Request Restraining OrderCal. Super. - 6th Dist.January 27, 2021- Request for Civil Harassment Restrainin Orders Read Can a Civil Harassment Restraining Order Help Me? Ororm CH-IOO- INFO) before completing this form. Also fill out Confidential CLETS Information O’orm CLETS-OOJ) with as much information as you know. Person Seeking Protection a. Your Full Name: ; LM wm mzm’w Q/UWfl Age; IE) Your Lawyer (ifyou have onefor this case) Name: fielflRepLeseflIed- State Bar N0.:w Firm Name:flamed b. Your Address (Ifyou have a lawyer, give your lawyer’s information, Ifyou d0 not have a lawyer and want t0 keep your - home address private, you may give a diflerem mailing address instead. You d0 not have t0 %ive te‘lephone, fax, 0r e-mail.) Address: 5’9“??? El Vrl r City: StatecflZigm Telephone: Fax: E-Mail Address: ® Person From Whom Protection ls Sought Full Name: jcbra d’ Hf/Iflno‘v/q 9C}; Address (:fknown): ZZQ 310590307 Hf 1/. Dr “m t! Clerk stamps fa' mum wlfgn forgp is flied Fill in court name and street address: Superior Court of California, County of Santa Clara 191 N. First Street 191 N. Flrst Street San Jose, CA 95113 Civil Courthouse - DTS Coun‘ fills in case number when form is filed. Case Number: 9‘3 PHflfiQQ? E LA: “J“UU JUL: J Age: 7" City: 6001/1 x3391} State: Ofl' ® Additional Protected Persons Zip: Walzé a. Are you asking for protection for any other family 0r household members? Yes UNO Ifyes, list them: Full Name Sex A e Lives with vou? How are thev related to V011? 1 Z)MVICL Milaeiuaz F aYes flNo 0009"” {,cvm‘w Vciwéqyaz l5 12’; aYeSQNO Cough? ROWIIW. Ha&i‘0\( F 3 EYes DNO Cough”? Persons "fbr a title, You may useform A/[C-025, Attachment. b. Why d0 these people need protection? (Explain below): a Yes a N0 Check here {fthere are more persons. Attach a sheet ofpaper and wrire "Attachmenr 3a-Additional Protected a Check here iffhere 1's not enough spacefor your answer. Put your complete answer 0n the attached Sheer 0f paper orform MC-‘025 and write “A(tachment 3b-Why Others Need Protection “for a title. Jq ,5 cat l. w: M Hag, Sm; baufiz waldo 504% '{9 Knau/n +0 Shaw up a4» ’PwP/aa méwgcg ~ w mam rm komcomwyg}, ThususnotaCourtOrd Ja‘éflcéé'afi‘é‘n’flé‘éy"?$36‘{%T"flfa'n‘鑧¥3+‘f#§fim°a'g°” Request for Civil Harassment Restraining Orders CH-1 00, Page 1 ofe Code or C‘wil Proce'dure. §§ 527.5 and 527.9 - ' Essential SEE {am (Civil Harassment Prevention) ROHCI [1 PVERN9 Case Number: ® ® Relationship of Parties How do you know the person in @7 (Explain below): a Check here ifthere is n0! enough spaceforyour answer. Pu! your complete answer 0n {he attached sheet 0f paper orform M9025 and write "Attachment 4~Rclalfonship ofPam'es "for a rifle. Jafod :9 6L M/Mcsr 4-7; ‘afld 43mm H, 9/4 50/7001; Ffz‘find o l1 V / Venue é “1004,15 . Why are you filing in this county? (Check all (ha! apply): a. a'The person in© lives in this county. b. a I was harass'ed by the person i1}@ in this county. c. a Other (specifi’): PWVS I 050C l Y @5501} l lz'éd Other Court Cases a.- Have you or any ofthe persons named in© been involved in another court case with the person in®? D Yes a N0 (Ifyes, check each kind ofcase and indicate where and when each wasfiled.) Kind 0f Case Filed in (Coszv/State) Year Filed Case Numberflflmown) (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 (1DD Other (specifi): b. Are there now any protective or restraining orders in effect relating t0 you or any ofthe persons in @and the person in®‘? 2N0 DYes (Ifyes, attach a copy ifyou have one.) Description of Harassment Harassment means violence or threats ofviolence against you, or a course of conduct that seriously alarmed, annoyed, or harassed you and caused you substantial emotional distress. A course ofconduct 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 0r estimated date): 0/ / 23 / Z ( 2 Wh l th ‘? . . . ‘( ) O e SC was ere [See attached declaration for a Description of Harrassment] This is not a Court Order. Remmmmtm‘a Request for Civil Harassment Restraining Orders CH-1oo, Page 2 ore mhcnm Essentlal IE] Fon-nS' (Civil Harassment Prevention) 9 Case Number: ® a. (3) How did the person in® harass you? (Explain below):D Check here rfrhere is nor enough spacefor your answer. Pm your complete answer 0n the attached sheet ofpaper orform MC-025 and write "Atlachmem 7a{3)-D_escribe Harassment "for a title.ond ’rh(“omMad cmd_it?n Y;S;‘/.v'6£fl1‘¥* ates C» _ ' :Mw séflifflfignww énna om d 1 . H6 PUSva Own fl mmmad, 07/ a Hfi Bow cMmé/L @0anMm H. ‘+ ah évamas hm4 rm‘a Ha; rmfirc, 2L5, (4) Did the person in® use 0r threaten to use a gun or any other weapon? BYes D N0 ([fyes, explain below): , D Check here ifthere is nor enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform ka-025 and write "Atrachmem 7a(4)-Use 0f Weapons "far a title. . jarofi, u 90d a, H onnrpfiyv [301L444 +0 H. + M‘L Cam: Hfiah d aha! an né 1 5175 was abld +0 Hum: fr ovwm am; {1L belcc/ 0n Hat; mfgu/zd I (5) Were you harmed 0r injured because 0f the harassment? aYes D N0 (Eyes, explain below): D Check here ifthere 1's not enough space foryour answer. Put your complete answer 0n the attached sheet 0 a er 0r arm MC-025 and write "Attachment 7a 5 -Harm 0r In'u " 0r a title. jawof‘ép {3% saw ,1 ma +0 Mr); 07wMW fam v smmla/ r’N 61m Mom? ch Wanna am d. wmm 1 +n'o é m ryfi w m ofiF no mead WV Hwac (6) Did the police come? ZYes DNO Ifyes, did they give you 0r the person in @an Emergency Protective Order?a Yes a No If yes, the order protects (check all that apply): DMe D The person in ® D The persons in ®. (A(tach a copy offhe order {fyou have one.) ' b. Has the person in © harassed you at other times? a Yes 8N0 (Ifyes, describe prior incidenzs andprovide dates ofharassmeni below): D Check here iflhere i5 nor enough space foryour answer, Put your complete answer 0n the attached sheer 0f paper orform MC-025 and write “Altachmenr 7b-Prevz‘ous‘Harassment ”for a rifle. This is not a Court Order. Revised January 1.2018 . Request for Civil Harassment Restraining Orders CH-1oo, page aote CH3 555, 9""3'. (Civil Harassment Prevention) ahmm ' Fm 9 Case Number: Check the orders you want. E E Personal Conduct Orders I ask the court to order the person in ®not t0 do any ofthe following things to me or t0 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 0f, 0r disturb the peace ofthe 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. a Other (specifil): a Check here ifthere is not enough spacefor your answer. Pu! your complete answer 0n the attached sheet ofpaper orform MC-025 and write ”Attachment 8c-Ot/2er Personal Conduct Orders, "for a title. The person in @1917! be ordered not to take any action t0 get the addresses 0r locations ofany protectedperson unless the courrfinds good cause not t0 make the order. ® aStayaAway Orders , ' a. Iask the court to order the person in ® to stay at least 2.9g?- yards away from (check all that apply): (I) a Me. (8) My vehicle. (2) fl The other persons listed in@. (9) Q Other (specz‘fiz): (3) My home. (4) a Myjob 0r workplace. (5) My school. (6) a My children’s school. (7) Q My children’s place of child care. b. Ifthe court orders the person in ®to stay away from all the places listed above, will he or she still be able t0 get to his or her home, school, orjob? a Yes QNO (17m), explain below): a Check here iffhere is nor enough Spacefor your answer. Put your complete answer 0n Ike aftached sheer 0f paper orform AfC-025 and write "Attachment 9Hray-Away Orders, "fiJr a title. Guns or Other Firearms and Ammunition Does the person in ®own or possess any guns 0r other firearms? QYes QNO .I don’t know Hrhejudge grams a protective order, the person in ® will be prolzibiredfiom owning, possessing, purchasing, receiving, 0r atrempting r0 purchase 0r receive a gun, otherfirearm, and ammunition while the protective order i5 in eflecf. The person in @wil! also be ordered t0 turn in t0 law enforcement, 0r sell to 0r store with a licensed gun dealer, any guns orfirearms within his 0r her immediate possession 0r control. Rmmanuamzm C' ' tRestrainin Orders c - CEB. 5559mm Request for [VII Harassmen g H 100, Page4ors “Mm Efims. (CIVII Harassment Prevention) a Case Number: ® E Temporary Restraining Order I request that a Temporary Restraining Order (TRO) be issued against the person in ® t0 last until the hearing. I am presenting form CH-l 1 0, 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? aYes D No (Ifyou answered no, explain why below): D Check here ifthere is not enough space for your answer. Put your complete answer 0n the attached sheet Of paper orform MC-025 and write “Attachment 1 J-Temporaly Restraining Order”f0r a title, ® a 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-INFO explains What Is “Proof 0f Personal Service”? Form CH-ZOO, Proof of Personal Service, may be used to Show the court Ihat the papers have been sewed.) If you want there t0 be fewer than five days between service and the hearing, explain why below: D Check here ifthere 1‘s not enough spacefor your answer, Put yéur completé answer 0n the attached sheet 0f paper orform MC-025 and write "Attachment 12-Reqztest to Give Less Than Five Days’ Notice ”for a title. D No Fee for Filing or Service a. a There should be n0 filing fee because the person in©has used or threatened t0 use violence against me, has stalked me, or has acted 0r spoken in some other way that makes me reasonably fear Violence. b. Q The sheriff 0r marshal should serve (notify) the person in®about the orders for free because my request for orders is based on unlawful violence, a credible thIeat 0f violence, or stalking. c. D There should be n0 filing fee and the sheriff 0r marshal should serve the person in ®for free because I am entitled t0 a fee waiver. (You must complere andfileform FW-OOI, Application for Waiver 0f Court Fees and Costs.) ' E Lawyer's Fees and Costs I ask the court to order payment of my D lawyer‘s fees Court costs. The amounts requested are: Itfl Amount m AmountEumgiee-_ $ 435 . -' $ $ $ $ $ D Check here iffhere are more items. Put the items and amounts 0n the attached sheer ofpaper orform M0025 and write "Atrachmenr 14-Lmvyer 's Fees and Costs "for a title. Thi'é is .nétra Court .O'rglgr? Re“se‘{Jag::e1r-‘:fa‘la Request for Ciyi_l Harassment Restraining Orders CH-1oo, Page 5 016 CEB [ERNIE (CIVII Harassment Preventlon) 9uhmm Case Number: Possession and Protection of Animals I ask the court to order the following: . a. aThat I be given the sole possession, care, and control ofthe animals listed below, which I own, possess, lease, keep, or hold, or which reside in my household. (Identifil animals by, e.g., type, breed, name, color, sex.) Bram cmd wnH/fi Om‘ucu/IMMOL $450016 0 ifl “40%; mm: {3am u 7L” I request sole possession ofthe animals because (specifii good causefor granting order): D Check here iff/zere is n01 enough spacefor your answer. Pu! your compleze answer 0n the attached sheet ofpaper orforl‘n MC-025 and write “Attachment 15a-Possessipn ofAm'mals "for a title. p 5cm a + 1. v55 cmd Haw A5 w; Ha mi b. aThat the person in® must stay at least \5 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 t0 make the following additional orders (specx'fiz): D Check here szhere is not enough Spacefor your answer. Pu! your complete answer 0n the attached sheer 0f paper orform MC-025 and wrile “Attachment I 6~-Aa'dfri0nal Orders Requesied, ”fbr a title.7-- a _ V I w _ V "' ' 'Vkr-l 1" -‘ U Number of pages attached to this form, if any: Date: SelEBapLesanIed- Lawyer ’s name (ifany) Lawyer ‘s signature I declare under penalty of perjury under the laws OfIhe State 0f California that the information above and 0n all attachments is true and correct. Dateo/ M?Ml Lowmmf J euflgomu r33; Type 0rprim your name Sign your name This is not a Court Order. Revised January 1. 2018 _ u I Request for Civil Harassment Restraining Orders CH-100, Page e ore Egg Dissepopm; (Civil Harassment Prevention) MC-OZO SHORT TITLE: cm NUMBER; LASTme AND LASTme 1 D Attachment to DV-100, Item 3 - Protected People 2 E Attachment to CH-100, Item 3 - Additional Protected Persons 3 D Attachment to EA-1 00, Item 6 - Additional Protected Persons 4 Houshold 5 Full Name Age Member? How are they related to you? 5 g; 520/76 1% (bya/m 3C3 g N0 Paw 6r 7 r Angan’wq WaMY 542 fig) No mm 7” 8 NMM 6L (/- Vawfl t ’z @ N0 woe/W 9 Mv/a, theibe/z, M No Loué/‘M 10 LOCK) {k 01 V6 lkéfiug Z [3 g No 0005/ I/7 11 FMI‘H Had/fl/ '5 g No (,oo em 12 ChéV/ém’ii AMCZZQ Nokow ”EL Yes @ (/L I‘VI-Ff, ZWd 13 Yes No 14 Yes No 15 16 17 18 19 20 21 22 23 24 25 26 (Required for verified pleading) The items on this page stated on information and belief are(specifyitem numbers, not line numbers): ‘ 27 This page may be used with any Judicial Council form or any other paper filed with the court. Page_:L ugggffiaoivffidfiyafié‘éfi] Attach to Judiciaftifififgg; :fgtier Court Paper mm 5m Oonnal Form C- lkmhaDmnz [55mm Hm" 1O 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: Qlfiw’m 3'“ ”5/”M552/ CASE #z Last Name Last Name CFépO, lt+eIm 7a(3)c; DSI’SEYRIEE HlARASSMENT:0 00 cw” s La haw!” a) How do you know the person you want to restrain? FOf’I/vfl/ 7f” [5/74 0%: é L(ocL/‘fi b) Are you living with the person? D YES [Z NO c) Has the person [Z physically abuse you. E physically or verbally threatened you andlor D harassed you many times? (Please check all that apply.) d) ln 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): 0r) smufo’WIOZ/w/ZI aw 1:00 AW 664nm! Héfmuwéz PFC: llama, 0p flan 7» mm ox 9m M a, Pcwry ma Jim; Mo MataruMJrh‘rzy w‘p/ocg’ aw 1; Oflorvd Wagon» fifm aw ubfif WOW é, [ya afq/Uéd 1b,? Ma 1/70 UJObé Pu§j7//74 \\' ym6 50 I'YU'( O’Lflfl/W/‘é/7d CW M mt] WV” “’0 (WW WM? ”5/ (Magma wHH/z WW @3716?wa 13051446! Mé M H2; Wund and 606W slan/rzd Jam” Ha éamhm/éa m lamb MY wf/flfimz; ?caa 0444 +Wau/ 145/ M546! x7774; We: C0/70/63%c a Hfi @x/al/HUMW *COM/Zéd 27a" umwewpfi mg f Waé/N’ ffimxyémyéé \\ CH-1 00, Item 73(3) -- DESCRIBE HARASSMENT Page- MC-020 8-HORTTITLE: CASENUMBER:_ 11019;an and H‘O/Wfim96: 1. fi Tecmd Harm Panoméd m6 x‘x/x‘ 2 +346 ¥0L0é CCwE/W/l WY HP cxfld *05757 3 +0 3mm, PW afi/flwbné’aowvamdé W06 4 5H“ uwmawé go MY H00 Wear 5 fifiandé fem 00+6/‘dé +0 £0?“ l/M‘M s 055$ omd Ml Mafia; F&ug/wfifl z/fl/LH 7 QCL/“éQ BCCWé‘ALQOQéflsg/vufifl fj‘ncuty s P’W M‘Flfic/‘u‘cfl/i ohfil/an/yé ajg/c-L’; up 9 Md Palu‘w 33 hawm/ 029a 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 (Required for verified pleéding) The items on this page stated on Information and belief are (specify item numbers, not line numbers): 27 This page may be used with any Judicial Council form 0r any other paper filed with the court. Page Farm Approyed by the ADDITIONAL PAG E CR0 201. 501 Jumdal Counul o! Camomia MC-OZDINew January 1. 1987] Attach to Judicial Council Form or Other Court Paper Optional Fon-n Martin Dean's Essential Fonns TM 1o 11 12 13 14 15 16 17 13 19 20 21 22 23 24 25 gamma Horm/M‘il CASE NAME: E0 CASE #: Last Name Last Name e) Were any guns or other weapons used orthreatened to be used during any abuse in the past three months? Z YES D NO If “YES", describe: anfiéév Ba 71"H& f) Were there any injuries during abuse in the past three months? D YES ZNO If “YES", describe: g) Did the police come t0 any of these recent events? Z YES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months? u YEs a No IWES", please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? EIYES HNO lf‘YES”,where: j) Has the person you want restrained ever been in jail for violence against you or your children? EYES ZNO lf“YES",when: Describe what the person did to you or your children that caused them to go to jail: cmoo, 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 #: Last Name Last Name k) Do you have a criminal protective order (restraining order from criminal court)? D YES E’NO If “YES", please attach a copy. l) Describe the worst abuse and when it happened: KThe most recent abuse i_s the worst abuse OR El The worst abuse was (approximate date) and the person l want a restraining order against (describe what they did to you): m) Describe any other previous (past) violenbe or threats 0f violence that you haven't already written about here (include dates or estimates as t0 when it happened): CH-100, Item 73(3) - DESCRIBE HARASSMENT Page
