Response Petition Civil Harassment Workplace ViolenceCal. Super. - 6th Dist.January 25, 202120 Response to Request for Civil ment Restrainin ~ Orders Use this form to respond to the Request (form CH-100) ~ Read How Can I Respond to a Requestfor Civil Harassment Restraining Orders? (form CH-120-INFO) to protect your rights. ~ Fill out this form and take it to the court clerk. ~ Have someone age 18 or older-not you-serve the person in Q1 or his or her lawyer by mail with a copy of this form and any attached pages. (Use form CH-2SO, Proof of Service of Response by Mail.) Q1 Person Seeking Protection Full name of person seeking protection (seeform CH-100, itemo1): t2mm r1 ln1 1 n Cn s 1 1 1 n s Q2 Person From Whom Protection is Sought a. Your Name: Ivlm v 1 n Gnd I m n Your Lawyer (ifyou have one for this case) Name: Nattfnl 1 m Fmrrn StateBar Non QFA30IR FirmName; mtfm nnfu Fff f 1 r m nf Nattfn1 I m Form b. Your Address (Ifyou have a lawyer, give your lawyer's information. Ifyou do not have a lawyer and want to keep your home address private, you may give a different mailing address instead. You do not have to give telephone, fax, or e-mail.)f Clerlr stamps date here when form is filed. Fill in court name and street address: Superior Court of California, County of Santa Clara 191 N. First St. 191 N. First St. San Jose, CA 95113 Family Justice Center Court fills in case number when form is filed Case Number: 21CH009822 Address: 5 I F Stnmm Ivtn«vftni n thr City; Fink 1 F nr State: CA Z'p:945h1 TelePhone: isnsf zncf A14C Fast E-Marl Address; nntfmrvrrdfnml 1 vrr i vntmvc r11mr i r nm Qs Q3 Personal Conduct Orders a. ~ I agree to the orders requested. b. ~ I do not agree to the orders requested. (Specify why you disagree in item Q11 on page 3.) c. ~ I agree to the following orders (Specify below or in i tern Present your response and any opposirion at the hearing. Write your hearigg date, time, and place from form CH-109 item Us here: cHearing Date: A3/'I hf&A2 I Time: Aq AA Date Dept.: 4 Room: If you were served with a Temporary Restraining Order, you must obey it until the hearing. At the hearing, the court may make orders against you that last for up to five years. Q11 on page 3.) Q4 GQStay Away Orders a. ~ I agree to the orders requested. b. ~ I do not agree to the orders requested. (Specify why you disagree in item Q11 on page 3) c. ~ I agree to the following orders (specify below orin item Q11 on page 3)i Qs Q3Additional Protected Persons a. ~ I agree that the persons listed in itemQsof form CH-100 may be protected by the order requested. b. Qg I do not agree that the persons listed in item Qsof form CH-100 maybe protected by the order requested. Judicial Coundl of California. www.courlc.ca.dov neviaed Janumy 1, 2016 Mandaloir Form Code of Civil Procedure, Is 527 6 and 527 0 ( $Q i Essential~m I raIFermtr Response to Request for Civil Harassment Restraining Orders (Civil Harassment Prevention) Ivlarxa Gods.na CH-120, Page 1 of 4'+ Electronically Filed by Superior Court of CA, County of Santa Clara, on 3/12/2021 4:48 PM Reviewed By: K. Nguyen Case #21CH009822 Envelope: 6027549 ! Case Number: 21CH009822 Qs Guns or Other Firearms and Ammunition If you were served with form CH-110, Temporaty Restraining Order, you cannot own or possess any guns, other firearms, or ammunition. (See item U~r of form CH-110.) You must sell to or store with a licensed gun dealer, or turn in to a law enforcement agency, any guns or other firearms in your immediate possession or control within 24 hours of being served with form CH-110. You must Ne a receipt with the court. You may use form CH-000, ProofofFirearms Turned In, Sold or Stored, for the receipt. a. Qg I do not own or control any guns or firearms. b. ~ I ask for an exemption from the firearms prohibition under Code of Civil Procedure section 527.9(i) because carrying a firearm is a condition of my employment, and my employer is unable to reassign me to another position where a firearm is unnecessary. (Explain):~ Check here if there is not enough space belowfor your answer. Put your complete answer on an attached sheetofpaper and write "Attachment 6b-Firearms Surrender Exemption" as a title. You may use form JtfC-025, Attachment. c. ~ I have turned in my guns and firearms to the police or sold them to or stored them with a licensed gun dealer. A copy of the receipt ~ is attached. ~ has already been filed with the court. Qy &Possession and Protection of Animals a. ~ I agree to the orders requested. b. ~i do not agree to the orders requested. (Specify why you disagree in item Q11 on page 3.) c. ~I agree to the following orders (specify below or in item Q11 on page 3.) Q8 ~Other Orders a. ~ I agree to the orders requested. b. ~ I do not agree to the orders requested. (Specify why you disagree in item Q11 on page 3.) c. ~l agree to the following orders (specify below or in item Q11 on page 3.) Qs QQ Denial I did not do anything described in item OT of form CH-100. (Skip to Q11 .) Ranace January \, 201 8 CEE Essential ~afaram P}FOrmS- Response to Request for Civil Harassment CH-120, Page 2 of 4 Restraining Orders (Civil Harassment Prevention) Maria Gadina ! Case Number: 21CH009tl22 10 M Justification or Excuse0 If I did some or ail of the things that the person in Q1 has accused me of, my actions were justified or excused for the following reasons (explain)J ~ Check here if there is not enough space below for your answer. Put your complete answer on an attached sheet ofpaper and write "Attachment 10-Justification or Excuse" as a title. You may useform MC025 Attachment. 11 Q3Reasons I Do Not Agree to the Orders Requested0 Explain your answers to each order requested that you do not agree with. Q3 Check here if there is not enough space belowfor your answer. Put your complete answer on an attached sheet ofpaper and write "Attachment 11-Reasons I Disagree" as a title. You may use form MC-025, Attachment. Rrrnc.hprt rtpa1nv.nrnnyr Remand January 1, 2018 CfE s~ntiaf ~freer,raIforms Response to Request for Civil Harassment CH-120, Page 3 of 4 Restraining Orders (Civil Harassment Prevention) Marxa Godxtta Case Number: 21CH009822 13 Q3 iylo Fee for Filing0 a. Qg I request that I not be required to pay the filing fee because the person in Q1claims in form CH-100 item Qis to be entitled to free filing. b. ~ I request that I not be required to pay the filing fee because I am eligible for a fee waiver. iForm FW-OOL Request to Waive Court Fees, must be filed separately.) 13 Q3 Lawyer's Fees and Costs0 a. ~ Iaskthe court to orderpayment of my //Lawyer's fees ~Court costs. The amounts requested areTED Item Amount Item Amount ~ Check hereif there are more items. Put theitems and amounts on the attached sheet ofpaper and write "Attachment I3-Lawyer's Fees and Costs" for a title. You may use form IIIIC-O25, Attachment. b. ~ I ask the court to deny the request of the person asking for protection that I pay his or her lawyer's fees and costs. 14 Number of pages attached to this form, if any:0 Date: 1/11 /2021 Na r b a 1 i ra F I r rcr Lawyer's name (ifany) f Alnffd n/y/2 Fpvvn Lawyer's signature electronic signature to be deemed original 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: d /'I 1 /2 02'I Mnrn n C-'nrtn 2m Type orprint your name HGrt'Ct 9. Cue el;nC, R. Sign your name Revised January I, 20 I 8 ( fg Essential~z~ P3Foyms. Response to Request for Civil Harassment cH-tao„Raus 4oi4 Restraining Orders (Civil Harassment Prevention)
