Request Restraining OrderCal. Super. - 6th Dist.January 6, 2021DowSign Envdope ID’ 5E8AB8C3-5F80-41 1F-BZEA-C36816316AD7 CH 1 00 Request for Civil Harassment aemsmmmmmmisrm' Restraininq Orders Read Cun a (‘H 1/ Hurmunm! Reuruining Order Help Me.“ (form CH-IOO- I L EINFO) before completing this {om}. Also fill out Cunfldenliul (.‘Ll-JTS Information (form CLETS-UUI ) with as much infomlation as you know. JAN - 6 2021 Person Seeking Protection Clerk of the Court a. Your l‘ull Name: Sup, - n o: CA County oc Santa 01m Mikayla Roiaq Age: l9 Y DEPUTY Your Lawyer ( ifyou have one for (his caxe} Fm m court name and sneer address: Name: Slate Bar No.:- Superior Court of California, County of Santa Clara 191 North First Street b. Your Address (lfyou have u lawyer, give your lawyer's 19 l Nor th F‘i rs t S treet San Jose, CA 95113 Fim) Name: 991 f -Reprp:pnr pd infnnnation. lfyou do no! haw u lawyer and wan! Io keep your home address private. you may give a d(fi'erem mailing address instead. You d0 no! ha ve m give Ielephune, fax. 0r e-muil.) Court fills m case number when form is filed. Address; Po Box 52225 c... Nu z City:EmmaLL-Statezmzmagoaa ”CH009799 Telephone: Fax: E-Mail Address: ® Person From Whom Protection Is Sought Full Name: Brandon Rina Age; 22 Address (ifknown): Unknown City; Unknown State: Zip: ® Additional Protected Persons a. Are you asking for protection for any other family or household members“! DYes .No Ifyes, list them: Full Name gel Agg Lives wilh you‘.’ How are lhev related to you? D Yes D No D Yes D N0 D Yes D No D Yes D No D Check here {f there are more persons. Attach a sheer ofpaper and write "Attachment 3a-Additional Protected Persons " for a litle. You may mefurm M0025. Auurhmem. b. Why do these people need protection? (Explain below): D Check here if there [a m)! enough xpace jbr your answer. Put your complete answer 0n the attached sheet 0f paper orfurm M0025 and write “Attachment 3b- Wh)‘ Others Need Protection " for a lille. This is not a Court Order. Wémfiafi%flwm%“w Request for Civil Harassment Restraining Orders cmoo. Page 1 ate °°"°' "'PW"‘5276”‘° 5279 (Civil Harassment Prevention) 9(EB'Eu-mfl“‘3” Rojas, Mikayla Docu$5gn Envelope ID: 558MBC3‘5F80-41 1 F-82EA£3GB1 6316AD7 SON “?'icHoo9799 CD CED Relationship of Parties How d0 you know the person in®? (Explain below): D Check here ifthere is n0! enough space fur your answer. Put your complete answer on rhe attached sheer 0f paper orform MC-025 and write “Attachment 4-Relan'0nship 0f Parties ” for a title. Mpt‘ through a dat' 1' mg app 720.??(2Mfi‘kfl 0.1% (\fl QraD‘YTtMYL Venue D Why arc you filing 'm this county? (Check all Illa! apply): a. m The person in ® lives in this county. b. m l was harassed by the person in® in (his county. c. D Other I specifiv): Other Court Cases a. Have you or any of the persons named in® been involved in another court case with the person in@? D Yes m N0 (lf_\=es, check each kind of caxe and indicate where and when each was filed. ) Kind 0f Case Filed in (Q‘uuntv/Sruteg Year Filed Case Number (ikaLown) (1) D Civil Harassment (2) D Domestic Violence (3) D Divorce, Nullily, Legal Separation (4) D Patemily. Parentage, Child Custody (5) D Elder or Dependent Adult Abuse (6) D Eviction (7) D Guardianship (8) D Workplace Violence (9) D SmallClaims (10)D Criminal ( l lD Other (specify): b. Are there now any protective or restraining orders in effect relating to you or any of the persons in @and [he person in@'? a No DYes (lfyes. uuach a copy ifyuu hare one.) Description of Harassment Harassment means violence or threats of violence against you. 0r a course of conduct that seriously alarmed. annoyed, or harassed you and caused you substantial emotional distress. A course 0f conduct is more than one act. a. Tell the coun about the last time the person in ® harassed you. (l) When did ix happen? (provide dale ur estimated dale): 999 Am- arhmpm: (2) Who else was there? €99 Atcarhmpm: This is not a Court Order. “MW” "2°“ Request for Civil Harassment Restraining Orders cmoo, Page 2 ore (ETm (Civil Harassment Prevention) 9 Rojas, Mikayla DowSIgn Envelope ID SEWBC3-5F8041 1F-82EA-C368 163 16AD7 Case Numzc H 00 97 9 9 ® a. (3) How did lhc person in®haruss you? (Explain below):m Check here if (here is n0! enough space for your answer. Pu! your complete answer 0n the attached sheet ufpuper orform M0025 and wrile "Alluchmem 7a(3)-~Describe Harassmen!" for a title. 999 Atrarhmpnr (4) Did the person in® use 0r threaten Io use a gun or any other weapon?D Yes a No (lfyes. explain below): m Check here ifthere is m)! enough space for your answer. Put your complete answer an the attached sheet aj'puper orfoml M0025 and write "Amu'hmem 7u(4 )-Use of Weapons " for a title. 999 Anrachmpnr (5) Were you harmed or injured because of the harassment? a ch D N0 (Ifycs. explain below): m Check hero Iftherc is nu! enough space fur your answer. Put your complete answer on the attached sheet ofpaper orfurm MC-025 and write "Anachmem 7a(5)-Harm or lnjury"f0r a title. Gap Agrarhmpnt’ (6) Did the police come? D Yes N0 [f yes, did lhcy give you ur lhc person in ®an Emergency Protective Order?D Yes D N0 If yes, the order protects (check ull (hut apply): DMe D The person in ® D Thc persons in ® (Attach a copy 0f the order (/"vou have one.) b. Has the person 1n ® harassed you at other limes?D Yes a N0 (Ifyes. describe prior incidents and provide dale: ofhurassmen! below): m Check here [fthere is no! enough space fnr your answer. Pul yuur Cumplele answer 0n the altaChed sheet 0f paper orform MC-025 um! write “Atlachmem 7h-Previaus Harassment" for a title. 999 Agrar‘hment This is not a Court Order. Wf“"“-’°‘° Request for Civil Harassment Restraining Orders CH-1oo. page acts(E awn“ (Civil Harassment Prevention) 9dun B.- Rojas, MikayLa DOOJS'QD Envelope ID: SEWECS-SFBO-M 1F-BZEA-C36816316AD7 Case Number: -9+e4+&9-9-7-9-9- Check the orders you want. E m Personal Conduct Orders [ask [he court t0 order lhc person in ®not lo do any of the following things Io me 0r Io any person to be protected listed in @2 a. mflarass. intimidate. molest. attack. strike. stalk, threaten. assault (sexually 0r otherwise), hit. abuse. destroy personal property of, or disturb [he peace 0f (he person. b. mCOntacl (he person, either directly 0r indirectly. in any way, including. bul nol limited lo. in person, by telephone. in writing, by public or private mail. by inleroffice mail, by c-mail. by (ext message, by fax, or by other electronic means. C. DOLher (speu'fi'): D Chevk here if there is no! enough space for your answer. Pu! your complete answer 0n the attached sheet ufpuper orfumn M0025 and write "Attachment 8c-Olher Personal Conduct Orders, "for a title. The person in ® will be ordered not lo take any action r0 get the addresses or locations ofany protected person unless [he c‘uurtfinds good ('auxe nut m make [he order. @ mStay-Away Orders a. I ask the court m order the person in ® I0 slay a1 least 3.0.0- yurds away from (check all that apply): (l) m Me. (8) D My vehicle. (2) D The other persons listed in@. (9) D Other (specify): (3) m My home. (4) m My job 0r workplace. (5) D My schuol. (6) a My children's school. (7) D My children's place ofchild care. b. If the court orders lhc person In ®to stay away from all the places listed above, will he or she still be able Io get Io his 0r her home. school. or job'.’ m Yes DNO (lfnu, explain below): D Check here if Ihere is not enough spuu' fur )‘(mr answer. Pu! your complele answer 0n the attached sheet of paper orform MC-025 and write “Anachmem 9b-Stuy-Awa)‘ Orders. " for a title. Guns or Other Firearms and Ammunition Does lhe person in ®own or possess any guns or o(hcr firearms? Dch DNO ml don't know If (he judge grams u proleuive order. (he person in ® will be prohibiu'dfrom owning, possessing. purchasing, receiving. 0r attempting Io purchuu or rccen'v a gun. whcrflruarm. and mmnunitiun while Ihe proleclive order is in eflecl. The person in ®wil! ulsu bc' urdt'rnl m turn 1n m Ian" m/nrwmenl. 0r sell Io 0r store With a licensed gun dealer, any guns urfireurmx within Ins ur lm- unmuluuc possession 0r comm]. This is not a Court Order. MmmryLZOIe GB“‘- Re uest for Civil Harassment Restrainin Orders CH-1oo. Pageaoasq 9m (Civil Harassment Prevention) 9 Rojas, Mikayla DowSign Envelope ID: W35F80-41 1F-8ZEA-C36816316AD7 CasoNuzTr-cHUO 97 99 ® mTemporary Restraining Order I request m_al a ‘Tcmporury Restraining Order (TRO) be issued against the person in ® [o last until [he hearing. I am presenting lorm CH-l l0. Tempurury Restraining Order. for the court's signature together with this Request. Has the person in ® been told (hat you were going Io go lo court to seek a TRO against him/hcr'.’ DYes m N0 (If you answered nu, explain why below): D Check here tfthere is nu! enough .vpace for your unswer. Pu! your complete answer (m the attached sheer of paper orform MC-025 and write "Anuchmem 1 l-Temporury Restraining Order" for a title. I fipar for my phyqiral safety ® D Request to Give Less Than Five Days' Notice ot Hearing You mus! have your papers personally served on Ilw person in ® m loustfive days before the hearing, unless the court orders u shorter lime far service. (Farm CH-200-1NFO explains Whul Is “Proof of Personal Service"? Form CH-200, Proof 0f Personal Service. may be uxed Io show the (our! that the papyrs have been served.) lf you want there lo be fewer than five days between service and the hearing. explain why below: D Check here If Ihere is no! enough xpuce far yuur answer. Pu! your complele answer 0n (he attached sheet 0f paper urfonn M0025 and write "Amu-hnwm IZ-Requm'l Iu Give Less Than Five Days' Notice "for a title. m No Fee tor Filing or Service a. m There should be n0 filing fcc because lhc person in®has used or threatened I0 use violcnce against me. has stalked me. or has acted or spoken in some other way [hat makes mc reasonably fear violence. b. m The sheriff 0r marshal should serve (notify) lhc: person in ®about (he orders for free because my request for orders is based on unlawful violence. a credible threat of violence. 0r stalking. c. m There should be no filing fec and lhc sheriff or marshal should serve the person in ®for free because! am entitled t0 a fee waiver. (You must complete andfl'le form FW-OOI. Application for Waiver of Court Fees and CoslsJ D Lawyer's Fees and Costs I ask the court lo order payment of my D lawyer's fees D Court costs. The amounts requested arc: I_t_e_m Amount lle_m Amount i $ 3L S S 7 , A, S D Check here ifthere are more imm‘. I’m 1hr {Mm um! unummx un the unuched sheet ofpaper urform MC~025 and write “Anuchnmu H [.un-u': 's I’mas um! (‘mlx "fur a title. This is not a Court Order. “m““W‘m‘” Request for Civil Harassment Restraining Orders cmoo. Pagesoaa (B ‘ Br“: (Civil Harassment Prevention) 9n- E- Rojas, Mikayla Dongn Envelope ID: 5E8A88C3vSF80-41 1F-82EA-C368 1 631 6A07 CasoNumelCI-I009799 ® D Possession and Protection of Animals l ask [he court lo order thc following: a. DThal l be given Ihc sole possession. care. and control 0f [he animals listed below. which l own, possess, lease, keep, or hold, 0r which reside in my household. (Identify animals by, e.g.. type, breed. name, color. sex.) l requcsl sole possession of the animals because (specify good cuusefor granting order).- D Check here Iflhere is m)! enough space for )‘uur answer. Put yuur complete answer 0n the attached sheet nfpaper orform M0025 and write “Attachment l5a-Pnssesxion ofAnimaIs" fora title. b. DThal the person in® must slay al lcasl yards away from. and not take, sell, transfer. encumber, conceal. molest. attack. strike. threaten. harm. 0r otherwise dispose of, the animals listed above. D Additional Orders Requested I ask the coun to make (he following additional orders (specify): D Cheek here ifthere is nut enough space far your answer. Pu! your complete answer 0n the attached sheet of paper orfonn MC-025 and write “Amu‘hmen! IO ~Additional Orders Requested, " for u title. ® Number of pages attached lo this form. if any: Date: Lawyer's name (ifany) Lawyer's signature l declare under penalty 0f perjury under the laWs of the Stale 0f California that the information above and on all attachments is true and correct. 12/11/2020 Dale: _-___ Documuhy: Mikavla Roias ’ (MW i1! h”T' - ' S" ' Law‘saagosazrrc)pe 07 pI'lIl’ yflur Ilaflle . lg" )OUF "amt' This is not a Court Order. MNW"“m Request for Civil Harassment Restraining Orders cmoo. Page e o: ew;m (Civil Harassment Prevention) Rojas. Mikayla SHORTTHLE. mm -Rojas v Pina ZICHOO 9799 I v | 1 ANTACHIENTHWMMIUZ _.___ flthfllfiMflflnflyboulfllflthhMflHleflllkmn) CH-lOO: DESCRIBE ABUSE RELATIONSHIP HISTORY BETWEEN THE PARTIES Respondent and I met in a dating app. We have met a few times prior to the incident. Respondent and I were an acquaintance. MOST RECENT INCIDENT In or around October to November 2017, we met up at my apartment complex and we went to the pool bathrocm and we were going to try some sexual intercourse. I had a condom and told the Respondent to put it on. He didn't put the condom on and he put the first part of his penis inside of me. I told the Respondent no and tried to push him away. I told him he was hurting me. After that, he put his finger in my vagina and said, "I'm going to make you bleed." He did make me bleed. REQUEST For the reasons stated above, I am requesting a two year Civil Harassment Prevention Act protecting me from the Respondent's abuse. I'm filing now because at the time, I didn't really realize what happened and how it has affected me until recently. When I was talking to him, he said he was living in the same neighborhood and I'm worried about running into him. (NunnunUnuflbAnummuiamnumsbnndlufihwunhuinMwyalulunmulnhh nqu__.aLl__ AmnhnuuulnufluuflhwunhuflpqmmJ auflpqpnalumiun nmumuuu .m AJTACHIENT nn-nnnuvwflgfi to Judicial council Fonn‘W Rojas, MikaylaEm SE IE
