m v - - . . Rewimnflcanft 231ZTJanfifwc°wfn°ag° Request for CIVII Harassment Restraining Orders CH-100. P8961 of6 cmeovow Procedure. §§ 5276M 527 9 (Civil Harassment Prevention) 9 “flflwfiuoosvsz ® Relationship of Parties How do you know thc person in ® ‘.’ (Explain below): N0 [ecm (0 h) D Check lwre {ftlxcrc is n0! enough spaccfbryour answer. Putyour complele answer 0n {he atmchcd sheet 0f p cr m'fo 'm MC-025 and write “Am Ciliflcnt 4- Irionslzip ofl’urn'cs " '- .m L m g A Aw '4 A 'W\ u..iz‘| |n~lVL\R“'-‘VV VJ V \ \ V VD V I ® Venue Why are you filmg in this county? (Check all that appb) The person in® lives 1n this county. vaH e \§ Mg$4 o9' ' MA h . . V \3 9V .W’ .h fi/ t 1 film QA“OWEM \ofi na in o \ed ixghot erCiCM gm the gm m ®? D Yes D N0 (lfyes, check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in (CountflSrate) Year Filed Case Number (ifknown) Other speci/fi‘ @o Other Co rtCa es a. Have you or any of the e (1) D Civil Harassment (2) D Domestic Violence (3) D Divorce, Nullity, Legal Separation (4) D Paternity, Parentage, Child Custody (5) D Elder or Dependent Adult Abuse (6) D Eviction (7) D Guardianship (8) D Workplace Violence (9) D Small Claims (10) D Criminal (11) D Other (specifi'): b. Are there now any protectiVe or restraining orders 1n effect relating to you or any of the persons in© and the person in® 9 D N0 D Yes (vayes, attach a copy ifyou hme one.) Description of Harassment Harassment means violence or threats 0f violence against you, or a course of conduct that seriously alarmed, annoyed or harassed you and caused you substantial emotional distress. A course of conduct is more than one act. a Tell the coun about the last time the person in® harassed you (1) When did it happen? (prox ide date 0r esnmatcd (lure) ' WW \ g WW (2) Wh else was thereWV \]( Q E 6 qw ¥M~ VV\tLW¢ \t‘-n {\ .nh n:- E/(M MM Wm WWWWK ' m Hf 3 This”Is not a Court Order. “W‘Wawam'm‘s Request for Civil Harassment Restraining Orders CH-1°°v P3982 0‘6 (Civil Harassment Prevention) '9 §an W310 9 7 9 2 ® a. (3) How did the person in® harass you? (Explain below):D Check here iffhere is n0! enough spaceforyour answer. Putyour complete answer 0n the attached sheet ofpaper orform MC-025 and write "A(n'lclmzent 7a(3)-Describe Harassment "for a title. \ \A I A- \ A (A 1/\\n \V\%\/ VH (H‘WY U‘jUM ‘/ Y.\(} fl A A. (x ‘0. M \ V IZVA A 1 A \ vx -V m X UN? MW. ‘1’” W1 L: f VI \w ‘r‘v v1 J'QAV‘L MMEJNM‘ \MAV uh W1 \/Y\% \m , (4) Did the person inQ® use or threaten to use a gun or any other \V eapon? D Yes No (Ifyes, explain below). D Check ere ifthere is not enough spaceforyour answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write “Anachmem 7a(4)-Use 0f Weapons "for a title. (5) Were you harmed 0r injured because of the harassment? g Yes D No (Ifyes, explain below).- Check here ifllxere 1'5 n01 enough spacefor vour answer. Put your complete answer on the attached sheet ofpapw orfo m MC-025 (mdur re “ ‘t’zchment (1(5)-Harm ogry'zzijffor itle. ' u‘ n H “0* 0"“ ' M m‘fiflfl'fll'lxmfimm M Vfllfl'fln ' A «mmmmj‘lfl‘HKWMKVILTA-k ‘ ”MINE.“ D - (6) Did the police come? 6 Yes [I No If yes, did they give yo or the person in® an Emergency Protective Order? D Yes? If yes, the order protects (check all that apply). D Me fl The person in® D i716 Persons in ©-//Q/WemWQAw(Attach a copy 0ft/1e order ifyou have one.) flb. Has the person in® harassed you at other times? g Yes D No (Ifyes, describe prior incidents and provide dates ofhamssment below): Check here ifthere is not enough spaceforyour answer. Put your complete answer 0n the attached sheet 0f paper orform C-02 ' and write "Attachment 7 P 'e 'ous Harass; Ignt "for a title 1 £74 ‘ k J Unit vh Vflflv lulv W1} \gV V“ 36W ‘ WW1 \UN“ l, N‘frexex.\er \Mvr MW» -- - 5 MW) Rewsmama’y‘ma Request for Civil Harassment Restraining Orders CH-100v Page 3 0f6 (Civil Harassment Prevention) 9 El /r‘ CasefluTbér'H 0 0 9 7 9 2 Check the orders you want. E D PersonalConduct Orders @‘P I ask the coun t0 order the person in® not to do any of the following things to me or to any person to be protected listed in®z a. Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually 0r otherwise), hit, abuse, destroy ersonal propeny 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 wn'ting, by public or private mail, by interoffice mail, by e-mail, by text message, by fax, or by other electronic means. - c. D Other (specifii): D Check here ifthere is not enough spaceforyour answer. Putyour complete answer 0n the attached sheet ofpaper orform MC-025 and write "Attachment 8c-Other Personal Conduct Orders, ”for a title. The person in ® will be ordered not to take any action t0 get the addresses or locations ofany protected person unless the courlfinds good cause not t0 make the order. Stay-Away Orders . I ask the court to order the person in® to stay at least 3QQ yards away from (check all that apply): (1) a Me. (8) «Eu My vehicle. (2) D The other persons listed in® (9) m Other (spec: '): (3) D My home. (\I/\ n LA AA {7 (4) D My job or workplace. ‘V I v‘\U\/Yf\A «lv\ (m (5) D My school. ‘VAQ AV? \\§\VA\/\ Ava! ( (6) D My children‘s school. j t‘ W <5 BU (7) B My children’s place of child care. Y b. If the court orders the person in® to stay ay from all the places listed abMe, will he or she still be able to get t0 his or her home, school, orjob? g Yes D N0 (Ifno, explain below): D Check here iftlzere is not enough spaceforyour answer. Putyour complete answer 0n the attached sheet of pap r orform MC-025 and vrite "A ttac/zmem 9h~5my-Away Orders, ”for a title. An l I I r . ~ U WW flGuWFiremndA munItI nW fir“ \LM/ Does the person in® own or possess any guns or other firearms? D Yes D No D I don't know Ifthejudge grants a protective order, the person in® will be prohibitedfrom owning, possessing, purchasing, receiving, 0r attempting t0 purchase 0r receive a gun, otlzerflrearm, and ammunition while (he protective order is in eflect. The person in ® will also be ordered to rum in m law enforcement, or sell to 0r store with a licensed gun dealer, any guns orfireanns within 111‘s or hcr immmliale possession 0r control. This is not a Court Order. ReV‘sedJanuaW‘-2°‘B Request for Civil Harassment Restraining Orders CH-100- P8964 °f6 (Civil Harassment Prevention) '9 CasegNimeeHO 0 9 7 9 2 ® D Temporary Restraining Order I request that a Temporary Restraining Order (TRO) be issued against the person in® to last until the hearing. I am presenting form CH-l 10, Temporary Restraining Order. for the court‘s signature together with this Request. Has the person in®been told that you were going to g0 to court to seek a TRO against him/her? D Yes D No (Ifyou answered n0, explain why below): D Check here ifthere is not enough spaceforyour answer. Put your complete answer 0n the attached sheet of paper orform MC-025 and write “A rtac/zment II-Temporaty Restraining Order "for a title. ® E] Request to Give Less Than Five Days' Notice of Hearing You must haveyour papers personally served 0n the person in® at leastflre days before the hearing, unless the court orders a shorter timefor service. (Form CH-200-[NFO explains What Is “Proof of Personal Service”? Form CH-200, Proof 0f Personal Service, may be used t0 show tlzc court that the papers have been sewed.) If you want there to be fewer than five days between service and the hearing, explain why below: D Check here ifthere is not enough spaceforyour answer. Putyour complete answer 0n the attached sheet 0f paper orform MC-025 and write “Attachment 12-Request to Give Less Than Five Days ' Notice ”for a title. D No Fee for Filing or Service a. D 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. D The sheriff 0r 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. D There should be no filing fee and the sheriff 0r marshal should serve the person in ®for free becausel am entitled to a fee waiver. (You must complete andfileform FW-OOI, Application for Waiver ofCourt Fees and Costs .) D Lawyer's Fees and Costs I ask the court to order payment ofmy D lawyer’s fees D Court costs. The amounts requested are: Item Amount 11L Amgunt $ S $ $ $ $ D Check here tfthere are more items. Put the items (Ind amounts 0n the attached sheet ofpaper orform MC-025 (md write “Attachment 147Lauycr '5 Fec‘y um! Costs "fiN' (I tille. This is not a Court Order. Re“se°Ja”“a'V‘-2°‘8 Request for Civil Harassment Restraining Orders CH-100, Page 5 of6 (Civil Harassment Prevention) 9 Case Numbe 210k509792 ® D Possession and Protection of Animals l ask the court to order the following: a. D That I bc given the sole possession, care, and control 0f the animals listed below, which I own, possess, lease, keep, or hold, or which reside in my household. (Identg'fi' animals by, e.g., type, breed, name, color, sex.) I request sole possession of the animals because (specify good causefor granting order): D Check here ifthcre is not enough spacefnryour answer. Putyour complete answer 0n the attached sheet ofpaper orform MC-025 and write “AtIac/mzem 15a-Posscssi0n ofAm'mals "for a title. b. D That the person in®must stay at least yards away from, and not take, sell, transfer, encumber, conceal, molest, attack, strike, threaten, harm, 0r otherwise dispose 0f, the animals listed above. D Additional Orders Requested I ask the coun t0 make the following additional orders (specifi'): D Check here iftlxere is not enough Spaccfin‘your answer. Put your complete answer 0n the attached sheer 0f paper orform MC-025 (md write ‘1-1tIac/1mcm 16-Addili0nal Orders Requested, "for a title. ® Number of pages attached to this form, if any: Date: V Lanyer ’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 0n all attachment§is true and correct. « en mQM M Nam gmmkm Tvpe 0r print vour name Sign vour name This is not a Court Order. “Me“amm-Zma Request for Civil Harassment Restraining Orders CH-100. PageGOfB (Civil Harassment Prevention) (.0 m \l O) (11 h (a) N -3 N N N N M _L _n ._L _‘ ._\ _\ _.z .4 .4 _x J3 (A) N -| O (D m V C) U] h (.0 M -‘ O N U1 CASE NAME. 5“" CASE#- 21 CH 0097Q 2 Last Name Last Name CH-100, Item 7a(3 -DESCRlBE HARASSMENT: )How do you know th parson yo v antto re rain? mWW Q&‘Afij:figngvysmm SwV b) Are you living with the person? D YES $NO c) Has the person #physically abuse you, D physically or verbally threatened you and/orQ harassed you many times? (Please check all that apply.) d) In the past three months, what did the person do or say that made you afraid (please start with the most recent event and explain exactly what happened in detail include dat s and times) ‘ m RM MSWW \M . \\/\Ak WM VWWWW Iv RUM My . wwmm WWW ‘ M NM‘W/r [WUmmmm ?Ax‘ ‘ 7VWW (.0 m V (D U! A (fl N -I N N N N N N N _n _A .1 .1 .4 .4 .1 .1 .1 .4 U) U! «h h) N -‘ O LO m \l 0) (JI h (a) N -l O N \j PSHORT TITLE: as {am . J I x 0 \ “VVWW \NWYVK VVN MM WtW /{r\ 11L\WMum AM A WVmmfifimm $50 M MWHL 63 VMRQ \3 UMA UW‘ A ,mW i:1f 3:5 I fiUk 0mWW \kae; Agvhfi numberrs) GS r)I (P-qu dforva .m,..p/cudnc)Tr it:ms on spage st:‘.:d on i:form=‘icn and be‘ em: sci‘1/ i'r--rn numbe rs notlzne with any Judfiz‘al Cams?! ‘C'm or shy cther paper filed wzth the court. I Page- l MC-OZO CASENL'MEE 1 C H009 79 2 \YWWo/Wn x9 {MAW} WW“ S Wm W4 Wfihf WWW J 2:”; '23! = a ADDITIONAL PAGE caczamm u - 152m 'c‘ .:,-; Mono (N; m_- .’-Eifl Attach to Judicial Council Form or Other Court Paper Opnonalror-n _ MartmDean's es- arms ‘M 10 12 13 15 16 17 18 19 20 21 22 23 24 CASE NAME: and CASE #z 2 1 C m) 0 9 7 Les: Nama Last Name e) Were any guns or otherweapons used or threatened to be used during any abuse in the past three months? D YES #0 If “YES", describe: 9 f) Were there any injuries during u the pastthree months?? QOM?% D NO If‘ YES" describelz/mwxsw OKWQK/g\ (T41M \m 03W / g) Did the police come to any of these recent events? flYESO D NO S Q/M r&e} ‘h) Did they give you an Emergency Protective Order for abuse in the past th months? D YES $0 lf‘ YES", piease attach a copy. i) Is the person you want to restrain in jaiI right now forviolence against you? DYEs firm If“YES",wherez j) Has the person you want restrained ever been in jail for violence against you 0r your 7f children? EYES filo If“YES",when: Describe what the person did to you or your children that caused them to go to jail: CH-100, Item 7a(3) - DESCRIBE HARASSMENT Dawn w 1O 11 12 13 CASE NAME: end CASE #z zlcwo097$2 Last Name Last Name k) Do you have a criminal protective order (restraining order from criminal court)? D YES NO If “YES”, please attach a copy. l) Describe the worst abuse and when it happened: D The most recent abuse i_s the worst abuse OR D The worst abuse was (apprcxmze dag) and the person l want a restraining order against (describe what may cm m you): \\- ka MM“ UMW WEE” 'A A'n ufl. 'A‘“VA ‘ . .IA‘ (14“ I.“ '~ v ' [m WW 6mm 02? XMWWWW. EX: n l §\.? r3 , 1“ “91/1 MMWk MWW WM \ (\l‘ m)Describe any___other previous(p as)t vloie-nce or threats of viOEence that you havent alr:~ady wrme about h:re( lude dates or estimate as to when it happene- : mW/‘E O&AMON 5 A . fl CHJOO, Item Ta(3)- DESCRIBE HARASSMEN4T
