Request Restraining OrderCal. Super. - 6th Dist.January 29, 2021Request for Civil Harassment - Restraining Orders Read Can a Cfvil Harassmem Restraining Order Help Me? (form CH-IOO- INFO) before completing this form. Also fill out Confidential CLETS Iigforman'on dorm CLETS-OOI) with as much information as you know. Person Seeking Protection Name:a. You Ful MIC\?\VD ®Ufi‘\@( Agezi/jlf Your Lawyer (zfyou have onefor this case) Name:WWE- State Bar No.2 Firm Name:jelhflepmfianieL_ b. Your Address (Ifyou have a lmvyer, give your lawyer’s information. Ifyou d0 nor have a lawyer and want to keep your home address private you may give a diflerent mailing address instead You d0 not have f0 give telephone, fangerae- mail.) Clerk stamps date here when form is filed. f Santa ClaraBY\49:DEPUTY / Fill in coun‘ 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 Court fills in case number when form is filed Address: W&\ Dream \Q33@WCL/O Q'- )Ct-Z-2 ch City: 40 u'fl TOVJ State: d/fiZip: q q [9) q Telephone: Fax: ‘xrrv Case Nu berrL a 3; i r159 gums?3’69 E-Mail Address: ® Person From Whom Protection ls Sought FullName: Pafi‘bkcai grwflt Address (ifimown) : ge. 719+ City: State: ® Additional Protected Persons -Zip:- a. Are you asking for protection for any other family 0r household members?%Yes DNO Ifyes, list them: _F-ull Name Sex Age Lives with you? ow are they related t0 you? \‘EXWKQJ-T ?\K/KA. fl: IO flYes D N0 I \ D Yes D N0 D Yes D No D Yes D N0 6 Check here ifthere are more persons. Aitaclz a sheet ofpaper and write "Attachmenr 3a-Aa’din’0nal Pro/ected \ Persons "for a title. You may usefonn M'C-025, Attachment b. Why do these people need protection? (Explain below): D Check here ifthere is nor enough Spacefor your answer. Put your complete answer 0n the arraclzed sheet 0f paper orform 11/161025 and write "Afrachment 3b-Why Others Need Protection ”for a title. 1 , KUI/MLK/a m mf'flxh l UV TV” Wu V' jyI [Hi5 isfiot a_- Court "Order. Judicial Council of California, www courts. ca gov Rewsed anuary1 20 1B Ménda cry Form Code of C'rvil Pracédure §§ 527 6 and 527 9 'Essenflal Request for Civil Harassment Restraining Orders (Civil Harassment Prevention) CH-100, Page1 ofG ROHCI___ [] PVERN9 Case Number: ® Relationship of Parties How do you know the person in @? (Explain below): D Check here {fthere is nor enough spacefor your answer. Pu! your complete answer on (he attached sheet 0f paper orform MC-025 and wrile ”Aflaclzmeut 4-Relali0nship ofParties ”for a title. £1 / MEL bar ® Venue Why are you filing in this county? (Check all that apply): a. The person in® lives in this county. b. V Iwas harassed by the person in® in this county. c. a Other (Specify) .' ® Other Court Cases a. Have you or any 0fthe persons named in© been involved in another court case with the person in@7 a Yes ¢ No (Eyes, check each kind ofcase and indicate where and when each wasflled.) Kind 0fCase Filed in (CozmnI/Slate) Year Filed Case Number (ifknown) (1) D Civil Harassment (2) Q Domestic Violence (3) a Divorce, Nullity, Legal Separation (4) D Paternity, Parentage, Child Custody (5) U Elder 0r Dependent Adult Abuse (6) a Eviction (7) D Guardianship (8) a Workplace Violence (9) a Small Claims (10). Criminal (I Um Other (specgfig): b. Are there now any protective or restraining orders in effect relating t0 you 0r any 0fthe persons in ©and the person in@? DNO mYes (1fycs, attach a copy {fyou have one.) ® Description of Harassment Harassment means violence or threats ofviolence against you, or a course of conduct that seriously alarmed, annoyed, or harassed y0u 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. (I) When did it happen? (provide date or estimafed date): 4 ’- Q‘OK 3‘ K [a QM [ya g ’2‘ f 2 W] l tl ?( ) 10 e SB was me [See attached declaration for a Description of Harrassment] This is not a Couu't O(der. Revised January 1. 201E . Request for Civil Harassment Restraining Orders CH-1oo, Page 2 ore SEE, ffifignmflgl. (Civil Harassment Prevention) 9 Case Number: ® a. (3) How did the person in® harass you? (Explain below):D Check here ifthere 1's not enough spacefor your answer. Putyour complete answer 0n- the attached sheet ofpaper orform MC-025 and write "Attachment 7a(3)-Describe Harassment ”for a title. {’Ql’éll- {Jav’mte/ @rawn Perd mW/lmbHM, StdacflomeWWSOI/l m WA O/UCW‘WWOB mehatlléavofi :1, wag modem, Cw [ML I>Lr65md~2d I’chmcm IARWO LAW WMCV‘WQK ’h) 03V, 030% Lh/L. 1®WWW prA/vflmp Aid mum mime C(Sme up Wt afleAAr JamaaL 3V1? éudr +0 MGWJ {Ffiflwd ‘ w amidnwzci"? (4) Did the person in® use 0r threaten to use a gun 0r any other weapon? gYes D N0 (Ifyes, explain below): Check here ifthere is not enough spacefor your answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and wrile “Attachment 7a(4)-Use 0f Weapons ”for a title. mm magma bemgeam. Um Mom? min - (5) Were you hamled or injured because of the harassment? 93165 D No (Ifyes, explain below): fl Check here Ifthere is not enough spacefor your answer. Putyour complete answer on the attached sheet ofpaper orform MC-025 and write “Attachment 7a(5)-Harm or Injury ”for a title . WA CM MS wme/ww hm Wafi Cm;mm (6) Did the police come? DYes dNo Ifyes, 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): flMe D The person in (2) The persons in ® (’Atfach a copy offhe order ifyou have one.) b. Has the person in ® harassed you at other times? Yes D N0 ([fyes, describe prior incidenrs andprovide dates ofharassment below): D Check here ifthere 1's not enough Spacefor your answer. Put your complete answer 0n the attached sheet 0f paper orform MC-025 and wrife “Aftachment 7b-Previous Harassment ”for a title. 1 (N 3034* \xWQQ, LOQQ 1n Wm aPaF-‘Ameh’? ’f‘HWQS She doggfi kw Me She was: echeé Lam‘w gvyarm+a M&- acmL 99f Mgwef osgcufirlrd r9 ()6th This isgnot a Court Order. Revised January 1. 2018 . Essential Request for Ciyi] Harassment Restraining Orders CH-1oo, Page 3 ofe “m[EM‘ (CIVII Harassment Prevention) 9 Case Number: ® Check the orders you want. E a Personal Conduct Orders I ask the court t0 order the person in @not to d0 any 0fthe following things to me or to any person to be protected listed in @2 a. mHarass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually 0r otherwise), hit, abuse, destroy . personal property 0f, 0r disturb the peace 0fthe person. b. ‘ Contact the person, either directly 0r indirectly, in any way, including, but not limited to, in person, by telephone, in writing, by public 0r private maiI, by interoffice mail, by e-mail, by text message, by fax, or by other electronic means. c. D Other (specififl: D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheer ofpaper orform MC-025 and wrife ”Attachment 8c-Olher Personal Canduct Orders, ”for a title. The person in ®will' be ordered not to rake anyracn‘on r0 get the addresses or locations ofany prorectedperson unless the courtfinds good cause no! r0 make (he order. fi Stay-Away Orders a. I ask the court to order the person in ® t0 stay at least __9¢b_ _ (1) m Me- (8) w My vehicle. (2) m The other persons listed in@. (9) a Other (specifid: (3) m Myhome. yards away from (check all that apply): (4) a Myjob 0r workplace. (5) D My school. (6) My children’s school. (7) 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 0r she still be able t0 get to his 0r her home, school, orjob? @Yes DNO (Ifno, explain below): a Check here ifthere is nor enough spacefor your answer. Put your complere answer on the attached sheer 0f paper orform [£40025 and write "Arrac/mmm 9b-Stqy-Away Orders, ”for a title. Guns or Other Firearms and Ammunition Does the person in @own 0r possess any guns 0r other firearms? DYes DNO m1 don’t know Ifflrejudge grains a protective order, the person in ® will be prohibitedfi‘om owning, possessing, purchasing, receiving, 0r atrempting to purchase 0r receive a gun, ollzerfirearm, and ammunition while the protective order 1's in effect. The person in ®wi/l also be ordered t0 turn in r0 [aw enforcement, 0r sell 10 0r store will: a licensed gun dealer, any guns orfirearms within his or her immediare possession 0r control. This is not} Court 0'r,der._ Revised Ja nuary 1, 201 8 cpbmm E 9mm Request for Civil Harassment Restraining Orders CH-1oo, Page4 ofe {asfiomg (Civil Harassment Prevention) 9f Case Num ber: ® E Temporary Restraining Order Irequest that a Temporary Restraining Order (TRO) be issued against the person in ® to last qntil the hearing. I am presenting form CH-l 10, Temporary Restraining Order, for the court’s signature together w1th thls Request. Has the perSOn 'n ® been told that you were going to go to court to seek a TRO against himfher? DYes N0 ([fyou answered no, explain why below): D Check here ifthere is Hot enough spacefor your answer. Pu! your complete answer 0n the attached sheer 0f paper Ol‘form M’C-025 and write ”Arlachmen! 1l-Temporary Restraining 0rder”f0r a title. , ' l I . r I hfl dmfi ML Mr emu ”YO Aw Wm bl/xe Mvmsicd‘MmmWadW hum: *0 #3 Am Comaam ”a m} mmgm/(‘m q-‘al P30 . ® D Request to Give Less Than Five Days' Notice of Hearing You mus! have your papers personally served 0n the person in® at leasrfive days before the hearing, unless the court orders a shorter timefor service. (Form CH-ZOO-INFO explains What Is “Proof of Personal Service”? Form CH-200, Proof of Personal Service, may be used (0 show the cour! {hat 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 not enough spacefor your answer. Put your complete answer 0n the attached shee! 0f paper orform MC-025 and write “Afraclmlenr 12-Request t0 Give Less Than Five Days' Nolice ”for a rifle. ® No Fee for Filing or Service I a. fi There should be n0 filing fee because the person in ®has used or threatened to use violence against me, has stalked me, 0r has acted or spoken in some other way that makes me reasonably fear violence. b. The sheriff 0r marshal should serve (notify) the person in® about the orders for free because my request for orders is based 0n unlawful violence, a credible threat ofviolence, or stalking. c. There should be n0 filing fee and the sheriff or marshal should serve the person in®f0r free because I am entitled to a fee waiver. (You must complete andfi/eform FW-OO], Application for Waiver 0f Court Fees and Costs.) E Lawyer's Fees and Costs 1 ask the court to order payment ofmy D lawyer's fees E Court costs. The amounts requeéted are: _m Amount ItL Amount Filing Fee ‘ g 435 $ ' ‘E ' $ $ $ D Check here ifthere are more items. Pu! the items and amounts 0n the afrached sheet ofpaper orform MC-025 and write “Attachment 14-Lawyer ‘s Fees and Costs”f0r a title. This fsinot a Court'O'rder, R°'ise"_Ja””a” :2: Request for Civil Harassment Restraining Orders CH-1oo, Page s ore Elam“. (Civil Harassment Prevention) ,9chow: Case Number: ® D Possession and Protection of Animals I ask the court t0 order the following: a. D That I be given the sole possession, care, and control ofthe animals listed below, which I owu, possess, lease, keep, or hold, or which reside in my household. (Identify animals by, e.g.. type, breed, name, color, sex.) I request sole possession ofthe animals because (speczfl good causefor graming order): D Check here ifthere 1's not enough spacefor your answer. Put your complete answer 0n r/re attached sllée! ofpaper orform MC-025 and wrire “Allachmenr '15a-Possessi0n 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, 0r otherwise dispose of, the animals listed above. DAdditional Orders Requested I ask the court to make the following additional orders (specifi): D Check here ifthere is nor enough spacefor your answer. Put your complete answer 0n the arrached sheer Qf paper orform MC-025 and write "Attachment 16-‘Addirional Orders Requesféd, ”for‘a title. ® Number ofpages attached to this form, if any: Date: SelfiRepnesantaL Self-Represented } - Lmvyer ’s name (ifany) Lawyer ’s signature I declare under penalty ofperjury under the laws ofthe State of Califomia that the information above and on all ' attachments is true and correct. '1 vm-Qoz/ C Mmmzaw Type 0r print your name ’Sign your name _This is'n'ot a Court Orderfl Rewseffig-flg: Request for Civil Harassment Restraining Orders CH-1oo, Pages ore (Civil Harassment Prevention) 10 11 12 13 14 16 17 18 19 20 21 22 23 24 25 ' CASE NAME: 3"“ CASE #: Last Name Last Name CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain?1“ m3$1fl81 l: ”ILA (WU) CUQQYZPMQ Q3“? r eaugvafiH/m b) Are you living with the person? D YES m0 c) Has the person D physically abuse you, fiphysically or verbally threatened you and/ormarassed 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): me-vaerm bow PQMCQ, mam Aaugmr WmW name Axe (fixmgk ‘thx/VfivM t0 46W 0V1 906M \Iokwmas cm WA») SM \fmgagW QMMiran i’9~\*a© nexrsir hmm /Lo bafik¥nmmr9 \ $13930 M AJmQ (9000\an M6 M&Waf wOVE-hmm §ormz,W 39.05 m MA 05mm} \QM w \okowxmW Wm UQIW \AMQ 1‘m (L Awfl [+6 qeebr okd (00mm UO‘nO/u Menu WW 1C7 M Qufidm 65m Comaamect @er 0W l an how m CMLMW Qle WA Wm \9 oLwérm; Ase m Wm b\bwmm TL was cm 4M «Mme QMW as'rJAqL 3am CH-1 00, Item 73(3) - DESCRIBE HARASSMENT Page JRT TITLE: CASE NUMBER: and 1o 11 12 13 14 1'5 16 17 13 19 20 21 22 23 24 25 25 27 Last Name Last Name ?ofixaas daucMcr Qirakeci uwtm ow" db 1&ngch 90 MLLCM 60 Mod I. @Mdufif unmisard -WJM 6h? 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Wwe 9&vaM 09W VWHJ'HE-gaég‘ :Wns‘i-cr VOMLzfi M 30m. kooks Chi, 30?}. cilchrfi CWQLM haw x 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: and CASE #: LastName Lastuame e) Were any guns or other weapons used or threatened to be used during any abuse in the past three months? leEs [:1 No If “YES" describe: A Wfi“? ULCQQ \NXCMlfl w Wm CMM amqwcer 9% mmm 9mms Com f) Were there any injuries during abuse'm the past three months? E] YES 1N0 lf “YES”, describe: g) Did the police come to any of these recent events? El YES flNO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES m0 If “YES”, please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? DYES fi-NO If“YES",where: j) Has the person you want restrained ever been in jail for violence against you or your children? EYES qfiwo Ir"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 Pace ‘10 11 12 13 14 15 18 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 coud)? D YES [QNO If “YES”, please attach a copy. l) Describe the worst abuse and when it happened: El The most recent abuse i3 the worst abuse OR :1 The worst abuse was (approximate date) l“ @flal and the person I want a restraining order against (desenbewhamwmdtoyou) ”W OJWM VJ [\MW éMm vw» dream Smmm 9M6 ie Maggot WW (“mm 4mm \va mWirwm/Om abowp as} mm car v9 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): $9401? 89?“ 9910 Mi WMQQV \n‘éervmd m9,W ?cddua cud WM émw 4N€ed 46> mafia. a0mflm+M mo. bad JHneq dank 60w \wfi Wag}, HM WWW \g wm+im (Car JAMS QCLQJ wax Axe ‘02 mecwé 60 4M: Gina 400 0m Q we mama L CH-100, Item 73(3) - DESCRIBE HARASSMENT Page_
