Request Restraining OrderCal. Super. - 6th Dist.January 25, 2021Request fOI' CIVII Harassment Clerk stamps date here when form is filed. CH'1 00 Restraining Orders Read Can a Civil Harassment Restraining Order Help Me? (form CH-I 00- I LINFO) before completing this form. Also fill out Confidential CLETS E DNInformation (form CLETS-OOI) with as much information as you know. JAN 2 5 2021 K. GUYEN® Person Seeking Protection Cler o h Court a. Your Full Name: 3099"“ Comii jg kinky ot Santa Clara . . BY ALnrm/lp (mJ Fag: Has Age: 65 DEPUTY Your Lawyer (ifyou have onefor this case) Fill in court name and street address.- Name:WM..- State Bar No.2- gupeiiorcfiourt of California, County of . I an a ara Fnrm Name.Mammal“ 191 N_ First Street b. Your Address (Ifyou have a lawyer, give your lawyer ’s 191 N. First Street information 1f ou d0 not have a law er and want Io kee our san Jose’ CA 951 1 3 ' y y py Civil Courthouse- DTS home address private, you may give a different mailing address instead. You do not have to give telephone, fax, 0r e-mail.) Court fills in case number when form is filed. Address: qzso Wm Q06 ”‘05” \LOLl Case Nurffzc H 00 98 2 2 City:QmfluJ-_ Stated}.Zimm- Telephone: Fax: E-Mail Address: ® Person From Whom Protection ls Sought Full Name: WJL'FL Q . CClnAxm, Age:il- Address (ifknown); CO 50 (pm (>N¢ Q9» \mm Cityzp/I “(Dds State: CQ-Zipzflmo ® Additional Protected Persons a. Are you asking for protection for any other family or household members? EYes D No Ifyes, list them. Full Name E Ag; Lives with you? How are they related to you? ‘ .M-i a Yes D No “mam 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 0f paper orform MC-025 and write 'Attachment 3b-Wh) Others Need Protection’'for a title. _I\o \ tn J (Cx- I...‘ ‘0 z § Wm .. \ ' ' \ 0.. o- MW O‘W‘ L" “ Qx"\\ " ~ a. (C’sl nu" “I v. kmam gear g(x \mxx CA Sr'q‘ mu) ( \m\(\¥€(\ ()md M%\Q. This is not a Court Order. c‘g‘fifiéfififlifiifigfifiszzw Request for Civil Harassment Restraining Orders CH-1oo, Page 1 ore (Civil Harassment Prevention) ROHCI n PVERN9 Case Number: ® Relationship of Parties How do you know the person in®? (Explain below): D Check here ifthere is n0! enough spacefor your answer. Pu! your complete answer on the attached shee! of paper orform MC-025 and write ”Atrachmen! 4-Re1ali0nship ofParties "for a title. QP‘ 10313n( C's) Venue Why are you filing in this county? (Check all that apply): a. 8 The person in® lives in this county. b. I was harassed by the person in® in this county. c. D Other (specifiys © 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 E N0 (Ifyes, check each kind ofcase and indicale where and when each wasfiled) Kind of Case Filed in (Countv/State) Year Filed Case Number {ifknownj (l) D Civil Harassment (2) D Domestic Violence (3) D Divorce, Nullity, Legal Separation (4) D Patemity, 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 (l l)D Other (specifi): b. Are there now any protective or restraining orders in effect relating to you or any ofthe persons in @and the person in@? a 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. (1) When did it happen? (provide date or esrimated date): (2) Who else was there? [See attached declaration for a Description of Harrassment] This is not a Court Order. Rmm'm" "2°” Request for Civil Harassment Restraining Orders CH-1oo, Pagezofe CH3. 53mm (Civil Harassment Prevention) 9 ® 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 0n 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 Yes a No (Ifyes, explain below): D Check here ifthere is not enough spaceforyour 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 or inj ured 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 sheet ofpaper orform MC-025 and write "Attachment 7a(5)-Harm or Injury ”for a title. (6) Did the police come? D Yes 8 No 1f 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): D Me D The person in ® D The persons in ©. (Attach a copy offhe order Ifyou have one.) b. Has the person in ® harassed you at other times? a Yes D No (Ifyes, describe prior incidents (mdprovide dares ofharassment below): D Check here ifthere is n0! enough spacefor your answer. Put your complete answer 0n the attached sheer 0f paper orform MC-025 and write “Attachment 7b-Previ0us Harassment ”for a title. . -\ ...«- A I. AVA) g‘q ‘. Md ‘J.’_! bflnd o. ~I‘ u A .. -u l' -1W. usemrfl ' LL. \s cf. I I. .’. 91A II bum 6‘2L)\q . This is not a Court Order. R’“”“‘"“’””m Request for Civil Harassment Restraining Orders CH-1oo, Page sore (IB' Ejmm“ (Civil Harassment Prevention) 9 Case Number: Check the orders you want. m Personal Conduct Orders I 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. a Contact the person, either directly 0r 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 (specifiz): 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 8c-01her Personal Conduct Orders, "for a title. The person in ®will be ordered no! t0 take any action to get the addresses 0r locations ofany protectedperson unless the courtfinds good cause n0! to make the order. ® .Stay-Away Orders a. I ask the coun to order the person in ® to stay at leastM yards away from (check all that apply): (1) a Me. (8) m My vehicle. (2) a The other persons listed in@. (9) m Other (specifil): (3) m My home. WAS (4) m Myjoborworkplace. C z“ ! g” Q: EV: = Q 1 2 j g .Y‘Q‘e/ (5) D My school. (6) m Mychndren,sschool_ (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, or job? a Yes DNO (Ifno, explain 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 “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 fireamIS? DYes DNo MI don’t know IfIhejudge 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 protective order is in effect. The person in ®will also be ordered t0 rum in t0 law enforcement, or sell t0 0r store with a licensed gun dealer. any guns orfirearms within his 0r her immediate possession 0r comrol. This is not a Court Order. , Request for Civil Harassment Restraining Orders CH-1oo, Page4 ofs CIB3m (Civil Harassment Prevention)m EE_NLW 9Revised January 1. 2018 CaseNumfir'l cH0098 22 ® E Temporary Restraining Order I request that a Temporary Restraining Order (TRO) be issued against the person in ® to last until the hearing l 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 (lfyou answered no, explain why 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 “Altachment l1-Temporary Restraining Order for a title. .7: d/dnv/ El/Jhem befaqfa ibzu are. ?Alhren’le/u addiex 11/?Mme- ® D Request to Give Less Than Five Days' Notice of Hearing You must have your papers personally served 0n the person in® at leastfive days before the hearing, unless the court orders a shorter Iimefor service. (Form CH-ZOO-INFO explains What Is “Proof 0f Personal Service”? Form CH-200, Proof of Personal Service, may be used to show the court that the papers have been served) [f you 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. 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. a No Fee for Filing or Service a There should be no filing fee because the person in®has used or threatened to use violence against me, has stalked me, 0r 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. m 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 l ask the court to order payment of my D lawyer's fees a Court costs. The amounts requested are: fling Amount Lte__ Amount Eifingiee $ 435 s $ $ $ $ D Check here ifthere are more items. Put the items and amounts 0n (he attached sheet ofpaper orform MC-025 and write "Attachment 147Lcm'yer 's Fees and ( '0sls"f0r a title. This is not a Court Order. . Request for Civil Harassment Restraining Orders CH-1oo, Page sofa (IBm (Civil Harassment Prevention)u... Em . 9Revised Januuy 1, 2018 Case Number: D Possession and Protection of Animals I ask the coun 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. (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. D Additional Orders Requested I ask the court to make the following additional orders (specifii): a Check here ifthere is nor enough spacefor your answer. Put your complete answer 0n the attached sheet of paper orform MC-025 and write "Attachment I6-Additional Orders Requested, "for a title. @ Number of pages attached to this form, if any: Date: Wanted- . ’ Se|f.3ep[gsen1edLawyer ’s name (ifany) Lawyer 's signature 1 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:\ m ) Manila.» Type orprim your name Sig'n your name This is not a Court Order. ““5“,”"m “2°13 Request for Civil Harassment Restraining Orders CH-1oo, Page 6 ore (IBM (Civil Harassment Prevention) 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 216H009822 CASE NAMEQO‘mm; 3"" gg‘gdgm CASE # 5 ame as ame CH-1 00, Item 73(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? (Ne‘wgnmC b) Are you living with the person? D YES K NO c) Has the person D physically abuse you. E physically or verbally threatened you and/or E 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): Cc’c’l Ml‘flcl-(dl CH-100, Item 73(3) - DESCRIBE HARASSMENT Page MC-OZO SHORT‘TITLE: CASE NUMBERZ 1 H- Casiuas and 600th c 00 98 22 Last Name . 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