Request Restraining OrderCal. Super. - 6th Dist.January 28, 2021Request for Civil Harassment CH'1 00 Restraining Orders Read ('un a ( 'iril llurussmenl Restraining Order Help Me? (form CH-100- INFO) before completing this form. Also fill out Confidential CLETS Information dorm CLETS-DOU with as much infomation as you know. Person Seeking Protection a. our Full Nam : ~ fl (Y ¢ V .u- u Your Lawyer (ifyou have onefor this case) Name:SfilfifleplesenL State Bar No.1- Firm Name: _S.elf:R£.pL&s.e.nled b. Your Address (lfyou have a lawyer. give your lawyer 's ,.4-Du._'_ _ information. Ifyou do nor have a lawyer and wan! Io keepyour home address private you may give a different mailing address instead You d0 no! have to give telephone far or e- mail ) Address. 383% Ba VKAV dndf Mfi3 migfigegz- State LA Zip-ASH}- Telephone. S0 q 20 ZQSS Fax: E-Mail Address: Q) Person From Whom Protection ls Sought l Fun Name MO! -(0 MIR“ 0L3?- Address (ifknom: \ Cityzjfin 39$: ® Additional Protected Persons State: _ A a Clerk stamps date here when form is filed. FILED JAN 2 8 2021 Cler o t Coun Superior my o! Santa Clara BY DEPUTY Fill in court name and street address: Superior Court of California County of Santa Clara 191 N. First Street 191 N. First Street San Jose, CA 95113 Civil Courthouse- DTS Coun fills in case number when form is filed. Case Number: 21CH009829 51Age: _Zip:3m a. Are you asking for protection for any other family or household members? MYes DNO lfyes, list them: Full Name E Age Lives with you? How are they related to you? ”$34 $10K) 9 Q F H m ch D No dou‘QM-Pr UICNX ‘ J; 09:0 M S a Yes D No 801'! LOLC C ;u UQKflfiauf? c S m Yes D No O ‘ ‘ O_flaflj gA Yes D No (u; £6 Check here ifthere are more persons. Attach a sheet ofpuper and write “Attachment 3a-Additional Protected Persons "for a rifle. You may useform MC-025. Attachmenl. b. Why do these people need protection? (Explain below: D Check here iflhere is not enough spacefor vour answer Pu! your complete answer on the attached sheet 0f paper orform MC-025 and M rite ”Allachmen! 3b-Whv ()Ihers Need Protection' for a title. KNqJYEN (aobc “”91 \QC uo‘mw me orc’ \wonf ?mlccchon FOI “Tm Because M“, ”(ago orc‘ hev Fomfiu ¢ when ”\(M 100$ CH “Ne CAu‘d’Cn OHM 4+?!“ 40 k“ ”(NM “4““ ”(/U’xL 6}!”ch 0‘0‘ mqke qvw W 50 IQSK om because C:\so when “‘69: mvplc (ooh ad om (molam Wm Hnrom $0on Low tome Hem This is not a Court Order. fi‘m'o‘cém"°‘cz%"°m'a meé’ginm" Request for Civil Harassment Restraining Orders (Civil Harassment Prevention) ml Proooduee §§ 527 60Wma 527 9 aBDm CH-100, Page 1 of 6 ROHCI [ I PVERN9 Case Number: 3 Relationship of Parties How do you know the person in ®? (Explain below): D Check here ifthere is not enough spaceforyour answer. Put your complete answer on the attached sheet of paper rforn M(_- and rite tachmen! 4-Relationship ofParties ”for a title.M32;Kimmy mr Venue Why are you filing in this county? (Check all that apply): a. m The person in® lives in this county. b. D l was harassed by the person in® in this county. c. D Other (specifi): 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 w N0 (Ifyes, check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in {Coungy/Statez Year Filed Case Number (ifknowm (l) 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 (10D Criminal (11D Other (specify): b. Are there now any protective or restraining orders in effect relating to you or any of the persons in ®and the person in®? m No DYes (Ifyes. attach a copy ifyou have one.) Description of Harassment Harassment means violence or threats of vioience 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 0r estimated date): 2 Wh l h ?( ) o e 5e waSt ere [See attached declaration for a Description of Harrassment] This is not a Court Order. Revused January 1. 2018 Request for Civil Harassment Restraining Orders CH-1oo, Page 2 ore (Civil Harassment Prevention) 9 MC-OZO $Ho'RT TITLE: case NUMBER; 9 usrmu: {\d‘m‘UeZAND LASTNAu: Hflhoq 2 1 CHOU 98 2 1 D Attachment to DV-100, Item 3 - Protected People 2 D Attachment to CH-1 00, 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? 6 gagfi L); gm 3 gaggg} Q g @ No “U5\9Qm) 7 Yes No 8 Yes No 9 Yes No 10 Yes No 11 Yes No 12 Yes No 13 Yes No 1 4 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 (specify item numbers, not line numbers): 27 This page may be used with any Judicial Council form or any other paper filed with the court. Pag°_]_ prm Approyed by me ‘ ADDITIONAL PAGE CRc 201.501 £635” cw'luaiafifagaz'méan Attach to Judicial Council Form or Other Court Paper lional Form r. - @934-.. Emmi”. FIRMS" Case Number: 216H009329 ® a. (3) How did the person in® harass you? (Explain below):a Check here {f(here is not enough spacefor your answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write “Altachment 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 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(4)-Use of Weapons "for a title. (5) Were you harmed or injured because of the harassment? D Yes fl No (Ifyes, explain below): D Check here ifthere is not enough spacefor your answer. Putyour complete answer 0n the attached sheet ofpaper orform MC-025 and write "Attachment 7a(5)-Harm or Injury ”for a Iitle. (6) Did the police come? D Yes fl 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 0fthe order ifyou have one.) b. Has the person in ® harassed you at other times? m Yes D No (Ifyes, describe prior incidents andprovide dares ofharassment below): D Check here ifthere is not enough spacefor your answer. Put your complete answer 0n the attached sheer of " 1n\n v ["Ano, Pr ‘fldéhnMa mob On ohukgjz. V mromm m luwn‘. . I JAR VOS o o. , - ‘ A v ’n Z L ' ...- EI'NBQ ’ . tn. .Ic u u 5n I o 10. .mmLo . ' uf This is not a Court Order. ; Request for Ci_vi_l Harassment Restraining Orders CH-1oo, Page 3 ofe (mgflwm'u (CIVII Harassment Prevention) 9 x \ paper orform MC-025 and write “Attachment 7b-Previ0us Harassmen ”for a title. 11“ . mi \< Revised January 1, 201B Case Number: Check the orders you want. E <8) m Personal Conduct Orders I ask thc 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 @2 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. - 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 (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-Other Personal Conduct Orders. "for a title. The person in ®wi/I be ordered not to take any action to get the addresses or locations ofanyprotectedperson unless the courlfinds good cause no! to make (he order. @ mStay-Away Orders a. l ask the court to order the person in ® to stay at least $.09- yards away from (check all that apply): (1) m Me. (8) m My vehicle. (2) m The other persons listed in@. (9) W Other (specify): (3) My home. EHQ/w‘k'gnf (flaw mmw (is; r} fifi/vlj . QM“ ([5 o l ‘50! Ii I <4) MW" orworkplace- amfi H) (fitte; 'm ELM-M' (5) My school. a 5p A w J-Vn'c w + c/;.~\I/Ie x (6) D My children’s school. (7) m My children’s place ofchild 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? fl Yes DNO (lfno, explain below).- D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheer 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 firearms? DYes DNo m1 don’t know Ifthcjudge grams 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 Io turn in r0 law enforcement, 0r sell 10 or store wilh a licensed gun dealer, any guns orfirearms \riI/Iin llis 0r her immediule possession or control. This is not a Court Order. “V‘s“,fm” “ 2°” Request for Civil Harassment Restraining Orders CH-1oo, Page 4 ofe (IB{W (Civil Harassment Prevention) 9 Case Number: 210H009829 ® m Temporary 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-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 m No (Ifyou answered n0, explain why below): D Check here iflhere is not enough spacefor your answer. Put your complete answer on the attached sheet of pa er orform AIC-025 and write “ Itachmen! II-Temporary Restraining Order ”for a title. C . J Pd r?! £3 V $0 1 é‘d 'V\‘O<\‘» Q“ \Qy d‘I- L Lung génna'ng On!!! 03095954 r y WW ® D Request to Give Less Than Five Days' Notice of Hearing You must have your papers personally served on 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 of Personal Service”? Form CH-200, Proof 0f Personal Service, may be used to show the court that Ihe papers have been served.) ‘P W\_\’l ¢1§Luflrl w?L o If you want there to be fewer than five days between service and the hearing, explain why below: D Check here ifthere is n0! enough spacefor your answer. Put your complete answer on the attached sheer of paper orform MC-025 and wrile “Anachmem 12-Request Io Give Less Than Five Days' a ice "for a title.j AU ’ 7 .u 0.0 .' A. \nm r ' HAC' 0f L ’m “Mu. ' On ‘llal .7 ..’A A: - 11.5 B? xbkjgicn gcfigytssmq momflx M2 Lin Mavin ® D No Fee for Filing or Service a. m 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. D Thc 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 I 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 lo order payment ofmy D lawyer's fees m Court costs. The amounts requested are:m Amount 1t_e__ Amount Eilingiee $ 435 $ $ $ $ $ D Check here ifthere are more items. Put the items and amounts on the attached sheet ofpaper orform MC-025 and write “Atlachmem Hilawwr 's Fees and Cosls”for a title. This is not a Court Order. Request for Civil Harassment Restraining Orders CH.1oo, Page 5 ore (Civil Harassment Prevention) 9 Revised January1.2018(mgm“I '_D 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.. type. breed, name. color, sex.) I request sole possession of the animals because (specifiz good causefor granting order): D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write “Atrachmem 15a-Possessi0n ofAm'mals "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. DAdditional Orders Requested I ask the coun to make the following additional orders (specifil): D Check here iflhere is not enough spacefor your 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: SelERepmsgmed_ sglfgepmsemgd Lawyer ’s name (ifany) Lawyer 's signature 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: O“ Zq- 201‘ V ' O ' Type or pri your name ’ Sign foir/Zz%e This is not a Court Order. R°"‘°",J,"’"“a" ‘- 2°18 Request for Civil Harassment Restraining Orders CH-1oo, Page 6 ofe (.1135m (Civil Harassment Prevention) 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME:\lmfiqugza"d HG'TQ CASE #; 210H009829 CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? “(1H Q \Xbm'mde l- NU gMoo v b) Are you living with the person? D YES m NO c) Has the person D physically abuse you, u physically or verbally threatened you and/or m 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): 0h ox-zk-Zeu 93‘ q'oonm ?nflu momma I was 55mm; on; gkogma \33 m m-flmngmninfie masWWWmE againfi m< o , a V \ m ‘ Qgemfl’So SgFOELd $1 ((“flxomv XuXQu Quiche Q6 0.; § .3. l.’ IO' ‘|.n ..‘ ‘1 ’ luv: \X m A o ‘H ti U u I O n OI L o K (m g 0 ‘0 o q 5 uv ' \ v ' v I 90 " 306 C s 7 ' a Y v a I v‘ A St CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT CASE NUMBERSHORT TITLE .7 vdfléauci' and Mama 2 1 C H 00 98 2 9 LastName L 'LastName 1 \VICXQEOCIO? 2 0 a ' C ’ 3 ‘ 2, {Q Q C 4 nnr\ 'A- 1’s nnX smut. Ml: (ueAfi EEQL EX; PQL‘Q fimd 525 b 5 Wad HOu me awwwfil- e .2 23-0; 2Q ondfl; 233ml (m m-zb- 202:. 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Page 6 dgmmggfim ADDITIONAL PAGE cnc 201. 5m memo $$apggfrtyn1. 19871 Attach to Judicial Council Form or Other Court Paper Mam» Dean's Essential Forms TM 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAMEUdfisaMZ and Ham'q CASE #: 2 1 9H 00 98 g 9 Last Narhe 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 fl NO If “YES", describe: f) Were there any injuries during abuse in the past three months? U YES w NO If “YES", describe: g) Did the police come to any of these recent events? fl YES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES $NO If “YES". please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? ‘fi YES $No If “YES", where: \(Lw ‘ Z ‘ n j) Has the person you want restrained ever been in jail for violence against you or your children? DYES QNO lf“YES",when: Describe what the person did to you or your children that caused them to go to jail: CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAMEMdSqw. and Hand CASE #: Last Néme Last Name 210H009829 k) Do you have a criminal protective order (restraining order from criminal court)? D YES m NO If “YES", please attach a copy. l) Describe the worst abuse and when it happened: U The most recent abuse 1g the worst abuse OR D The worst abuse was (approximate dam) g 2\ ‘ Zbr 202] and the person Iwant a restraining order against (describe what mey usd to you): Ogafl‘l “i Conknuum - med, Lev Pwvm dam Snot Hana 4am mt mwmmk \‘av Commas Mm} she \‘QS ”1340‘ng and 5‘: J \ ‘ 05 Q ° fiaWN 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): u Mmin am} éLps Edwin; AMWV indégn‘l LLnL g(uwvcd Um§ QLL DI-OJm-ZQPI AL “2:0” (1m hi! 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Coundl of ifonia January 1. 196T] 'onal Form Marlin Dan's [SSENTIM fflRMS" ADDITIONAL PAGE CRC 201. 501 Attach to Judicial Council Form or Other Court Paper