Request Restraining OrderCal. Super. - 6th Dist.January 21, 2021CH 100 Request for CiVII Harassment Clerk stamps date here when Iormis filed. ‘ Restraining Orders Read ('un u ( 'ivi/ llumssmem Reslraining Order Help Me? (form ('H-100- I L EINFO) before completing this form. Also fill out Confidential CLETS Information (form ('LETS-UOI) with as much information as you know. MAR 1 9 2021 ® Person Seeking Protection Clerk of the Court . Supodov Com d CA Coun nu Gare a. Your Full Name. BY DEPUTYMano C Dweg valenrm Age; 4D - Your Lawyer (ifyou have onefor [his case) Fill in court name and street address: Name:meneam- State Bar No.2- Superior Court of California, County of F' N -_Self:Bep:esnnted santa Clara”m ame' 191 N. Fgrst Street b. Your Address (Ifyou have a lawyer, giveyour lmvyer 's 191 N. Flrst Street in ormation. Ifyou d0 n0! have a lawyer and want Io keep your giaVQIJcoosghfiéugssg I 301-5 home address private, you may give a diflerem mailing address instead. You do not have Io give telephone, fax. 0r e-mail.) Court fills in case number when form is filed. Address: $2 '3QM“4M 'AuAg ‘ Case Number:Cityzmg- StatekL Zipzc‘un’t n 2, I CH wxm Telephonez'BLLuS-LD WQ\ Fax: E-Mail Address: ® Person From Whom Protection Is Sought Fun Name; mmm WM \l omQSSYA C06” IO Age; 42 Address (ifknown): Wzl b Ch (1'Myer 3+ Cit)“ gem 30m StateLH Zip: a 5‘ Al G) Additional Protected Persons a. Are you asking for protection for any other family or household members? DYes o Ifyes, 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. Anach a sheet ofpuper and write “Attachment 3a-Additional Prolected Persons "for a title. You may useform MC-025. Attachment b. Why do these people need protection? (Explain below): Check here iflhere is not enough spacefor your answer. Put your complete answer on the attached sheet of ‘ pgger orform MC-025 and wrige "Arlachmenl 317*Why Others Need Protection "for a rifle. M-ss goPm ham Me m mhkg Lag mm cw 3+6 a + cam This is not a Court Order. fiémfiiflfifijw Request for Civil Harassment Restraining Orders CH-1oo, Page 1 om"" ' ' ‘ ’ (Civil Harassment Prevention) ROHCI PVERN9013‘m [1 Case Number: mo H ooaeab ® Relationship of Parties How do you know the person in®7 (Explain below): m 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 4-RelationshCipWWofParties ’for a title.mamené a+ vim Scnro. © Venue Why are you filing in this county? (Check all that apply): a The person in® lives in this county. b.cm l was harassed by the person in® in this county..D Other (specifi):@c Other Court Cases a. Have you or any of the persons named in® been involved m another court case with the person in @2’ D Yes $ No (lfyes. check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in {County/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 DD Other (specifil): b. Are there now any protective or restraining orders in effect relating to you or any of the persons in @and the person in®? $140 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) When did it happen? (provide date or estimated date). ‘ S 60 Q . D {D leh’“ 2 Wh 1 th ? .( ) 0 e 5e was ere [See attached declaration for a Description of Harrassment] afiow 0mm Mmm/ mm mepA-x a4 M19»? 0+ ’k mndom ’LNM H (?\Cugiw» ,ct This is not a Court Order. Request for Civil Harassment Restraining Orders CH-1oo Pagez ore ‘Esunfld . . _ .figmm (CIVII Harassment Prevention) 9 Revised January 1. 2018 Case Number: A&Imme'u) ® a. (3) How didthe personin®harass you? (Explain below):D Check here ifthere is not enough spacefor vour answer. Pu! vour complete answer 0n the attached sheelofpuper orform MC-025 andurire‘ 4ttachmen! 7a(3)--Describe Harassmem''foramle. Monika ware (ASLMI) {0/ M CWN Vet” YN wedMm MSW? Tom N9 TD DAM (-xqgcg f I dr‘n’c 9N Lou} MN“ m Swim wcz N. MW mmm when N mm ‘XDW WY +0 GAB. buC/L m OWN KQUK go “’fl ('adcl Nib! QM 6N? GW‘L (\emx m Dom» MM” lqu or (4m W4” (mm W 3n W 0+ flown,» mp mama Mme (4) Did the person in® use or threaten to use a gun or any other weapon? D YesQ No (IfyeS, explain below): D Check ere ifthere is not enough spacefor your answer. Put your complete answer on (he attached sheet ofpaper orform MC-025 and write “Attachment 7a(4)-Use 0f Weapons ”for a title. (5) Were you harmed or inj ured because of the harassment? w Yes D No (Ifyes, explain below):D Check here iflhere is n0! enough spacefor your answer Put your complele answer 0n the attached sheet ()fpaflier 0rform MC-025 and write “Attachment 7a(5)-Harm or Injmy' 'for a title. ‘TN ”Low §\/~€ mt/N ma; Marta W “11/2 RM“? Com S40 ADM (\mut W 11nd mthwcai IV‘C‘CEM (6) Did the police come? @Yes D No If yes did they give you or the person in ®an Emergency Protective Order?Wes D No 1f yes the order protects (check all that apply) e D The person in ® D The persons in @. (Attach a copy oflhe order ifyou hare one.) b. Has the person in ® harassed you at other times? m Yes D No (lfyes, describe prior incidents and provide dates ofharassment below: D Check here [flhere is not enough space/br your answer. l’ul your complete answer on the aflached sheer of paper orform MC-025 and write“ Attachment 7b-l’rev'Ions Harassment "for a title. wow QM mw_ mm WW {N Wm) 4m» H SN Emu m m " W SW max ’1)be 1° km VM. 0km ha mN Q f “A 1M) w This is not a Court Order. Request for Civil Harassment Restraining Orders CH-1oo, Page 3 oreOBm (Civil Harassment Prevention) u... EM 9 Rmudme 1‘ 2018 Case Number: ® 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. E 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. D Other (specifil): D Check here ifthere 1's not enough spacefor your answer. Put your 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 to get the addresses or locations ofany protectedperson unless (he courtfinds good cause not to make the order. Stay-Away Orders a. I ask the court to order the person in ® to stay at leastk yards away from (check all that apply): (1) Q Me. (8) a My vehicle. (2) D The other persons listed in®. (9) D Other (specifv): (3) a 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. lfthe 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 “No (Ifno, explain below): D Check here iflhere is not enough spacefor your answer. Put your complete answer 0n the attached sheet 0f aper orform MC-025 and write “Attachm/chgw9b-Stay-Away Orders, ’for a title.N57 +0 WB/«N ‘Ei Nuor ‘Spw a0:Wm ‘lém? . Guns or Other Firearms and Ammunition Does the person in ®own or possess any guns or other firearms? D Yes DNo I don‘t know [fthejudge grants a protective order, the person in ® will be prohibitedfrom owning, possessing, purchasing, receiving, 0r attempting t0 purchase 0r receive a gun, otherfirearm, and ammunirion while the protective order is in eflect. The person in ®will also be ordered Io turn in to law enforcement. or sell (o or store with a licensed gun dealer, any guns orfirearms within lu'x or her inmzcdiate possession or control. This is not a Court Order. Revised January 1. 2018 Request for Civil Harassment Restraining Orders CH-1oo, Page 4 ofe'W(IB[Em (Civil Harassment Prevention) 9 C se Number: Mqus’u) @ 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, 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? _ _ Yes DNO (Ifyou answered no, explain why below): D eck here {fthere is not enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write “Attachment II-Temporary Restraining Order "for a tille. (1+ Lam unhu W \B Sr/uLoA ® D Request to Give Less Than Five Days' Notice of Hearing You must have yourpapers personally served 0n the person in® at leastfive days before the hearing, unless the court orders a shorter timefor service. (Form CH-200-1NFO 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.) lf you want there to be fewer than five days between service and the hearing. explain why below: D Check here ifthere is not enough spacefor your answer. Put your complete answer 0n the attached sheet 0f paper orform MC-025 and write "Attachment 12-Reques! t0 Give Less Than Five Days' Notice "for a title. ® m No Fee for Filing or Service a. g 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. 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 l 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 of my D lawyer's fees E Court costs. The amounts requested are:m Amount m Amount Eumfiee s 435 s $ $ L $ D Check here iflhere are more items. Put Ihc items and amounts 0n the attached sheet ofpaper orform MC-025 and write “Attachment 147Lcm1vcr 's Fem um! ('osrs"for a IiIIe. This is not a Court Order. “m“‘m’ ”m” Request for Civil Harassment Restraining Orders CH-1oo, Page 5 ote (IBI5EJNW (Civil Harassment Prevention) 9 (SWiwgm D Possession and Protection of Animals I ask the court to order the following: a. D That l 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. (Identifiz 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 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. MAdditional Orders Requested I ask the court to make the following additional orders (specifi): D Check here iflhere 1's n0! enough spacefor your answer. Put your complete answer 0n Ihe attached sheet of fier‘h orform MC 025 and write ‘rlachmen! 1 6-Aa’diti0nal Orders Requested, "for a title. 9% amy M aM no Cmiucr (phm SD (emf. ® Number of pages attached to this form, if any: Date: SfilERepLesenled- . d ’ self-Beptesemed ___Lawyer 's name (ifany) Lawyer 's signature I declare under penalty of perj ury under the laws of the State of California that the information above and on all attachments is true and correct. Date: 3‘ ‘Q S QL‘Q_.L L ‘\ AV v Type 0r print your name Sign your name This is not a Court Order. Request for Civil Harassment Restraining Orders CH-1oo. Pageeofe(IBI'M (Civil Harassment Prevention) Revised January 1, 2018 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 WING gamma cafimo CASE NAME: 3"“ CASE m2 |6H 00099-0 . Last Name Last Name CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? UDOACCd ‘EYW Sim QM as a 3mm b) Are you living with the person? D YES 9N0 c) Has the person D physically abuse you, Cl physically or verbally threatened you and/org 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): m 'JnsgaoQ/l 1CD Caaqswp m ?”W é: Inf Sew 30+ “Hm she. m rm'rhy .5 (tamm5 r10mm “W am me. (hfwénflffi 9* ”N $E- “5 fin Sam m, gm m4 m ?mm- Hay Wm 3m (wide lx‘iwd f0 WK :H er (M QXQ. [mow gum? ”L; hum T4- 1c\lr\n+ u(AmQ. Mama. ; 1- wui 'tw: ‘11) escfflpun W+ :1 Wu? \‘AD lmM (hm TI) LHNL 1;)va W‘ O’NL W («20$ fiuné 'thAm 016V («s q §memgofcga ’XW SM mam mu (ml m- we imfiw flue Ins; Pm h'm5e1(~ m m MMMQ “f0 4N 'b 57w kw l QDU Mr 1 Luna fin)“; ‘1» (“on 4N (mo S CM! 8M SW“ " 1 de Cum" mu lalqpi- rfmms 47W rm ma. Vim mu: hnf‘ W4?- Jata)‘ mm ”>44 Sid 5&- n~l Phae. 3m “rhooc. (A fig“) @chva =~A 17M h WCQV‘\ 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: and CASE #2 Z l CH'D 048 QO 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 mNO If “YES". describe: f) Were there any injuries during abuse in the past three months? D YES D N0 If “YES", describe: g) Did the police come to any of these recent events? U YES \fl NO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES S?NO If “YES", please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? DYES WC lf"YES",where: j) Has the person you want restrained ever been in jail for violence against you or your children? DYES \P NO If“YES",when: Describe what the person did to you or your children that caused them to go to jail: CH-100, Item 73(3) - DESCRIBE HARASSMENT Page_ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: and CASE #: 2‘66“”qu 30 Last Name Last Name k) Do you have a criminal protective order (restraining order from criminal court)? D YES Q 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 (approximate date) and the person | want a restraining order against (describe what mey dad 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 7a(3) - DESCRIBE HARASSMENT Page
