Declaration In SupportCal. Super. - 6th Dist.February 4, 2021ATTACHMENT CV-5014 NAME AND ADDRESS OF PARTY 0R ATTORNEY FOR PARTY: TELEPHONE NUMBER: FOR COURT USE ONLY RQWQ/Du 30m 21H (mum MM .scm )ogg ,m qgmb AWORNEY FOR(~amc): Self-Represented l L E DSUPERIOR COURT 0F CALIFORNIA, COUNTY 0F SANTA CLARA FEB _ ISTREET ADDRESS: 191 North First Street, San Jose. CA 951 13 4 202] MAILING ADDRESS: 191 North First Street CITY AND ZIP CODE: San José, CA 951 13 BRANCH NAME: Downtown Courthouse Person/Entity Seeking Protection: ?QVQmu MN“ Person From Whom Protection is Sought: FQ \An LQ DECLARATION IN SUPPORT 0F EX PARTE APPLICATION FOR CASE “UMBER: ”P”: CIVIL RESTRAINING ORDERS Z 1 C H 00 98 ll 8 l. the undersigned. declare: 1. I am (choose one): D attorney for Person or Entity Seeking Protection m self-represented Person or Entity Seeking Protection D other (explain): 2. The opposing party Is represented by an attorney: D Yes mo (If you checked “yes". fill in the attorney's name. address. and telephone number. If you checked “no". fill in the other party's name address. and telephone number. Party/Attorney name: W1W0 L Q Address/Telephone number: Z700 (UYU'Sfm haw \Sun 10$ e C A qg \ ‘1 b 3. OTHER CASES: Have the parties to this case been involved in litigation with each other in another Civil. Family. Probate Juvenile, or Criminal Cour! Case? D Yes m No If “yes". case(s) number(s): 4. NOTICE a. I HAVE given notice to the opposing party and/or their attorney by the following method: D Personal delivery D Overnight Carrier D First Class Mail D Other: Date: Time: | have received confirmation that the other party has received my papers as follows: (describe) b. I HAVE NOT given notice of the request for orders because (Check all that apply. You must explain below): M This is an application for Civil Harassment Prevention Act, Elder Abuse. Private Postsecondary School Violence. Transitional Housing Misconduct. or Workplace Violence Act restraining orders and: Great or irreparable injury will result before the matter can be heard on notice. D It is impossible to give notice. D The other party agrees to the orders requested. D Other: c. Explanation: D A hearing between the parties is already set | am asking that this motion be heard at the same time. D l am unable to serve the other party in the time required by law. l fear for my physical safety (and that of others, if applicable). D Other: I declare under penalty of perjury that the forgoing is true and correct. ?QVQW/m 10m /AaZ/a ’fig/w Date Print Name Degérant's SignaW ' CV50“ REV 09/15/13 DECLARATION IN SUPPORT OF EX PARTE APPLICATION FOR P399 1 °'2