Request Restraining OrderCal. Super. - 6th Dist.January 28, 2021‘ CH 100 Request for Civil Harassment olemsrampsdare ham when rammed. " Restraining Orders Read Can u ('ivi/ Harassnwm Restraining Order Help Me? (form CH-I 00- INFO) before completing this form. Also fill out Confidential CLETS I L EInformation (form CLETS-OOI) with as much information as you know. D JAN 2 8 2021 the Court K. County d Santa Clara G Person Seeking Protection a. Your Full Name: I pqa\ ’Z'L‘Lg Age: $6! super"), Your Lawyer (ifyou have onefor this case) Fill in court name and street address: Name:Wanted- State Bar No.:___ Superior Court of California, County of F' N m -_Sal&8eptesenled santa Clara"m a e' 191 N. First Street b. Your Address (Ifyou have a lawyer, give your lawyer 's 191 N. First Street . . , , y San Jose, CA 95113 mformatzon. Ifyou d0 not have a lawyer and want to keepyour Civil Courthouse_ DTS home address private. you may give a difleren! mailing address instead. You do notfie r0 give telephone, far, or e- nail.) Court fills in case number when form is filed. Address: 6H0] Tho! “W“ “( F'V4 case NMeHOO 98 30 City. Statet A zip qg l2 7 ‘ Telephone: 3 60 (\QS 7q3%ax: E-Mail Address: ® Person From Whom Protection ls Sought FullName: ge/qflio ?JHHCD Agni Address:Q‘fknown): I < L‘ q é T1" 0 "4 W JJ Dr “'k . City: fl - TU) k State: QLZipzflSIl 3 G) Additional Protected Persons a. Are you asking for protection for any other family or household members? DYes D No Ifyes list them. Full Name fl Age Lives with you? How are they related to you? D Yes D No 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 spaceforyour answer. Pu! your complete answer on the attached sheet of paper orform MC-025 and write “Attachment 3b--Why Others Need Protection ”for a title. This is not a Court Order. figsg‘féfimizof'gsgxfiggw Request for Civil Harassment Restraining Orders CH-1oo, Page1 ate (Civil Harassment Prevention) ROHCI n PVERN9 D.- Case Number: ® Relationship of Parties How d0 you know the person in ®? (Explain below): D Check here ifthere is not enough spacefor your answer. Pu! your complete answer on the attached sheet of paper orform MC-025 and write “Attachment 4-Relationship ofParties "for a title. ‘f 00M wx <+L G) Venue Why are you filing in this county? (Check all that apply): a. g The person in ® lives in this county. b. I was harassed by the person in® in this county. c. D Other (specifi): ® Other Court Cases a. Have you or ny of the persons named in@ been involved in another court case with the person in®?D Yes $310 (Ifyes, check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in (Counry/State) Year Filed Case Number {ifknown) (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 (10D Criminal (1 lD Other (specifiz): b. Are there now any otective or restraining orders in effect relating to you or any ofthe persons in @and the person in®?$0 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 alamed, 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): ‘06:, 4W“ \“ 2 WI l th ?( ) 10 e 8e was ere [See attached declaration for a Description of Harrassment] This is not a Court Order. Request for Civil Harassment Restraining Orders CH-1oo, Page 2 ofs Mmm'u‘! (Civil Harassment Prevention) 9 Revised January 1, 2016 (IEdun Case Number: ® a. (3) How did the person in® harass you? (Explain below):D Check here ifthere is n0! enough spacefor your answer. Put your complete answer on the attached sheer ofpaper orform MC-025 and write “Attachment 7a(3)-De%‘ribe Harassment "for title. Furouv, enwv‘ reoM LQWH w“ Cw/i C “H €90”);le 1" +kk Q\r J / ?.ij VSDM g1» \\ 0M wk‘Lk S‘OLVp'k, CvA \nfl M 04 Mm ké-J H’W- Me bra Qu ami 30hr )‘I'p wkl/x (4) Did the person in® use or threaten to use a gun or any other weaporn? @1442/ t k) EYCS D No ([fyes, explain below): Check here Iflhere is no! enough spacefor your answer. Putyour complete answer 0n the attached sheet ofpaper orform AIC-025 and write “Altachmem 7a(4)-Use 0f Weapons "for a title. {?Hde Mg LJ‘+L\ W‘l aw C 6"4 SU(W‘AJUA) 14 +HQ Va“)- (5) Were you harmed or injured because 0f the harassment? $Yes D N0 (Ifyes, explain below): D Check here ifthere is n0! enough spaceforyour answer. Put your complete answer on the attached shec! ofpaper orform MC- 25 and write “Atlachmenr 7a(5)-Harm or Injury "for a title. (6) Did the police come? @Xes D No If yes, did they give you or the person in ®an Emergency Protective Order?D Yes dNo If yes, the order protects (check all that apply: DMe D The person in ® D The persons in G). (Anach a copy OfIhe order ifyou have one.) b. Has the person in ® harassed you at other times? Yes a No (Ifyes, describe prior incidents andprovide dates ofharassment below): D Check here iflhere is not enough spacefor your answer. Pu! your complete answer on the attached sheet 0f paper orform MC-025 and write "Attachment 7b~Previous Harassment ”for a title.a C 3 r! This is not a Court Order. RWMJM “ 2°“ Request for Civil Harassment Restraining Orders CH-1oo. Page 3 ore (IBWEW (CIVII Harassment Prevention) 9 Case Number: ® Check the orders you want. E E 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 ®z m Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy personal property of, or disturb the peace 0f 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. D Other (specifi’): D Check here ifrhere is not enough spacefor your answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write "Attachment 8c-0ther Personal Conduct Orders, "for a title. The person in @will be ordered not to take any acrion Io get the addresses 0r locations ofany protectedperson unless the courlfinds good cause not to make the order. Stay-Away Orders yo . I ask the court to order the person in ® to stay at least __C)_ yards away from (check all that apply): (1) Me. (8) My vehicle. (2) The other persons listed in@. (9) Other (specifi): _ (3) $ My home. fifi‘fli-V’V“ 70w Mwfi’L 6/«01 .1 cm”: 4 M .b kl oh/«w from [‘(wgon [A /fl) dvlm/fl() yJo orworpace. 0‘4, (dhrcoxw fiip‘u4/x1r/‘T’ (5) My school. (6) D My children‘s school. (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, orjob? EYes DNO (Ifno, explain below): D Check here ifthere is no! enough spacefor your answer. Put your complete answer on the attached sheer of paper orform MC-025 and write “Alrachmcm 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 I don’t know IfIhejudge grants a protective order. the person in ® will be prohibitedfrom owning, possessing, purchasing, receiving. or attempting Io purchase or receive a gun, otherfirearm, and amnnmilion while the protective order is in eflect. The person in ®will also be ordered to turn in Io law enforcement, 0r sell to 0r store with a licensed gun dealer, any guns orfirearms within his or hcr immediate possession 0r control. This is not a Court Order. “(“ig’m " 2°” Request for Civil Harassment Restraining Orders CH-1oo, Page 4 ore ,atm‘:m (Civil Harassment Prevention) 9 Case Number: 91pun 9330_-v"vv ® E Temporary Restraining Order I request that a Temporary Restraining Order (TRO) be issued against the peyson in ® to last qntil the hearing. l am presenting form CH-l 10. Temporary Restraining Order. for the court’s Signature together wnth thls Request. Has the person in ® been told that you were going to go to court to seek a TRO against him/her? DYes D No (lfyou answered n0, explain why 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 1 l-Temporary Restraining Order "for a title. @fi Request to Give Less Than Five Days' Notice of Hearing You mus! hare your papers personally served on the person in® at Ieastfive days before the hearing. unless (he court orders a shorter timefnr service. (Form CH-ZOO-INFO explains What Is “Proof of Personal Service”? Form CH-200, Proof of Personal Service, may be used Io 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 is no! enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write “Allachmen! 12-Request to Give Less Than Five Days’ Notice "for a title. D No Fee for Filing or Service a. D There should be no filing fee because the person in®has used 0r 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 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 ofviolence, 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.) @ a Lawyer's Fees and Costs l ask the court to order payment ofmy D lawyer's fees a Court costs. The amounts requested are: lte_m Amount ILL Amount Enjngjae ' $ 435 $ $ $ $ $ D Check here Iflhere are more items. Pm the ilcms and amounts 0n the attached sheet ofpaper orform MC-025 and write ”Attachment 14 Lawyer ”.s‘ I’ws um! ('0.s‘!s"for a title. This is not a Court Order. “mm?“ ‘- 2°” Request for Civil Harassment Restraining Orders CH-1oo, Page 5 ore(mgm (Civil Harassment Prevention) 9 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. (Identifil animals by, e.g., type. breed, name, color, sex.) I request sole possession 0f the animals because (specifil good causefor granting order): D Check here ifthere is not enough spacefor your answer. Put your complete answer 0n (he attached sheet ofpaper orform MC-025 and write ”Attachment 15a-Possession 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 (specifiz): D Check here iflhere is not enough spacefor your answer. Put your complete answer 0n (he attached sheet of paper orform MC-025 and write ”Arlachmem I6-Additi0nal Orders Requested, ”for a title. @ Number of pages attached to this form, if any: Date: Sflhflepmsgmed- - d ’ s .Lawyer 's name (ifany) Lawyer ’s signature l 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: Z 5 ‘Z ‘ 0c. ’zxx pad 7 'k k } W ;Z« '. ./ ' Type 0r prmt your name Sign your name This is not a Court Order. R'““°’°““"" " 2°“ Request for Civil Harassment Restraining Orders CH-1oo, Page e ofe(m1m (Civil Harassment Prevention) 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: 3"“ CASE #; 2 1 c H 00 98 3 0 Last Name Last Name CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? V oowwx.» M b) Are you |iving with the person? D YES flNO c) Has the person g(physically abuse you, éfihysically or verbally threatened you and/orfiharassed 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): gtA-HIJ VOom q; l‘ 0M Wk Wk I; V<3 $\flr0’fi VNW‘ We (\vv ‘\‘\’\e MQMJ ACsHHQJ WK wk“ T- Jmev” 4mW Qopw‘d MK aowwedv\ I €6,911 f L‘I)‘ aka" CC ”M! Dbl W, C LAM, GNQH/ Wm IMWJRHY afiv arrq+ M Qmjrlfu/ +M V00» gL/uH/k) fin) b\H cm Chm @Aewi/V j: \euvk 0‘th flak M7m / CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT Dana 1O 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: and CASE #: 2 1 C H 00 98 3 0 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? WES U NO If“YES”, describe: SW”? “1") b‘v‘ ( GMLA C L\ C "‘ f) Were there any injuries during abuse in the past three months?fiEs [J NO |f“YES", describe: 5P ‘ ’ x‘ Eb» \DLL‘A Al? 1' ‘0 \OIH\4/C/‘ §IA( OP k4
