Request Restraining OrderCal. Super. - 6th Dist.February 3, 2021r CH 100 ' Request for CIV" Harassment Clerk stamps date here when form is filed. -_estraining Orders . - H L E r AwRead Can a Civil Harassment Restraining Order Help Me? (form CH-I 00- . i ‘ INFO) before completing this form. Also fill out Confidential CLETS FEB Iry’ormation abrm CLETS-OOJ) with as much information as you know. ‘ 3 2021 ' Clerk of Ih Cou Q w , U rt x® Person Seeking Protection BfflMgm Q90 a. You FullName: PUTY Qvaa \AHXK mm wards 2bAge. Your Lawyer (Ifyou have onefor this case) Fm in court name and street address: Name:Selfiaeplesefllfld- State Bar No.2- Superior Court of California, County of F. N ‘ _ Santa C|_ara”m ame‘mmm 191 N. First Street b. Your Address (Ifyou have a lawyer, give your lawyer‘s 191 N. First Street San Jose, CA 95113 Civil Courthouse- DTSinformation. Kyou d0 n0! have a lawyer and want t0 keep your home address private you may give a different mailing address instead. You d0 not have t0 give telephone fax, 0r e- mail) Court fills in case number when form Is fired. Address: 0L72H 06161 [1 fl l hi A ‘J ‘i Case Number: t;W33 33w M-L m a H n n 9 a z; zg ‘- H Telephonefi Fax- u. m v - - v u v w H l' E-Mail Address. HQWOJ )a 2,6,4 la G l 0'5) Omani ‘ Q0 r“ ® Person From Whom Protection ls Sought Full Name: 6fl¥ W‘ql SKJK Age; 2.5 Address (yrknown):29 2q Ya Sc‘“W“ W- ‘ City: gt? n joj£ Statezm" Zing 57' (2'7“ ® Additional Protected Persons a. Are you asking for protection for any other family or household members? DYes DNO flyes, list them: Full Name fl Ag; Lives with you? How are they related to you? D Yes D N0 D Yes D No D Yes D N0 D Yes D N0 D Check here if(here are more persons. Atrach a sheet ofpaper and write "Attachment 3a#Addi!i0nal Protected Persons ”for a title. You may useform 1110025, Attachment. b. Why d0 these people need protection? (Explain below): D Check here I‘frhere is nor enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write “Afiqchmem 3b-Why Others Need Protection ”for a rifle. This is'not a Court Order, 3:32:93giggingé?§f§i§:§£g§g§f§;j9°“ Request for Ci_vj| Harassment Resgraining Orders CH-1oo, Page 1 ofe nua] (CIVII Harassment Prevention) ROHC/ [l PVERN9 mhmm E- Case Number: ® Relationship of Parties How d0 you know the person in®? (Explain below): D Check here ifrhere is nor enough spaceforyour answer. Pu! your complete answer on the attached sheer 0f paper orform MC-025 and write ”Al(achmenr 4-Relali0nsjzip ofParfies " 0r a title. 9v 1,3 a {owyvm‘ll *J‘ML \E'UfiJ ”I JAM flame r © Venue Why are ou filing in this county? (Check all that apply): a. The person in® lives in this county. b. D [was harassed by the person in© in this county. c. a Other (speczfl): ® Other Court Cases a. Have you or y 0fthe persons named in© been involved in another court case with the person in@? a Yes 5:10 (Ifyes, check each kind ofcase and indicale where and when each wasfiled.) Kind 0f Case Filed in {Commr/Srate) Year Filed Case Number (ifknown) (1) a Civil Harassment (2) a Domestic Violence 7' (3) D Divorce, Nullity, Legal Separation (4) D Paternity, Parentage, Child Custody (5) a Elder or Dependent Adult Abuse (6) a Eviction (7) D Guardianship (8) D Workplace Violence (9) D Small Claims (10)D Criminal (lDD Other (specijfiJ): J b. Are there now any protective 0r restraining orders in effect relating Io you or any of the persons in @and the person in@? a No DYes flfyes, a(lach a copy ifyou have one.) ® Description of Harassment Harassment means violence or threats ofviolence against you, or a course 0f 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. I (I) When did it happen? (provide date 0r estimated date): OI I 1L1 f 3‘ 2 1 I t1 ? . .( ) W10 e SB was me [See attached declaration for a Description of Harrassment] This is not a Court Order. RW‘9‘Pagge‘r-‘igf Request for Ciyi] Harassment Restraining Orders CH-1oo, Page 2 ofs 935%, jaFonnw (CIVII Harassment Prevenhon) 9 Case Number: ® a. (3) How did the person in® harass you? (Explain below):D Check here zfthere is not enough spacefor your answer. Pu! your complete answer 0n rhe attached sheet ofpaper orform MC-025 and write “Attac/nnen! 7a(3)-Describe Harassmenf”f0r a title. \WG a \cnKGQ 00\- o“ XML H03 WW6 OWEN M cmd M emf Mm (‘jurgcs Mona Vail? $Lf‘CQ/HL4 Cvf 0‘6. b\‘mbfl \‘g W b\A b\UAMflR TY‘Q Jm‘es yo \nhmx‘dwe M Voqlrructfi‘r (toW‘k-A (4) Did he person in® use or threaten to use a gun or any other weapon? Yes D No (Ifyes, explain below): D Check here zfrhere is not enough spacefor your answer Put your complete answer 0n the attached sheet ofpaper 0rform MC-025 and write "Attachment 7a(4)-Use of Weapons’ f0: a title. \V/P< IAJ «Um m‘ l/nlva . (5) Were you har ed or injuredbecause ofthe harassment? D Yes N0 (Ifyes, explain below): D Check here :fthere is not enough spacefor your answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write "Anachment 7a(5)-Harm 0r Injury”for a title. 1/ (6) Did the police comej/fiYes a No Ifyes, did they give olu or the person in @an Emergency Protective Order?D Yes dNo If yes, the order protects (check all that apply): D Me D The person in ® D The persons in’ © (Attach a copy 0fthe order ifyoz: have one.) b. Has the person in ® harassed you at other times? Yes D N0 (Ifyes, describe prior incidents andprovz‘de dares ofharassmen! below): a Check here ifthere is nor enough spacefor your answer. Put your complete answer on the attached sheet 0f paper orform MC-025 and write "Aftachmenr 7b-Prew'ozts Harassment"for a title umc OWL -H VHL ‘3: um < WMShMm +lm” n WINK and 11f ”(‘mmr Hm WM ha C K 0‘an J» {vi +0 kaant 19L“; f fim (N Hum MLwe, +0“ 1n Mu ML. m/Lot) T J»; ll Kt >41 n r‘ rind hf +€ H "W‘L Mm". nu+ owl 1V +9 \K ‘nl m b8 Lao (a 22 Am¥ LA»Jawf +00 (MIA M . ~ _ L,905V mm} 01f m Thisis notaCourtOrder. Rem‘mma’y‘ 2;“: Request for Civil Harassment Restraining Orders CH-1oo, Page 3 ore CEB Essen“ Civil Harassment Prevention 9Gum, 2ijorrnS' Case Number: Check the orders you want. E a Personal Conduct Orders I ask the court to order the person in ®not to do any ofthe following things to me or to any person to be protected listed 1n @z a. E Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy personal property of, 0r disturb the peace 0fthe 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. V c. DOther (specify: D Check here ifthere 1's not enough spacefor your answer. Put your complete answer 0n lhe attached sheet ofpaper orform MC-025 and wrile ’C4ttachmen! 8c-Other Personal Conduct Orders, "for a title. The person in ®will be ordered not to take any action [0 get the addresses 0r locations ofany proreciedperson unless {he courffinds good cause nor (0 make the order. ®Stay-Away Orders a. I ask the court to order the person in ® to stay at leastbio- yards away from (check a1! that apply): (1) m Me. (8) a My vehicle. (2) D The other persons listed in@. (9) m Other (specxfi): (3) @Myhome. Exxrmfl'omf gav IMM‘§" ‘5th 4 M .b kl 3-112 5 rwmr. fucu/f’w /,74£/”5t’/'1OE m0 orwor Pace. MI 7:) ruL Jr 1/014. s4”: M (5) a My school. 1‘ nnL-ic’ - (6} D My children’s school. (7) a My children’s place 0f child care. b. lfthe court orders the person in ®t0 stay away from all the places listed above, will he 0r She still be able to get to his 0r her home, school, orjob? D Yes DNO ([fno, explain below): D Check here Jrlrere is not enough spacefor your answer. Put your complete answer 0n {he aflached sheer of paper orform MC-025 and write "Attachment 9b-SIay-Away Orders, "for a title. I don"t know possessing, purchasing, Does the person in @own 0r possess any guns or other firearms? DYes DNO Ifthejudge grants a protective order, the person in ® will be prohibitedfrom owning, receiving, or arrempfing to purchase or receive a gun, otherfirearm, and ammunition while the protective order is in eflecr. The person in ®wil1 also be ordered to turn in t0 law enforcement, 0r sell to 0r store with a licensed gun dealer, any guns orflrearms within his 0r her immediate possession or control. This is not a Court Order. Guns or Other Firearms and Ammunition $ Remmm" 2°” Request for Civil Harassment Restraining Orders CH-1oo, Page4ore CEB'g (Civil Harassment Prevention) 9W mm Case Number: ® E Temporary Restraining Order I request that a Temporary Restraining Order (TRO) be issued against the peyson in ® to last qntil the hearing. I am presenting form CH-I 10, Temporazy Restraining Order, for the court’s Slgnqture together w1th thls Request. Has the person in been told that you were going to go to court to seek a TRO against him/her? DYes N0 (Kym: answered n0, explain why below): D Check here Ifthere is not enough spacefor your answer. Put your complete answer 0n the attached sheet 0f paper orform MC-025 and write “Attachment IJ-Temporary Restraining Order "for a title. Befiudfi 3'5 hard 4W: '1 m3 44o +6» NC ud‘ Ha lnc' WI . ram rl +- A‘gabi’mfgl’ 114/!er +Aflm‘nj IALAVI hEM Le 3&3 @555 D? ® D 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 It'mefor semu'ce. (Form CH-ZOO-INFO explains What Is “Proof 0f Personal Service”? Form CH-ZOO, Proof of Personal Service, may be used I0 show the court 112a! the papers have been served.) lfyou want there to be fewer than five days between service and the hearing, explain why below: a Check here zfthere is nor enough spacefor your answer. Put your complete answer 0n the attached Sheet 0f paper orform NIC-025 and write "Attachmen! 12-Reqzlest (0 Give Less Than Five Days'Notice ”for a title. D No Fee for Filing or Service a. a There should be no filing fee because the person in®has used or threatened t0 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 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 threat 0f violence, or stalking. c. D There should be n0 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-OOI. Application for Waiver of Court Fees and Costs.) a Lawyer's Fees and Costs l ask the court to order payment 0f my D lawyer's fees E Court costs. The amounts requested are:m Amount m Amount Filing Fee 5E 435 $ $ $ 1: $ . D Check here ifthere are more items. Put the irems and amounts 0n the attached sheer ofpaper orform MC-025 and write “Attachmenl J4-Lawyer ’s Fees and Costs”f0r a title. This is not a Court Order. E‘EEJagféyegifa‘f Request for Ciyi'l Harassment Restraining Orders CH-1oo, Page 5 ore Epomsu (CIVII Harassment Prevention) 9 Case Number: 65> 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, 0r hold, or which reside in my household. (Idemtfil animals by, e.g., type, breed, name, color, sex.) Irequest sole possession 0f the animals because (spchjJ good causefor granting order): D Check here ifthere is not enough spacefor your answer. Put your complete answer 0n the attached Sheer ofpaper orform MC-025 and write "Attachment 1 5a-Possession ofAnimals ”for a tille. b. DThat 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 0f, the animals listed above. DAdditional Orders Requested I ask the court to make the following additional orders (specifi’): D Check here ifrhere 1's not enough spacefor your answer. Put your complete answer 0n the alrached sheet 0f paper orform MC-025 and write "Attachment I 6-Addiri0nal Orders Requested, ”for a title. ® Number 0f pages attached to this form, ifanyz- Date: SelLRepLesented- - ’ Self-Represented Lawyer ’s name (:fany) 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: F2) Z7 :92 f ,/ /_/_./::F:7 ‘r > 5’W KNType or prim yo name ign your name This is not a Court Order. , Request for Civil Harassment Restraining Orders CH-1oo, Pageaore C&EB 'Efigfig (Civil Harassment Prevention) Revised January 1. 201a 10 ‘11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: and CASE #z Last Name Last Name CH-‘IUO, Item 78(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? RamaExWfim b) Are you living with the personW El NO c) Has the person III physically abuse you, physically or verbally threatened you / anleassed you many times? (Please check ail 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): (’30 :50“wa 7.3 20% m \mgwkuag ?)rek WnN/Sq (“mendW \\Pm OJ“ Uqur SVMRA \Xf \\mc\ OKOA. magma$$WP‘NM €06 otaco, \MWMYW ‘r\m\)86\\®\d\j ‘2\O\V\\- QQEQJQ \3 ?QA- Smflflak \Quumq 0(0va W \nooS‘Q aw Lowmwed b3 \Aa/U. 5M km: Pom‘v 1 (Lam VAMQQ Sin‘r \ZvQ/k a Nssqsa CUr \\. Sépm \(0 VNQSQ 3%? SU‘Qmequ and’r wfloeck m OWU WARNS \V\W \rxwxz ?Mz MM am mee,m MM momm {BM («mMmd ‘ro (\xmwd mq w/quv am§ amvné \HOWL mus K29? 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Page avié‘f‘ Jugggpgggggxggggggmm ADDITIONAL PAGE cac 201 5m moozofimaalnggrflyntmen Attach to JudicialCouncilForm orOther Court Paper Wag “\Vq S‘P‘n N Mam‘n en's Essentiar Forms TM x De and 599m ken ke/fl‘W 0&0 W 0x 3 5W0 - 10 1‘I 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: and CASE #z Last Name Last Name e) Were any guns o‘r other weapons used or threatened to be used during any abuse in the past three months? Jz/YES D No If “YES". describe:WWW \QWQQ/ f) Were there any injuries during abuse in the past three months? U YES filo 1f “YES". describe: g) Did the police come t0 any of these recent events? fiES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES P40 lf "YES”, please attach a copy. i) Is the person you want to restrain in jaiI right now for violence against you? :1 YES .g’fio If "YES", where: j) Has the person you want restrained ever been in jail for violence against you or your children? D YES V NO lf“YES”, when: Describe what the person did to you or your children that caused them to go to jaiI: CH-‘IOO, Item 78(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 F40 [f “YES”, please attach a copy. l) Describe the worst abuse and when it happened: E1 The most recent abuse i_s_ the worst abuse O B/The worst abuse was (approximate date) Q! [f2 fl 2;! and the person l want a restraining order against (describewhazmey diam you): QL 49% +031 +6 06mm {hug "(gnm DOOV 0m J 179, 15.” O\\{\5\>Y\\ \DD um 1 \LM’ Kgfl¢ \AL/Ix no 16 dnmco. 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CA'QS1_1_0‘ CASE NUMBER: "rYPE 0F 1NCIDEN ‘.." 3),. . ,, ". ’INSTRUCTIQN fyou are a Ehme vlctlrn Alyourinsumnca pqu; andtaxpurposes V summary of a p_b|!ce [epqrt To s piy ad Ifiona‘ n'onnaflon cén ' Poxoe Dépanmetpl Non- -Eme‘ Veywna'xanyfl - J lle ed for safakee In ,vc’pnmEt the Pmpgfly Warehousg (277-4268) lo claim yuur pTéfi'eny NONE; To mcamr propam co p g _nd will pe m_cyqed: aucfloued'dbnatad; or Pmpafiy no! dalmed wlm'vh sq day§ MII bawrnp ma properjy 01 the City of San‘Joser n I ‘ ' di§posed Olas i‘efusé > ‘ . 7‘ a : I . ' véhicl'a mG'slcontact 1 catéd within a véh1cla which has b'e_cn o 'me regIIsterad ’owfier of ma gor T6 recover pinperty q mssuesafise ”Udng thé low cémpgny. Cotht t_he San Jos_a Pojioé D dfnenl Non Emergejhgy Une [31 1) {or a 0M1 grand ' cuss. ...r ‘ ' SB SO» m . - rde 'E‘u‘riejpé‘ne.Pam dar: pjmacTon didonal‘conwespecloa , ‘ ‘fiiifnero 3M- ATENCION' SI La pdlldales re_fl_m p}? Hadad p_or seguddad paratec‘amarw‘propiedad? (q 'éda ’que no se aclar_ne an! de 98 ' du fibreglstra' odél'canp ‘ inumbem 311 para en eipem c‘nanijafl _/ a WWW 039 REQUIRED STATEMENT OF REASON FOR TERNHNATION OF TENANCY OR EVICTION AND NOTICE OF SMALL BUSINESS TENANTS’ RIGHTS (Per County 0f Santa Clara Ordinance N0. NS-9.287, as amended by Ordinance Nos. NS-9.288, NS-9.289, NS-9.292 and NS-9.293) The County of Santa Clara has enacted a moratorium on evictions for non-payment of rent where small business tenants have incurred substantial income loss and/or substantial out-of-pocket medical erenses as a result 0fthe COVID-19 pandemic. As of September 1, 2020, this moratorium protects small businesses. Many residential tenants now qualify for eviction protection under state and federal law. Under the County Ordinance, a landlord is required to add to any notice to terminate a tenancy (such as a 3-day notice to pay or quit, or a 30- or 60-day notice) the following: 1. The reason for the termination of the tenancy or eviction; 2. A notice of the tenants’ rights under the Ordinance; and 3. A notice of emergency rental assistance programs. The above information must be supplied on this form. Reason for Termination 0f Tenancy 0r Eviction Please state the reason(s) for termination of tenancy or eviction (to befilled out by Landlord/properly owner): Vlofent: disrupting the peace within the household and pulfing a knife out on renters. Daiiy being drunk: Yelling and banging on renters bedroom doors. Harrazing renters by groping them and invading their personal space. Consumption of daily drugs within the household. Damage to Property pulled a knife out and started slashing the door with it. Renters are anxious and scared for their safety. Having to call the cops 0n individual (Bret Hennesy) numerous times. Page l of3 11.032020 Version REQUIRED STATEMENT 0F REASON FOR TERIVIINATION OF TENANCY OR EVICTION AND NOTICE OF SMALL BUSINESS TENANTS’ RIGHTS (Per County 0f Santa Clara Ordinance N0. NS-9.287, as amended by Ordinance Nos. NS-9.288, NS-9.289, NS-9.292 and NS-9.293) Notice 0f Tenants’ Rights On March 24, 2020, the County enacted Ordinance N0. NS-9.287, which temporan'ly bans evictions for non-payment of rent if you, a small business tenant, demonstrate that you have sufl‘ered a substantial loss of income or substantial out-of-pocket medical expense due to the COVID-19 pandemic. As of September 1, 2020, this eviction moratorium applies to small business tenants and has been extended until March 3 1, 2021. Ifyou qualify for protection under the Ordinance, your landlord cannot evict you for non- payment of rent if: 1. You are unable to pay your rent because of substantial loss of income resulting from the COVID-19 pandemic; or 2. You are unable t0 pay your rent because 0f substantial out-of-pocket medical expenses for yourself 0r an immediate family member resulting from the COVID- 19 pandemic. Ifyou qualify for protection under the Ordinance, you have tights that relate to your repayment of past-due rent. These are: 1. You have uQ t0 6 months fi'om the date the Ordinance expires 0r is terminated t0 repay at least 50% 0f your past-due rent; 2. You have up t0 12 months fiom the date the Ordinance expires 0r is terminated to repay all ofyour past-due rent; and 3. A landlord cannot charge a late fee and/or penalties for rent that was deferred as a result ofthe Ordinance so long as you repay your rent according to this timeline. You should notify your landlord in writing that you arc unable to pay your rent due to COVID- 19 as soon as possible. The County has a form you may use to notify your Landlord, which you can find 011 the County website at: bitJy/scctenant. You can show your inability to pay through documentation such as closure ofbusiness or reduced business income, bank statements or other financial documents. (The Ordinance lists other examples.) Ifyou are served with a notice of eviction durifig the moratorium, you have the right to: 1. Receive this Notice as well as all other legally required notices; 2. Receive the reason for the termination oftenancy or eviction in writing; and Page 2 0f3 11.032020 Version REQUIRED STATEMENT OF REASON FOR TERMINATION OF TENANCY OR EVICTION AND NOTICE OF SMALL BUSINESS TENANTS’ RIGHTS (Per County of Santa Clara Ordinance N0. NS-9.287, as amended by Ordinance Nos. NS-9.288, NS-9.289, NS-9.292 and and NS-9.293) 3. Receive information on emergency rental assistance programs. For more information, please refer to the Frequently Asked Questions on the County website at: bit.lx/sccemfags. You should also seek legal help to understand your rights and reSponsibilities under the Ordinance. A list of emergency rental assistance programs is available on the County website at: bit.ly/sccemresources. Page 3 0f 3 11.03.2020 Version