Request Restraining OrderCal. Super. - 6th Dist.January 19, 2021CH 1 00 Request for CIVII Harassment Clerk stamps data here when form is filed. Restraining Orders Read Can a Civil Harassment Restraining Order Help Me? (form CH-I 00- INFO) before completing this form. Also fill out Confidential CLETS l L EInformation form CLETS-OOI) with as much information as you know. D @P s k' Ptt' JAN19202’el'SOl'l ee Ing I'O ec IOI'I wage Court K NGUMEN U a. ur IfullName: é) Z Saperi CountyotSanta Clara . +6 zmon onrorcw Age;3_3_ av anl [TV Your Lawyer (ifyou have onefor this case) Fill in courtn% and street address: Name:ngRepLesentei- State Bar No.:_ gupegrccloun of California, County of - _ an ara Flml Name.mentEd 191 N. First Street b. Your Address (Ifyou have a lawyer, give your lawyer ’s 191 N. Flrst Street . . V San Jose, CA 95113 Information. Ifyou d0 not have a lawyer and want t0 keep your Civil Courthouse _ DTS home address private, you may give a diflerent mailing address instead. You d0 not have r0 give telephone, fax, 0r e-m i1.) Court fills in case number when form is filed. ress: ‘S n¥ ase um : 233:; WM statg'yzfapglzé ° " ”§1CH009816 Fax:Telephone: E-Mail Address: Person From Whom Protection ls Sought Full Name:WW b éhda Id PC. g(rl‘q'flq Age: S; Address (ifknown): City: ”/0”5 State: _>/<_Zip:&_ GD Additional Protected Persons a. Are you asking for protection for any other family or household members? mYes DNO Ifyes, list them: Full Name fl A e Lives with you? How are they related to you?LE; g. Yes a No en [gm d. D Yes D No D Yes D No D Yes D No D Check here ifthere are more persons. Attach a sheet ofpaper and write “Attachment 3a-Additional Protected Persons ”for a title. You may useform MC-025, Attachment. b. Why do these people need protection? (Explain below): D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write ”Attachment 3b-Why Others Need Protection ”for a title. I.. r '\m pm (ans 9m mag...“ .4 ., ... 9‘ 0’ s e lg A 4‘ I I G¢ A ' (on.r ‘n' Jag '0 A '4: “ .ca "‘-l I This is not a Court Order. 5 k)?- ‘rV‘C‘rV Y 4° l’k r ‘H (9.1.9 nrr (09193 &%‘1‘F§LS§:3§¥Y°{.C236‘{%T"&sm6r$°€§rih°a'9°v Request for Civil Harassment Restraining Orders CH-1oo, Page1 ore °°d°°'c"’"P’°°°°“'°' “527's and 5273 (Civil Harassment Prevention) ROHc, n PVERN9@3D5'L'WH” Case Number: C4) Relationship of Parties C5) ® How do you know the person in ®? (Explain below)."[-Y l. ¢ACJ ' D Check here ifthere is not enough spacefor your answer. Put your complete answer 0n the attached sheet of paper orform MC-025 and write “Artachment 4-Relati0nship ofParties ”for a title. Venue Why are you filing in this county? (Check all that apply): a. D The person in® lives in this county. b. m Iwas harassed by the person in® 1n this county. c. D Other (specifiz) 1&4 M Ir INCS In "4| S (OHM)!- Other Court Cases a. Have you 0r any of the persons named in® been involved in another court case with the person in®? D Yes m No (Ifyes, check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in (Counry/State) Year Filed Case Number (ifknown) (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 (1 DE] Other (specifiy): b. Are there now any protective or restraining orders in effect relating to you or any of the persons in @and the person in Q)? m No DYes (Ifyes, attach a copy ifyou have one.) Description of Harassment Harassment means violence or threats of 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 court about the last time the Person in ® harassed you l/l‘ _/v20(1) When did it happen? (provide date 0r estimated date). ll 2 Wh l h ?( ) o e se waSt ere [See attached declaration for,a Description of Harrassment] This is not a Court Order. Revised January 1, 2018 Request for Civil Harassment Restraining Orders CH-1oo, Page 2 ofe 'J Essentld ' ' '(IB ‘Em (CIVII Harassment Prevention) 9 Case Number: 21;;5999816 ‘ ® a. (3) How did the person in® harass you? (Explain below):D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write “Attachment 7a(3)-Describe Harassment ”for a title. (4) Did the person in® use or threaten to use a gun or any other weapon? D Yesm No (Ifyes, explain below):D Check here ifthere is not enough spacefor your answer. Pu! your complete answer on the attached sheet ofpaper orform MC-025 and write “Attachment 7a(4)-Use of Weapons ”for a title. (5) Were you harmed or injured because of the harassment? D Yes m No (Ifyes, explain below).-D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached shee! ofpaper orform MC-025 and write “Attachment 7a(5)-Harm or Injury ”for a title. (6) Did the police come? D Yesm No If yes, did they give you or the person in ®an Emergency Protective Order?D Yes D No If yes, the order protects (check all that apply): DMe D The person in ® D The persons in @. (Attach a copy 0fthe order ifyou have one.) b. Has the person in ® harassed you at other times? m Yes D No (Ifyes, describe prior incidents andprovide dates ofharassment below):D Check here ifthere is not enough spacefor your answer. Put your complete answer 0n the attached sheet of paper orform MC-025 and write “Allachment 7b-Previ0us Harassment "for a title. 4" v . 4H ‘ _r r u a mg J M’ 0 ' IU ‘ QOIng. L0 hauc, Pro (em5. and ' {0L2“Aha r854. ‘ Mkwane“: $4qu. Revised Januaty 1. 2018 Request for Civil Harassment Restraining Orders CH-1oo, Page 3 ofs (IB‘Jmm” (Civil Harassment Prevention) , Case Number: ® Check the orders you want. M m Personal Conduct Orders l 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 @: a. a Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy personal property 0f, 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. D Other (specifi): D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write ”Atrachment 8c-0ther Personal Conduct Orders, "for a title. The person in ®will be ordered not to take any action to get the addresses or locations ofany protectedperson unless the courlfinds good cause not to make the order. mStay-Away Orders a. l ask the court to order the person in ® to stay at least 329- yards away from (check all (hat apply): (l) m Me. (8) B My vehicle. (2) a The other persons listed in®. (9) D Other (specifil): (3)p My home. (4) m My job or workplace. (5) D My school. (6) D My children’s school. (7) D 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 t0 his or her home, school, orjob? m Yes DNO (Ifno, explain below): D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet of paper orform 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? DYes DNO MI don’t know lfthejudge grams a protective order, the person in ® will be prohibitedfrom owning, possessing, purchasing, receiving, or attempting (0 purchase 0r receive a gun. otherfirearm, and ammupflion while the protective order is in effect. The person in ®will also be ordered I0 turn in r0 law enforcement, 0r sell to or store with a licensed gun dealer, any guns orfirearms within his m- hcr immediate possession or control. This is not a Court Order. Rm“ “"“a” ‘- 2°” Request for Civil Harassment Restraining Orders CH-1oo, Page 4 ots (H3‘m (Civil Harassment Prevention) 9aim Case Numbfizl cHUU 98 16 ® E Temporary Restraining Order l 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, Temporan' Restraining Order, for the court’s signature together with this Request. Has the person i ® been told that you were going t0 g0 t0 court to seek a TRO against him/her? I lYes No (Ifyou answered n0, explain why below): D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet of p er orform MC 5 and write “Attachment 1 I-Te porary Restraining Order " or a title.§éa.q I "1:- 'ne o -., ’ fling voom o w v. -a .u coma She ed. 1'9...’ ’ ut I' m/ ® D Request to Give Less Than Five Days' Notice of Hearing You must have your papers personally served 0n the person in ® ar leastfive days before the hearing, unless the court orders a shorter Iimefor service. (Form CH-200-INFO 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.) Ifyou want there to be fewer than five days between service and the hearing, explain why below: D Check here iflhere is not enough spacefor your answer. Pu! your complete answer on the attached sheet of paper orform MC-025 and write “Attachment 12-Reques! Io Give Less Than Five Days' Notice ”for a title. ® m No Fee for Filing or Service a. m 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 0r spoken in some other way that makes me reasonably fear violence. b. m The 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. D 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 andfileform FW-001, Application for Waiver of Court Fees and Costs.) E Lawyer's Fees and Costs I ask the court to order payment ofmy D lawyer's fees a Court costs. The amounts requested are: 1t_§_r_n_ Amount Ite- Amount Eil'mgiae $ 435 $ $ $ $ $ D Check here {fthere are more items. Put the items and amounts on the attached sheet ofpaper orform MC-025 and write “Attachmenl 14 Lmvycr 's Fees am! ('osls"for a title. This is not a Court Order. “°"”“‘"”""-2°‘° Request for Civil Harassment Restraining Orders CH-1oo, Page 5 ofe(m 1[m (Civil Harassment Prevention) 9 Case Number: ® D Possession and Protection of Animals l ask the court to order the following: a. D 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. (Identify animals by, e.g., type, breed, name, color, sex.) I request sole possession of the animals because (specifil good causefor granting order): D Check here iflhere is not enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write "Attachment I5a-Possession ofAm'mals ”for a title. b. D That the person in® must stay at least conceal, molest, attack, strike, threaten, harm, or otherwise dispose of, the animals listed above. yards away from, and not take, sell, transfer, encumber, DAdditional Orders Requested I ask the court to make the following additional orders (specify): D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write “Attachment 16-Additional Orders Requested, "for a title. ® Number of pages attached to this form, if any: Date: Salffiepnesamed- . d ’ s - Lawyer 's name (ifany) Lawyer ’s signarure 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.Migu- Hcci‘oedb ézwm ZOMWOL LWVM vpe or print your name ’Sign your ngme This is not a Court Order. Request for Civil Harassment Restraining Orders CH-1oo, Page 6 ofs(mm IMUM (Civil Harassment Prevention) Revised January 1 2018 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME:é<€svo ngcufad gag (3%CL CASE #: 2 1 c H 00 98 1 6 CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? $618 b) Are you living with the person? D YES m NO c) Has the person U physically abuse you, fl physically or verbally threatened you and/orfi 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 dates and times): ”“135 fixerkd (fl 4V2, MOW)!“ DC Hovqrnber‘ 202,0 L 6L0! 4'24, ”\eLHnQ Ca”? £10m ¥\ns Devsgn Han Qua AQMQQ AVridOm 0n hm m“5 she. 53cc Jrcd AME 04mm“) 4v m BCCWSQ Q‘mas4- qp(§W 41304- 5\nz, Med ((303: 14m buyer uni 5*! 50‘ J 4N. 4vurk o¥ a(‘haap HICC.&CQ\>Z SHCL WE Q“ emgcgm 'Sbe gZa§ ?,‘ngag 4e z d o r d ’ {Masada bf ’HGL CW (Wk) 'X'ko‘ aarrPin'C. 3h; handed now Mag-LHe om-W; Kys QQQLUIAO} an amwn-L 0c WVHCYX 9kg agreed; l CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT 1 1O 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 SHORT TITLE: ozm'owévon and QWVO‘OK‘A. 210H009816 La “Row «Harv Lai’F’TIIA/mza leefirodecx OS km? mo fol mexz on ”H's? :lquk 0nd, QCCQSQS mp 0U graham ‘4 from haw.MWneA mp . hg lolérwv §r il $41:ij Lh‘ml ware Mm .Bnme’hm'g bod. wgiMoYo 4'0 kumfi 1'0 me “50Wonr ffl my_fidg 0nd. £(0m4h0rg barn {KCEI‘UMQ ®H§1 HQ IC -rMame; 0n mv gbpno y f(MH‘enfl W. 9‘40 0353 élgd‘ C\FOm-|D‘o;n_J \‘n L): DMU _ [CgardW13 4ka QC-l ilrni ‘ bdéblm’ her Ca’fr‘rg r19 Song 4; Aha nnméom-l Lyons mod: flrflwmlqm-L 14’ E:\Hpvfi m)! WOf/V ‘hoxfl a CVonc ®mrun'y (A (huuo bran {oanunn th Polls. For ék Ikngw, \' Xg’ Her. Tam gun, ~147me found bu-J- ‘hnoA- ‘hzd my ()u/q Kompony \Op ‘h'bdfflh m 45¢ cagjcfi Ex hm,” £0 9c; mogg¥ £ram m2 mama fl a aib .‘Qié I thug 9&5);me - GOm Abe mama QJ Sbg CaHed m! ‘1 @1‘4 xflYIFI ~ ‘ 0(4- ‘for QW-L‘On: . 0nd ?(Y‘Co ‘M’V ”\Dfl‘hfi DC muo‘rnb/OC x4! >60! bzo‘ Uflid ‘3‘“, pm sag; &:Lg 5mm been Co. Hing nap. and -\'\n rea-‘mmnfir -\'\n¢ Some @600 WHO améO‘JPQ pffu'qu‘. flSkvnO} find A(mcndv'ne mm; G001 rip CH- CQUS-t 5H2 bg Q‘QMI‘I'YJ \KQ-L (quui drogenrgeg‘ZI‘ead/‘rvgrgerit‘e sson {hislpqage/Elfated or! igmatiogan bggfgrecfspejgmimbm+h WE- numbers): U a 27 This page may be used with any Judicial Council form or any other paper filed with the coun. Page gay wmfiggmm ADDITIONAL PAGE cm; 201, 5m M64120 [New January 1. 19671 Attach to Judicial Council Form or Other Court Paper Optional Form lMam‘n Dean's Essential Forms TM \é \qo n 40mg Of AD 6:2»! 6W15fmd g Hm 30069” G4“ Ofld‘ Uqu Qronqe 4H‘In9 h \AQQPeq 97“?) AH‘IO ge Cblls §4ov+cd One of S‘lrmnyc Jam“?- wog‘ +m+ §an Vonamcaw cur, ave 'r‘r WOL$ Yon. my 9"(wrfend. J'han ,}hi$ V5 0H boon)». Ophij P0“ $0” {A COOL r0 [\‘C‘t Mum be” #Zomqoaé? 01H ,keJley #73 o Qau £05 90°05 (/4 palm: Jppglonck 'uo alum 01 Jaded pezgs-Jenel Jeuloue esn eseeld iiefied sun uo 9mm LON oa - A VVI 9”a / 1O 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME(éazm 2&an 9W (096* CASE #: 21 C H 00 98 1.6 Last Name Last Name e) Were any guns or other weapons used or threatened to be used during any abuse in the past three months? U YES U NO If “YES", describe: f) Were there any injuries during abuse in the past three months? D YES ,QNO If “YES”, describe: g) Did the police come to any of these recent events? fi‘YES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES m NO If “YES”, please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? D YES q NO If “YES”, where: j) Has the person you want restrained ever been in jail for violence against you or your children? DYES flNO If“YES",when: Describe what the person did to you or your children that caused them to go to jail: CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ’ ' 21CH009816 CASE NAME and «rM ‘ CASE #z Last Name Last k) Do you have a criminal protective order (restraining order from criminal court)? U YES Q NO If “YES", please attach a copy. I) Describe the worst abuse and when it happened: fl The most recent abuse i3 the worst abuse OR D The worst abuse was (approximate date) OI 20:2 I 2°71 and the person Iwant a restraining order aggai?st (describejatthey did to you): rwve‘cqllq «om 1m 9mm la" A'VWQOJEnmm W4enmoi mp ARA 311/)m Dime, Arham )rho mane)! bud. 4h r139 woulA k: m) Describe any pier previous (past) violence or threats of violence that you haven't already written about here (include dates or estimates as to when it happened): \J‘ 702,0 -+V\e_ UOndq \uf'z A H)! A (\[nené\ COW- Wotan 4km Linea 'l'Vw-L Xheg Q v2 &fl gm m fig Q QE £15m 4W4 hqpfengd 512(¥ ( lggc 40 Mam 4th awash Can.-m m 4o 05k 123., mpnay and, 4o 4M Yeden Mp. CH-1 00. Item 73(3) - DESCRIBE HARASSMENT
