Request Restraining OrderCal. Super. - 6th Dist.February 4, 2021CH 100 Request for Civil Harassment olemstampsdaze here wnenronmsmed.___'__ ,_ Restraining Orders Read Can a Civil Harassment Restraining Order Help Me? (form CH-100- I L EINFO) before completing this form. Also fill out Confidential CLETS Information (form CLETS-OOI) with as much information as you know. FEB - 4 2021 Person Seeking Protection Umy o, Santa cm a. Your F ll Name: Z TY _ QV 0/0/00 1”” Age: Li Your Lawyer (ifyou have onefor this case) Fill in court name and street address: Name: SeIf-Represented. __ State Bar No.2 __ _. gupeziorcclourt of California. County of . _ an a ara b. Your Address (Ifyou have a lawyer, give your lawyer's 191 N. Flrst Street . . . San Jose, CA 95113Information. lfyou d0 no! have a lawyer and wan! t0 keep your Civil courthouse _ DTS home address private, you may give a diflerent mailing address instead. You do not have to give telephone, fax, 0r e-mail.) Court fills in case number when form is filed. Address: Z T“ C QYQJTm WQ1 Case Nu r' 8 City: Sun 3 USP State: .CA. Zipzflfiflfl- ET c H 00 9 8 a Telephone: Fax: E-Mail Address: ® Person From Whom Protection ls Sought Full Name: ¥pV\n L9 Age;mu‘ 3O Address (ifknown): 7 30 b CCHQS Kn W0 1 City: J0“ IDS Q State: CA Zip: qsflb G.) Additional Protected Persons a. Are you asking for protection for any other family or household members? mYes D No lfyes, list them: Full Name m Ag; Lives with you? How are they related to vou? QOW‘JUH‘V ]U\fl\ F 55 m Yes D No “Um“hmr‘npm wm r1 4} m Yes a No mmvD Yes D N0 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 M0025. Attachment. b. Why do these people need protection? (Explain below): D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write ”Attachment 3b-Why Others Need Protection ”jbr a title. He \J (tqwmu us and mnum‘mg. np mcads *mmmm mm vahws dWLm. This is not a Court Order. udlp’al CouncloiCaliforni .www. nacagov ' ' - - $33.39 mmrggédmassmfigfig Request for (Celia: :a?;:::$$3:eseer‘st§gra‘;nlng Orders CH-1oo, page 1 ofs m- fgjuu'u ROHC/ [l PVERN9m ' ___... Case Number: 21CH009848 Q) Relationship of Parties How do you know the person in ®? (Explain below): D Check here if(here 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. ' N m (Ahmr J® Venue Why are you filing in this county? (Check all that apply): a. E The person in® lives in this county. C. b. a l was harassed by the person in® in this county. Other (speqfi'): @ 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 m No (lfyes, check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in (Counry/Stale) Year Filed Case Number (ifknown) (l) D Civil Harassment (2) D Domestic Violence (3) D Divorce, Nullity, Legal Separation (4) D Paternity, Parentage, Child Custody (5) D Elder or DependentAdultAbuse (6) D Eviction (7) D Guardianship (8) D Workplace Violence (9) D Small Claims (10)D Criminal (l DD Other (speciflz): b. Are there now any protective or restraining orders in effect relating to you or any of the persons in @and the person in®? m No 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. (1) When did it happen? (provide date or estimated date): O\ / 2 q / 201‘ 2 Wh l h ?( ) o e se waSt ere [See attached declaration for a Description of Harrassment] This is not a Court Order. “'“MJ'M‘”‘-2°‘° Request for Civil Harassment Restraining Orders CH-1oo. Pagezots(mw (Civil Harassment Prevention) 9 Case Nu ??%H009848 CI) a. (3) How did the person in® harass you? (Explain below): D Check here ifthere is not enough spaceforyour answer. Pu! your complete answer on the attached sheet ofpaper orjbrm MC-025 and write "Attachment 7a(3)-Describe Harassment "for a title. 31L WWW (4) Did the person in® use or threaten to use a gun or any other weapon? w Yes D No (Ifyes, explain below):D Check here ifthere is not enough spaceforyour answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write "Attachment 7a(4)-Use of Weapons "for a title. (5) Were you banned or injured because of the harassment? D Yes E No (Ifyes, explain below): D Check here ifthere is not enough spaceforyour answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write "Attachment 7a(5)-Harm 0r Injury "for a title. (6) Did the police come? m Yes D No If yes, did they give you or the person in ®an Emergency Protective Order?D Yes m No If yes, the order protects (check all that apply): DMe D The person in ® D The persons in ® (Attach a copy 0fthe order ifyou have one.) b. Has the person in ® harassed you at other times? Yes D No (Ifyes, describe prior incidents and provide dates ofharassment below): a Check here ifthere is not enough spaceforyour answer. Putyour complete answer on the attached sheet 0f paper 0rjbrm MC-025 and write “Attachment 7b-Previ0us Harassment for a title.m 3x1 2020 v nqvuned (m (mm m an mm w qo cm er 10mm 8M1 mum m noun m kw, hwse ouaInde (mm; m em am g mater am cmnum Pavwd w (av an dmmwt wwwd arm omd awed’WW 0H M / zuzm This is not a Court Order. l Request for Civil Harassment Restraining Orders CH-1oo, Page 3 ots GB|w (Civil Harassment Prevention)a... Elm -)Rcv‘mod January 1. 201B Case Number: Check the orders you want. E m 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 @2 a. a 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. c. Other (specifv): 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 8c-Other Personal Conduct Orders, "for a title. The person in ®will be ordered not to take any action to get the addresses or locations ofany protectedperson unless the courtfinds good cause not to make the order. mStay-Away Orders a. l ask the court to order the person in ® to stay at least ix.)- yards away from (check all that apply): (1) Q Me. (8) B My vehicle. EXWM SMW (2) $ The other persons listed in©. (9) m Other (specify): _ I (3) m My home. _ ‘ 1 m BO a (4) E Myjob or workplace. M E % MK E Eg\§& (5) D 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, or job? m Yes DNo (Ifno, explain below): D Check here ifthere is not enough spaceforyour answer. Put your complete answer on the attached sheet of paper orform MC-025 and write "A ttachment 9b-Stay-Away Orders. "for a title. Guns or Other Firearms and Ammunition Does thc person in ®own or possess any guns or other firearms? DYes DNO $1 don’t know Ifthejudge grants a protective order. the person in ® will be prohibitedfrom owning, possessing, purchasing, receiving, 0r attempting Io purchase or receive a gun, otherfireurm, and ammunition while the protective order is in effect. The person in ®will also be ordered t0 turn in m law cn/hrcement, 0r sell to 0r store with a licensed gun dealer, any guns orfirearms wiI/u'n 111's nr lzcr Immediate possession 0r control. This is not a Court Order. R“’°°“"”"’ "2°” Request for Civil Harassment Restraining Orders CH-1oo, Page4 ore QE m (CIVII Harassment Prevention) 9 Case Nuniber: 2 CH009848 ® m Temporary Restraining Order I request that a Temporary Restraining Order (TRO) be issued against the person in ® to last until the hearing. I am presenting form CH-l 10, Temporary Restraining Order, for the court’s signature together with this Request. Has the person in ® been told that you were going to go to court to seek a TRO against him/her? DYesa No (Ifyou answered no. 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 II-Tempormy Restraining 0rder"for a title. m u don sums and 1 do m mm «u meat; «o mm imam w, sn‘vs purmm n0 ‘u a dmc}: addwi r: moi camm mandlc him aw- ® D Request to Give Less Than Five Days' Notice of Hearing You must have your papers personally served on the person in® at leastfive days before the hearing, unless the court orders a shorter timefor service. (Form CH-200-INFO explains What Is “Proof 0f Personal Service”? Form CH-200, Proof of Personal Service, may be used t0 show the court that the papers have been served.) If you 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 on the attached sheet of paper orform MC-025 and write "Attachment 12-Request to Give Less Than Five Days’ Notice "for a title. ® m No Fee for Filing or Service a. There should be no 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. 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. ® There should be no filing fee and the sheriff or marshal should serve the person in® for free because Iam entitled to a fee waiver. (You must complete andfileform FW-001, Application for Waiver of Court Fees and Costs.) m Lawyer's Fees and Costs I ask the court to order payment ofmy D lawyer's fees m Court costs. The amounts requested are: hLm Amount “L Amount EllimEea $ 435 $ $ $ $ $ D Check here ifthere are more items. Pu! the items and amounts 0n the attached sheet ofpaper orform MC-025 and write ”Attachment l4~Lau1rer 's Fees unu’ Costs"for a title. This is not a Court Order. R‘“‘°“_J°"”°’Y"2°'° Request for Civil Harassment Restraining Orders CH-1oo, Page sofa (Civil Harassment Prevention) 9 Case Number: 4914-0948-48- Possession and Protection of Animals I ask the court to order the following: a. ' 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. (Identify animals by e g, type breed, name, color, sex.) com‘ EM mgt) flogard h amt \1 mu H \COWJC b\u (knom ,whxff; burr“ DH]; HMW I request sole possession of the animals because (specify good causefor granting order): D Check here ifzhere is not enough spaceforyour answer. Put your complete answer 0n the attached sheet ofpafer orform MC-025 and write “Attachment 15a-Possession ofAm'mals "for a title. 9 WM wahf mm huYthj OY HHW‘C} WH‘ oi och- b. bThat the person in® must stay at least wyards away from, and not take, sell, transfer, encumber, conceal, molest, attack, strike, threaten, harm, or otherwise dispose 9f, the animals listed abovefiWtcpw So Wm 9m M41 mum M MAW residuum DAdditional Orders Requested I ask the court to make the following additional orders (specifiz): 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 16-Additional Orders Requested, "for a title. ® Number of pages attached to this form, if any: Date: SelfiflemesemaL d } s . Lawyer 's signatureLawyer 's name (ifany) 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: Z \ Z r RQVWQ ION %/‘7