Request Restraining OrderCal. Super. - 6th Dist.February 2, 2021Request for Civil Harassment cnmstampsm hm when roams med. Restraining Orders Read ('uu u ( 'iw'l Humsuvmen! Rus‘fl‘uining Order Help Me? (/brm ('H-IOO- INFO) before completing this form. Also fill out Confidential CLETS I L EInformation (form (‘LETS-OOI) with as much information as you know. . FEB - 2 2021 Person Seeking Protection K. NGUYEN a. Your Full Name: Clerk f t e Court OhEau'o‘ pa 334 mg Age. fl SuperiorCoun un dSanla ra ' E Your Lawyer (ifyou have onefor this case) Fill in court name and street address: Name:SelfiReptesenL State Bar No.2___ gupeiiaorccrurt of California, County of ' . an al’a Flrm Name.Wd 191 N. First Street b. Your Address (Ifyuu have a lawyer, giveyour lawyer '3 191 N. Flrst Street information If vou do not have a lawver and wan! t0 kee vour s-an Jose’ CA 9511 3 ' - - v P- CIVII Courthouse - DTS home address private. you may give u different mailing address instead. You do n0! ha 'e Ia give telephone. far. or e-mail.) Coun fills in case number when form is filed. AddresszaLP‘q aflflnlfl' RV& CaseNflfH 81 0 City:M-Stamfl Zip: 675’ LL 00 9 ’ Telephone: Fax: E-Mail Address: Person From Whom Prote tion Is Sought Full Name: SfCVOR D H’D GUOL D HO Age: £53 Address (ifknown): I City: State: Zip: ® Additional Protected Persons a. Are you asking for protection for any other family or household members? DYes DNO (fives, list them: Full Na e $35 A ve Lives with you? How are they related to you? _‘ ihacl’? mug?" r 33 uYes D N0 mrfiuzf #0! n (’hqu M I’) Yes D No SNPBOQ LOG” ma! E bb/ g Yes DNO motN‘V‘ LQK}a Yes D No D Check here ifthere are more persons. Attach a sheet ofpaper and write "Attachment 3a-Addilional Protected Persons "for a title. You may useform MC-025. Attachment. b. Why do these people need protection? (Explain below): D Check here iflhere is nor enough space for your answer. Pu! your complete answer 0n the attached sheet of paper orform MC-025 and write "Alrachmen! 3b-Why 0!}:ch Need Protection ”for a title. This is not a Court Order. :fifiififigggggfigfijw Request for Ci_v§l Harassment Restraining Orders CH-1oo, Page 1 ore GB. (CIVII Harassment Prevention) ROHc, [1 FVERN9“FIFE Case Number: Q) Relationship of Parties How do you know the person in ®? (Explain below): pen ’5‘ (- f1“ D Check here iflhere is nor enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and wrire “Attachment 4-Relalionship ofParties "for a title. ® Venue Why are you filing in this county? (Check all that apply): a. D The person in ® lives in this county. b. E l was harassed by the person in® in this county. c. D Other (specify): ® 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 D N0 (Ifyes, check each kind ofcase and indicate where and when each was filed.) Kind of Case Filed in (Countv/State) Year Filed Case Number (ifknown) (l) D Civil Harassment Evfl A (la V“ (”I l’ J1 ’2‘ 2! ‘ 0 17’03'5‘1 (2) D Domestic Violence (3) D Divorce. Nullity, Legal Separation (4) D Paternity, Parentagc, Child Custody (5) D Elder or Dependent Adult Abuse (6) D Eviction (7) D Guardianship (8) D Workplace Violence (9) D Small Claims (10m Criminal (1 DD Other (specifiz): b. Are there now any protective or restraining orders in effect relating to you or any of the persons in @and the person in®? D No wYes (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. (l) When did it happen? (provide date or estimated date): (2) Who else was there? [See attached declaration for a Description of Harrassment] This is not a Court Order. R“’°“’"“"’”°‘° Request for Civil Harassment Restraining Orders CH-1oo, Pagezore (I3m (Civil Harassment Prevention) w... Em 9 [Case Number: §16H009840 ® a. (3) How did the person in® harass you? (Explain below):D Check here ifthere is no! enough spacefor your answer. Put your complele answer 0n the attached sheet ofpaper orform MC-025 and write "Attachment 7a(3)-Describe Harassment "for a title. (4) Did the person in® use or threaten to use a gun or any other weapon? Yes D N0 (Ifyes, explain below): D Check here iflhere is not enough spacefor your answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write “Atrachmem 7a(4)--Use of Weapons "for a title. 1 WC“) swa'fll’rl jenAlmtg 3 A 12. Hand GUM 1* 30 " 1‘ (5) Were you harmed or injured because of the harassment? es D No (Ifyes, explain below): D Check here ifthere is no! enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write "Attachment 7a(5)-Harm or Injury "for a title. Xwas Skot- ON |‘30r2‘ (6) Did the police come? Yes D No If yes. did they give you or the person in ®an Emergency Protective Order?flYes D No If yes, the order protects (check all that apply): Me D The person in ® D The persons in @. (Attach a copy OfIhe order ifyou have one.) b. Has the person in ® harassed you at other times? Yes D No (Ifyes, describe prior incidents andprovide dares ofharassment below): Check here ifthere is n0! enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write “Alrachmem 7b-Previ0us Harassment ”for a title. h Hound AH mu Vchylcs Tire; Cnse 1L 2i‘OZ7‘O%€‘( ON hZ’z’U I This is not a Court Order. R'“”‘“‘"“" "2°“ Request for Civil Harassment Restraining Orders CH-1oo, Page 3 ofe (IEm (Civil Harassment Prevention) 9 Case Number: Check the orders you want. E E Personal Conduct Orders l ask the court to order the person in @not to do any of the 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 of, or disturb the peace of the person. b. mContact 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. mOther (specifi’): 3+ ‘\ Y AW“ Y I500 VG rd 5 D Check here {fthere is not enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write "Attachment 8c-01her Personal Conduct Orders. "for a title. The person in ® will be ordered not to lake any action to get the addresses or locations ofany protectedperson unless the courtfinds good cause not (0 make the order. ® DStay-Away Orders a. l ask the court to order the person in ® to stay at least joo- yards away from (check all that apply: (1) Me. (8) My vehicle. (2) ‘The other persons listed in®. (9) Other (specifil): (3) My home. (4) ‘ My job or workplace. (5) My school. (6) z 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, or job? w Yes DNO (Ifno, 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-Slay-Away Orders, "for a title. Guns or Other Firearms and Ammunition Does the person in ®own or possess any guns or other firearms? Yes DNO DI don't know IfIhejudge grams a protecrive order, the person in ® will be prohibitedfrom owning. possessing, purchasing, receiving. 0r attempting Io 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 enforcement. or sell r0 or store with a licensed gun dealer, any guns orfirearms within his 0r hcr imnmliate possession or control. This is not a Court Order. “mm“ ‘- 2°” Request for Civil Harassment Restraining Orders CH-1oo, Page4 otsGBw (Civil Harassment Prevention) 9 Case Number; _21_Cflflfl£8_lLlL___ ® E Temporary Restraining Order I request that a Temporary Restraining Order (TRO) be issued against the person in ® to last qntil the hearing. l am presenting form CH-I l0, Temporary Restraining Order. for the court’s signature together wuth this Request. Has the perso in ® been told that you were going to go to court to seek a TRO against him/her? DYes o (lfyau answered n0, explain why below): D Check here ifrhere is not enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write “Attachment 11-Temporary Restraining Order "for a title. ® Request to Give Less Than Five Days' Notice of Hearing 'ou must have your papers personally served 0n the person in® at leastfive days before the hearing, unless the court orders a shorter timefbr 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 [hat (he papers have been served.) Ifyou want there to be fewer than five days between service and the hearing. explain why below: D Check here {fthere is n0! enough spacefor your answer; Put your complete answer 0n the atlached sheet 0f paper orform MC-025 and write "Attachment I2-Request to Give Less Than Five Days' Notice "for a title. ® D§£ Fee for Filing or Service a. There should be n0 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 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 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 l 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 I ask the court to order payment of my D lawyer's fees m Coun costs. The amounts requested are: Ltgm Amount m Amount Eilingfiee $ 4.35 $ $ $ L $ D Check here ifrhere are more items‘ Put flw items um! amounts 0n the attached sheet ofpaper orform MC-025 and write “Attachment IJ-Lawyur 's Fees and ('osrs"fi)r a title. This is not a Court Order. WWW” ‘- 2°“ Request for Civil Harassment Restraining Orders CH-1oo, Page 5 oteGB DEM'“ (Civil Harassment Prevention) 9 Ease Number: D Possession and Protection of Animals I ask the court to order the following: a. DThat I be given the sole possession, care, and control of the animals listed below, which l own, possess, lease, keep, or hold, or which reside in my household. (Identify animals by, e.g., ope, breed, name. color, sex.) l request sole possession of the animals because (specifii 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-Possession 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. yAdditional Orders Requested I ask the court to make the following additional orders (specifiy): D Check here Iflhere is n0! enough spacefor your answer. Pu! your complete answer 0n the attached sheet 0f paper or orm MC-OZfigdfi'rfle "Attachment 16-Additiona1 Orders Requested, "for a title. Mme u+ Y no (‘mjac ordef .fl w -4 ,-‘ ¢ r 9 ® Number of pages attached to this form, if any: Date: - d } self-Bepcesented - Lawyer 's name (if(myy 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: $0010! pubsnflm p Type or prim your name Sign yo'ur name ' This is not a Court Order. Rum Jmuay 1. 201B Request for Civil Harassment Restraining Orders CH-1oo, Pagesore (IE > gm“ (Civil Harassment Prevention) 0N \W 10 y 12 '13 14 15 16 17 18 19 20 21 22 23 24 25 210H009840 CASE NAME: b“ m 3"“ D CASH S ame as ame CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? RCA 4' { V b) Are you living with the person? w YES D No c) Has the person wphysically abuse youfi physically or verbally threatened you and/or w 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): HA5 Came TO mxg Pow mqml OCCQSI'O n mum Mt m +0 6me ow Sw’a Ba ul WW Pmflirw Damaomfl Q 30 I“ qucmm‘. Ad ww \lek \e/ s Inns Wart ?\uktmtl beyond QLp((\Vt 0N I50!Zl +Kflld W43 V“ log! Amome Hr and me a Muiw‘l Com but 3 wa 3 Wade; zed Ha de YYIC he, W515 CxOm‘) T0 IL“ H WW CHM“ \l KL \IJ’ V“: lflSlO‘fl and fiO‘f' GU n I he. CCU“ a {BccuL 0er Cmd ”(w a of +0 1’19 M m0 «Uxefl 9401’ m0 \ CH-100, Item 73(3) - DESCRIBE HARASSMENT Page_ MC-020 . SHORT TITLE: CASE NUMBERr LastName and L m Zlcfloogeho 2 3 5r! Fear b( rm humbly am} Hut SaHy i \dlo‘ +(\[ W Ox®+€C+ fhém bu‘f’ I FaI/éé/ and IWQS SHM” SHNc/n Pro Hwy 0/1 mmeUS OCCCISIDHS ’DISHUWA WW Dmpwhl o And Sufi 30K QDHC6 \JotrL Callzd {o 1. Case :L zvomrogsq amp lt~oeo-0587_/ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 (Required for ven'fied 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. Page Form Awmauy me ADDITIONAL PAGE CR0 201. 501Juaad Coma o! cadomuMom NewJmmr 19671 Attach to Judicial Council Form or Other Court Paper Mann man's Essonod Poms T“ 10 11 12 13 CASE NAMEPOSSGMand H O CASE #z 21 cunn 93 99 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? p YES U No IWES". describe: #WI \ R O SNH Mb f) Were there any injuries during abuse in the past three month37mES D NO IWES". describe: 06w if avw/ ’94 77 6 (gr \e q was $hm 0m L‘ 50rd, r361 h} 9 HMUN/ g) Did the police come to any of these recent events? EYES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months?wEs D NO If “YES", please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? MES DNO |f“YES",where: 3hr J (4 (Icy u a {‘0 J41 ( j) Has the person you want restrained ever been in jail for violence against you or your children? DYES muo If"YES",when: Describe what the person did to you or your children that caused them to go to jail: Aesz wmx a GUM: 1 was 8M1“ Cage fizmaoogw 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 NAMEQamma and H O CASE #; 2 1 C H 00 98 4 0 Last Name 'Last Name k) Do you have a criminal protective order (restraining order from criminal court)? C1 YES ENC If “YES", please attach a copy. l) Describe the worst abuse and when it happened: p The most recent abuse i_s the worst abuse OR U The worst abuse was (approximate date) \’ 3 O ' Zt and the person I want a restraining order against (describe what mey did to you): H C TH r 9 q + L’n XOHU Mygamdy mxd-wl‘un \aa SHof me, 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_