Request Restraining OrderCal. Super. - 6th Dist.January 25, 2021CH 1 00 Request fOl' CiVil Harassment Clerk stamps dale here when form is filed. _ ' Restraining Orders Read Can a Civil Harassment Restraining Order Help Me? (form CH-100- INFO) before completingthis form.Also filloutConfidentialCLETS I L E DInformation (form CLETS-OOI) w1th as much mformatxon as you know. P s k_ P t f JAN252021 erson ee Ing ro ec Ion K a. Your F l Na . lefk the Court NGUYEN W‘YloS Q24 1C5 3% superior A Cou y ot Santa Clara Age: B V ¢ anm'v Your Lawyer!(Ifyou have onefor this case) Fill in court name and street addreSS' Name: - State Bar No.1- gupeiiorcclourt of California, County of ' . an a al'aFm“ Name' ' d 191 N. First Street b. Your Address (Ifyou have a lawyer, give your lawyer's 191 N. First Street information. Ifyou d0 not have a lawyer and want t0 keep your giavqlJcoosgrtfiéugsse" 3DTS home address private, you may give a different mailing address instead. You d0 not have t0 give telep pig‘w fax, oree-mail.) Court fills in case number when form is filed. Addres g 5/; pa()4)! [AMU #1}! Case Numbg: 1 HCityIStmezkfipzflL c 009823 Telephone: \qo w (fl ”97/1 Fax E-Mail Address: ® Person FrgmAWom Prote ion ls Sought Full Name: V0“ ma? Age:_gL Address (ifkngwn); 7933 Um Dnacu‘oa City: $Qf\ VOW State: CA Zip: <3) Additional Protected Persons a. Are you asking for protection for any other family or household members? Lfies mNo Ifyes, list them: owH Full Name _ \ a §_e§_ Ag! Lives with you? are tftey related to you? ' ‘w _ ‘_ DYesDNo_ ‘A 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-Additi0nal 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 0n 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. C‘g'fig'ficgfipglymeifimmfigfimfiggw Request for Civil Harassment Restraining Orders CH-1oo, Page 1 ofe "" '°° u” §§ a (Civil Harassment Prevention) ROHCI [l PVERN9(IBDFM‘T' Case Number: ® Relationship of Parties How do you know the person in ®? (Explain below): D Check here ifrhere is not enough spacefor your answer. Put your complete answer on the attached sheet 0f paper orform MC-025 and write “Arlaclment 4-Relalionship ofParfies ”for a title. g(dkfl exvc‘jd-Cn'o G) Venue Why are you filing in this county? (Check all that apply): a. QThe person in ® lives in this county. b. g was harassed by the person in® in this county.c. Other (specifi): G) 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 WNO (Ifyes, check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in (CounIv/State) 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 DependentAdultAbuse (6) D Eviction (7) a Guardianship (8) D Workplace Violence (9) D Small Claims (10)D Criminal (lDD Other (specz'fiz): b. Are there now any protective or restraining orders in effect relating to you or any ofthe persons in @and the person in®? mo 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 dale 0r estimaled date): r/I//(! ' /, /7 '4 /8 2 Wh l h ?( ) o e 5e waSt ere [See attached declaration for a Description of Harrassment] M4 bmw- QMfiCO chkly [o‘\0\ This is not a Court Order. Request for Civil Harassment Restraining Orders CH-1oo, page 2 ofs GB. rm (Civil Harassment Prevention) 9 Revised Jammy 1. 2018 ® 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 ' ,arassme ‘ n4 / Case NuzTr’c H 00 98 2 3 t”f0r a title.ttachment 7a(3 -Descr1be m €$ é: r ”’10 hr). r‘ sheet ofpaper 0r orm MC-025 and write Vf‘A l, m flasfi n L/ cu 745 ' ' 3 13w 1/1 bmflw‘ é/un/CD V /)eS/m// dmdc/ fi/W/‘C 1 60/. {9% flmm’ // (?kHflM 42/18 Umflmfl 0h , 445/ W/flc/m) 0/75 my r/ Lm/K SAW”; L (‘or‘lfiha é M n/r) Df‘ fl - (4) Did the person in® use or threaten to use a gun or any othe/weapon? D Yes D N0 (Ifyes, explain below). D Check here ifthere is n0! enough spacefor your answer. Putyour complete answer 0n the attached sheet ofpaper orform MC-025 and write “Attachment 7a(4)-Use of Weapons ”for a title. (5) Were you harmed or inj ured because of the harassment?z Yes D No (Ifyes. explain below)D Check here ifzhere is not enough spacefor vour answer. Pu! your complete answer 0n the attached ' sheet ofpaper 0rform M -_025 and write “Artachment 7a(5) Harm or Injury'‘or a title. _ ’ ‘11 A 4"MIUWM’um , ls Mfihu b) h/J H r _L. A". o Im o cut! V'WA/ WM U/w (6) Did the police come?pes D o fi’mw Jed Ifyes, did they glve y u or the person in ®an Emergency Protective Order?DYewo . If yes the order protects (check all that apply) D Me 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” es D No (Ifyes, describe prior incidents andprovide dates ofharassment below) Check her e Ifthere ls not enough space for your answer. Pu! your complete answer on the attached sheet of paper orform MC-0 5 and write ”Attachment 7b-Previ0us Harassmen!’ for a title M14» r ; /7 - Mk m ALH day ///’Z [mmm/ra /a/W8>‘Zé%);g I flgiLKM wl/ km MS 012%! bf? HQ gum glam ' ' CH-1oo,Pagesofs 9 Request for Civil Harassment Restraining Orders (Civil Harassment Prevention) Revised January 1. 2018 gg‘xam Case Number: Check the orders you want. M E Personal Conduct Orders ® I ask the court to order the person in ®not to d0 any of the following things to me or to any person to be protected listed in® : 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. Montact 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, 0r by other electronic means. D Other (specify): 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-Other Personal Conduct Orders, ”for a titl‘ ' ‘- ’ / The person in ®will be ordered not r0 take any action to get the addresses or locations ofany protectedperson unless the courtfinds good cause not t0 make the order. Stay-Away Orders . I ask the court to order the person in ® to stay at leastM yards away from (check all that apply): (1) D’Me. (8) my vehicle. (2) The otherpersons listed in@. (9) D Other (speafi): (3) yhome. 7‘ (S 5mg! 6+w1 awn ijg 044sz ltééMLNJ MILL ARM J ' (4) D/My job or workplace. (5) D My school. (6) E/My children’s school. (7) My children’s place of child care. b. lf 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? es DNO (Ifno, explain 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 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 Udon’t know Ifthejudge grants a protective order, the person in ® will be prohibitedfrom owning, possessing, purchasing, receiving, 0r attempting to purchase or receive a gun, otherfirearm, and ammunition while the protective order is in eflect. The person in ®will also be ordered Io turn in Io law enforcemem. 0r sell t0 or store with a licensed gun dealer. any guns orfirearms within his 0r her immediate possession or control. This is not a Court Order. “““df‘m‘” 12°” Request for Civil Harassment Restraining Orders CH-1oo, Page4 ate CCB Sm (Civil Harassment Prevention) 9chm Case Number: 21CHDO98 23 ® ETemporary 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- 1 10, Temporary Restraining Order for the court’ s signature together with this Request. Has the erson in ® been told that you were going to go to court to seek a TRO against him/her? Yes D No (Ifyou answered n0, 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 1 I-Temporary Restraining Order "for a title. ® D Request to Give Less Than Five Days' Notice of Hearing You must have vourpapers personally served 0n the person in® at leastfive days before the hearing, unless the court orders a shorter timefor service. (Form CH-200-INFO explains What ls “Proof of Personal Service”? Form CH-200, Proof 0f Personal Service, may be used t0 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 ifthere 1's not enough spacefor your answer. Pu! your complete answer 0n the attached sheet of paper orform MC-025 and write 'Attachment 12-Reque to Give Less Than Five Da/SW'Notice 'for a title.g/mz/ 7mm S’ aPagania C/flqélu mM/ flaw em 2ndMSmm m 75W flmquma’j om 225/” mam fifi' 7/mam %L74/¢% ’owfl. gem 46am 07K r‘ OA/A® m No Fee for Filing or Service Me are (/er‘ Sm/fiirm r mm a. here should be n0 filing fee because the person in®has used or threatened to use iolence against me, //L(S, has stalked me, or has acted or spoken 1n 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 f0 rders is based on unlawful violence, a credible threat of violence, or stalking. c 8%; 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.) m Lawyer's Fees and Costs I ask the court to order payment of my D lawyer's fees a Coun costs. The amounts requested are: 1te_m Amount m Amount Einngfiee s 435 s $ $ $ $ D Check here ifthere are more items. Put the items and amounts on the attached sheet ofpaper orform MC-025 and write “Attachment 14~Lawyer '5 Fees and Costs"f0r a title. This is not a Court Order. , Request for Ciyi_| Harassment Restraining Orders CH-1oo, Page 5 ofe (IB ; Dimm"m (CIVII Harassment Prevention) 9 Revised January 1, 2018 Case Number: D Possession and Protection of Animals I 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. (Identifi/ animals by, e.g., ape, 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-P0ssessi0n 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 coun to make the following additional orders (specifiz): a Check here ifrhere 1's not enough spaceforyour answer. Put your complete answer 0n 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: Semaeptesemed- - d S - 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: flfix/os @yas , {34r/os dyes Type 0r print your name Sign your name' This is not a Court Order. Revised January 1. 2018 CEB, Request for Civil Harassment Restraining Orders CH-1 00, Page 6 of 6m (Civil Harassment Prevention) 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ' - 21 C H 00 98 2 CASE NAME: J and W CASE #z 3 as ame as ame CH-100, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? p) (okf‘; Ax ‘(><(K( 1r b) Are you living with the person? D YES MO c) Has the personflphysically abuse you, Vysically or verbally threatened you and/orWarassed 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 nd times): \ln u 7 \«mfirL DE \noA 61 mm C1 M EAR‘MLS‘ OL/QAQA [WELLA OVA; l \mmmA Mg HA 4m lace ($903 ”WAC 003 T [EMS M Wm 00X %57>M(5\ 11 Brno €1an dx q§733 LAW W \OZWA (MA vvmlj Nme) (incl \A/u/j b oboP/ (AMA Mum gt M0, {MD Romy; Cmi a” vxfk CH-1 00, 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 #: 21 C H 00 98 2_3 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 U NO If “YES". describe: f) Were there any injuries during abuse in the past three months?WES U NO If“YES' describe: NOR OUWOJISUH’W hm OLAQJALé m {261M (mmeQ [/an hH bu (3ij g) Did the police come to any of these recent events? ES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES W0 If “YES", please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? DYEs fie If“YES",where: j) Has the person you want restrained ever been in jail for violence against you or your children? DYES WC |f“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: and CASE # 21 c H 00 98 2 3 Last Name Last Name k) Do you have a criminal protective order (restraining order from criminal court)? D YES MO If “YES", please attach a copy. l) Describe the worst abuse and when it happened: E The most recent abuse i_s the worst abuse OR Whe worst abuse was (approximate date) [Hi g 112' and the person l want a restraining order against (describe what they did to you): M \M Wemd er k“ or W6 M8 \AWA 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_