Request Restraining OrderCal. Super. - 6th Dist.January 20, 2021CH 1 00 Request fOI' CIVII Harassment Clerk stamps date here when form is filed. ,___'__7 Restraining Orders Read ('un u ('ix'i/ llurunmcm Restraining Order llelp Me? (/brm (‘H-100- INFO) before completing this form. Also fill out Confidential CLETS | L EInformation (form (‘LETS-OOI) with as much information as you know. _ , JAN 2 0 2021 Person Seeking Protection a. Your Full Name: Cler of th COUl't . o ‘ , a Santa Clam‘Aeflfi d(s Ma Ig“ a' Agezfl bf’w”“M CA w jEPUTY Your Lawyer (ijyou have onefor this case) FiIIin coun name anH’street address.- Name:SehRemesanEd- State Bar No.:L- Superior Court of California, County of F' N -_Self_-Reptesen12d santa Clara"m ame' 191 N. Fgrst Street b. Your Address ([fyuu have a lawyer, giveyour lawyer 's 191 N. Flrst Street in ormation vaou d0 n0! have a Imvver um! want to kee vour s-an Jose’ CA 9511 3 ' - - - p- CIVII Courthouse - DTS home address privule. you may give a different mailing address instead. You do n0! have to give telephone, fax, 0r e-mail.) Court fills in case number when form is filed. Address: ‘333 th'getd M r3 Case Nuanc H 00 98 17 City:m_wn- State:C_A ZiyiS-‘L Telephone: Fax: E-Mail Address: Q) Person From Whom Protection Is Sought Full Name: 046°} MONK;- Age: ‘gg Address (ifknown): l 953 MidIHC ‘d M &a City: Sam §°K State: (W Zip: qg' 12’ C3) Additional Protected Persons a. Are you asking for protection for any other family or household members? DYes No lfyes, list them: Full Name E Agg Lives with you? How are they related to you? D Yes D No 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. Pu! your complete answer on 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. uaadCouwlofCaMormamm mmmmmmfl’mww Request for Civil Harassment Restraining Orders CH-1oo, Page 1 ore Cocoa Wm .555275n15279 . . .° (CIVII Harassment Prevention) ROHCI n pVERN9[IE [-3meda- Case Number: G) ® Relationship of Parties How do you know the person in ®? (Explain below: D Check here iflhere is not enough spacefor your answer. Pu! your complete answer 0n the aflached sheet 0f paper orform MC-02 and write "Attachment 4-Re1ationship ofParlies ”for a title. “a MMMW Xiomara: 35 M4 hovfl J00! nc‘émbo/ and DouSy NV!)- K . ,p J; Venue banMd Mtg b“ "8 Why are you filing in this county? (Check all that apply): a. The person in ® lives in this county. b. a] was harassed by the person in® in this county. c. D Other (specify): Other Court Cases a. Have you or any of the persons named in® been involved in another court case with the person in ®‘2 D Yes E No (Ifyes, check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in (County/Slate) Year Filed Case Number (ifknown) (l) 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 (lDD Other (specifi): b. Are there now any protective or restraining orders in effect relating to you or any of the persons in @and the person in@7 a No D Yes (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) When did it happen? (provide dale 0r estimated date): \ l '5 I 2- ‘ 2 Wh l h ?( ) o e 5e was‘ ere [See attached declaration for a Description of Harrassment] This is not a Court Order. RemiJanumzma Request for Civil Harassment Restraining Orders CH-1oo, Pagez ofs (IB PW (Civil Harassment Prevention) 9 Case Number: 21911099817 ® a. (3) Ho did the person in® harass you? (Explain below): Check here ifthere is n0! enough spacefor your answer. Pu! your complete answer on the attached sheet ofpaper orform MC-025 and write "Attachment 7a(3)--Describe Harassment ”for a title. A-Hfldnfl/In+ 7A(3) (4) Did the person in® use or threaten to use a gun or any other weapon? D Yes fiNo (Ifyes, explain below): D Check here ifthere is n0! enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write "Attachment 7a(4)--Use 0f Weapons "for a title. (5) Were you harmed 0r inj ured because of the harassment? D Yes flNo (Ifyes, explain below): D Check here ifthere is not enough spacefor your answer. Put your complete answer 0n the attached sheer ofpaper orform MC-025 and write "Attachment 7a(5)-Harm 0r Injury "for a title. (6) Did the police come? D Yes ENC 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? D Yes aNo (Ifyes, describe prior incidents andprovide dates ofharassment below): D Check here ifthere is not enough spacefor your answer. Pu! your complete answer on the attached sheet of paper orform MC-025 and write “Attachment 7b-Previ0us Harassment "for a title. This is not a Court Order. R”‘°‘{’"‘“"’"2°‘“ Request for Civil Harassment Restraining Orders CH-1oo, Page sore (IB film (Civil Harassment Prevention) 9 Case Number: (é) Check the orders you want. E a Personal Conduct Orders l ask the court to order the person in ®not to do any of the 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 of, or disturb the peace of the person. b. aContact 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 0n the attached sheet ofpaper orform MC-025 and write "Attachment 8c-Olher Personal Conduct Orders, "for a title. The person in ®will be ordered not I0 take any action to get the addresses 0r locations ofany protectedperson unless the courtfinds good cause n0! to make the order. EStay-Away Orders a. l ask the court to order the person in C2) to stay at leastw yards away from (check all that apply): (1) m Me. (8) a My vehicle. (2) D The other persons listed in@. (9) w Other (specifv). __ (3) a My home. txmefi‘ SQ 1 M (4) D My job or workplace. 1') “nu“ s? (5) D My school. (6) D My children’s school. (7) D My children‘s place of child 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? D Yes 8N0 (Ifno, explain below): D Check here ifthere is n0! enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write “Attac hme t 9b-Stay-Ana) Orders' ’for a title. . 3H6. HMS Whine; MK booddwq Moronmcflllj \SO {-093 0&wa Guns or Other Firearms and Aanmition Does the person in ®own or possess any guns or other firearms? DYes DNo Kl don’t know Ifthejudge grants a protective order, the person in ® will be prohibitedfrom owning, possessing. purchasing, receiving, or attempting to purchase or receive a gun, otherfirearm, and ammunition while the prolective order is in effect. The person in ®will also be ordered to turn in to law enforcement, or sell to 0r store with a licensed gun dealer, any guns orfirearms within his or lzcr immediate possession or control. This is not a Court Order. chain R'“”“_‘°"“”“2°‘° Request for Civil Harassment Restraining Orders CH-1oo, Page4ofe (I13 pym'u‘ (Civil Harassment Prevention) 9 Case NuEbfr'c H 00 9 8 1 7 ® m 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 go to court to seek a TRO against him/her? DYes mNo (Ifyou answered n0, explain why below): D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet 0f paper orform MC-025 and write “Attachment 1 l-Temporaiy Restrainin Order "for a title. 1 am 916%M auaq Mm her am vlavt her? MY 600! ((0554 3+ AW ’31,”:- ® D Request to Give Less Than Five Days' Notice of Hearing You must have your papers personally served on the person in® at leastfive days before the hearing, unless the court orders a shorter timefor service; (Form CH-200-INFO explains What Is “Proof of Personal Service”? Form CH-200, Proof of Personal Service, may be used t0 show the court that the papers have been served.) lfyou want there to be fewer than five days between service and the hearing, explain why below: D Check here {fthere is not enough spacefor your answer. Put your complete answer on the attached sheet 0f paper orform MC-025 and write “Attachment 12-Request Io Give Less Than Five Days’ Notice "for a title. ® D No Fee for Filing or Service a. a 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 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. a 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.) a Lawyer's Fees and Costs I ask the court to order payment of my D lawyer's fees The amounts requested are: a Court costs. It_en_1_ Amount m Amount Ellingfle $ 435 $ $ $ $ $ D Check here ifthere are more items. Put the irems and amounts 0n the attached sheet ofpaper orform MC-025 and write “Attachment 147Lcm’yer 's Fees and C0sts"for a title. This is not a Court Order. R“’°°”"°""'2°‘“ Request for Civil Harassment Restraining Orders CH-1oo, Page sofa (IBFEWMH (Civil Harassment Prevention) 9 o ‘ 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. (Identtfl animals by, e.g., 077e, breed, name, color, sex.) I request sole possession of the animals because (specifi/ good causefor granting order): D Check here ifthere is not enough spacefor your answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write ”Attachment 15a-Possessi0n ofAnimals "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, or otherwise dispose of, the animals listed above. DAdditional Orders Requested I ask the court to make the following additional orders (specifiz): 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 "Attachment I6-Addirional Orders Requested, ”for a title. ® Number of pages attached to this form, if any: Date: SelfiBeptesenteL ___Self:Bepmsented } SWML-Lawyer ’s name (ifany) Lawyer ’s signature I declare under penalty of perj ury under the laws 0f the State of California that the information above and on all attachments is true and correct. Date: \ LO L‘ / Mefeedts Hairwa ’ Type 0r Print your name Sign 7nd,“ This is not a Court Order. Revised January 1. 2018 . Request for Civil Harassment Restraining Orders CH-1oo, Pages ofsQBm (Civil Harassment Prevention) 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 21CH009817 CASE NAME: Mairma and Mon 1c) CASE #z Test Name Last Name CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? 39K CS M1 WV“? (\ciflvVIbN'S dauqnw and 4150 IWCS m 414 5am: (omfllr. b) Are you living with the person? D YES K NO c) Has the person D physically abuse you, Kphysically or verbally threatened you and/or D 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): 0A “Xanga/g V5 : ZOU 4* moon) y'aMa-wh; §~ 5?) 9”. l uwi ov’rSiok m5 apar+m£n+ ’W ravine mj moloof p lom‘FSL uhiun \ had +a¥€n 00+W a Lew miny-ws +0 «J‘WP Mm _S an. fiuddmhal and wH’I/zofi' grovoah‘“, D6459} "0061406! MW Mom's dOol 64nd btjan jclliuy A‘\’ WW- ama SWOUAWUI} WoHnH-Ce} 0 4w. genial Mark 5M6 Mad airmail]; +olJme h Vic “OWL Mk! Ruanq ?\mnfiu 0V1 Her 53M. Mq §0n¢ ES“ WIera;JwAJ \A'SH-im me md I MS Mfi‘pmc‘ W \oaausae \haa‘ been mfflnhnimy. NC war?! b02591 watt a4 we. u , . MA mm 9w +1» asp MW m+m gnaw was- 5w was godma, M vs CH-100, Item 7a(3) - DESCRIBE HARASSMENT Page___ MC-020 SHORT TITLE: CASE NUMBER Manama and Mann? acumen 1O 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Last Name ' “Last Name ’FWM WMMA M screen AODV and ‘\'O\o‘ him 4m+ \ was 01 "Adam indie" am! “47% thaw? Lovfd Md Woe“ she‘s bud o4 M AM wodd hour mn 45C whilc SN «24> Md‘ivk MK 414M” SLC L4!” rfw‘l'fihgj k Olflvem W )SC/Véem 0’00/ and Mg Sm Vlad 4o 'push m 0'0“ 9340b 4» 9%va Mar rFrovv‘ Cowman: ofo- : wa) via} «WM! and my 5M hld we *0 Q0? ‘b/Lsfou AS 1: MM} woflbmn‘ Masha,M said 'fm aoim. h hob «13W aSSI and 4m, W4 vw maula anew Mn sw 5.0 + «Mummy. Mu SM {)uSWd VIM doofU+° WW W rFWm (/hmllvué M Mal W mm inSIaCZ . U/‘rull U’C WM infifi; m! Could Mea/ W 540/ vgdlc'wgv 1‘ mm conCe/wd (Gal mg Judy wavy i hue a(om mad 9N; 5AM: 14H mom Vino mas_ . Q&mfi £v0m M (0W 0400!: 61w e404 mar) ma Dads; INC) batman? m»! bullcfiné- Hand! (HEW?! T:- lzmue +0 WMU" hm} «?mWn‘f' when \ Coma \nowe 4.»va walk, and I hawk {o Q4” bu \Mr \owldiuq“ rm am.» Mafia 51¢ (pomp 2,an g4 I hem no (plea. wow} SN waf yehmar a4 me. (Required for verified pleading) The items on this page stated on information and belief are (specify item numbers, not line numbers): This page may be used with any Judicial Council form or any other paper filed with the court. Page l Form Approved by me ADDITIONAL PAGE CRc 201. 501 Judicial Council of California M04320 NewJanuan/ ‘- 19871 Attach to Judicial Council Form or Other Court Paper tional Forman Dean‘s Essential Forms TM Mairena v. Montes Attachment for MC-ZO My son and l called the police that night at around 8:30 p.m. to report what happened. | spoke to officer Juan Cuellar #4569, and he gave me an incident number #21-013-0878. I will be ordering a police report online, but the officer urged me to obtain a restraining order. Iwas unable to file sooner because I had to complete my quarantine and MLK was this past Monday. Today is the first day I am able to file. I am still very concerned for my safety and | am requesting a restraining order so Daisy does not hurt me. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 216H0098 17 CASE NAMEMairMa and Honk} CASE #z 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? D YES KNO If “YES". describe: f) Were there any injuries during abuse in the past three months? D YES KNO If “YES". describe: g) Did the police come to any of these recent events? D YES KNO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES D NO If “YES", please attach a copy. i) Is the person you want to restrain in jail right now for violence against you? UYES QNO IfWES",where: j) Has the person you want restrained ever been in jail for violence against you or your children? DYES QNO 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 Page_ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: Mama and Monk5 CASE g; m H 00 98 17 Last Name Last Name k) Do you have a criminal protective order (restraining order from criminal court)? D YES flNO If “YES", please attach a copy. l) Describe the worst abuse and when it happened: fie most recent abuse jg the worst abuse OR D The worst abuse was (approximate date) and the person l want a restraining order against (describe what meydu to you): m) Describe any other previous (past) violence or threats of violence that you haven't already written about here (include dates or estimates as to when it happened): CH-100, Item 73(3) - DESCRIBE HARASSMENT Page_
