Request Restraining OrderCal. Super. - 6th Dist.February 4, 2021Aqucle C\ Request for Civil Harassment CH4 00 Restraining Orders Read ('uu u ('iw‘l lluru.s'.mm1! Restraining Order Help Me? (form ('H-l()()- INFO) before completing this form. Also fill out Confidential CLETS Information (form (‘LETS-OOI) with as much information as you know. Person Seeking Protection a. Your FIJI] NakaflE, Your Lawyer (if mu have onefor this case) Age:w Name: SelLRepLesented- State Bar No.:__ B" DEPUTY Firm Name:Wd b. Your Address (Ifyou have a lawyer, giveyour lawyer ’s information. Ifyou do not have a lawyer and wan! t0 keepyour home address private, you may give a difl'eren! mailing address instead. You do no! have Io give telephone. fi , 0r e-mail.) Addr s: City: Statezfi Zip: o Telephone: Fax: E-Mail Address: Person From Whom Protection ls Suogh FuIIName HM QAUHQJQ (ifknow 1): G) Additional Protected Persons Clerk stamps date here when form is filed. FILED FEB 2 4 2021 Clerkdoflhe Court CountyotSamnGara Fill in court name and street address: Superior Coun of California, County of Santa Clara 191 N. First Street 191 N. First Street San Jose, CA 95113 Civil Courthouse- DTS Coun fills in case number when form is filed. Case Number: a:aHooqaéj Age:m a. Are you asking for protection for any other family or household members? DYes DNO Ifyes, list them: Full Name ‘ Sex Lives with you? How are they r ated to you?AWEL Yes D No man Ifl- m Yes D No w. iD Yes D No D Yes D No D Check here iflhere are more persons. Attach a sheet ofpaper and write "Attachment 3a-Additional Prorected Persons "for a title. You may useform MC-025. Attachment b. Why do these people need protection? (Explain below): D Check here ifrhere is no! enough spacefor your answer Put your complete answer 0n the attached sheet 0f paper orform 1C-025 and ‘Mare ”Aflamfigfi'h (b [Em Neesd§{%!:ction'. 'for atille \h 0 This is not a Court Order. ”°‘M'“%%‘¥Wumuy 3.19:” Request for Civil Harassment Restraining Orders 2 ' (Civil Harassment Prevention) Codedémlproco'due §§ (mMdn- E]- CH-1 00, Page 1 of6[ ] PVERN9ROHCI Case Number: 07/M60795/ Q) Relationship of Parties How do you know the person in ®? (Explain below).- D Check here iflhere is no! enough spacefor your answer Pu! your complete answer 0n the attached sheet of paper orform MC-025 a§urite flicmer? 4-Relalionship ofParIies’'for a title ® Venue Why are you filing in this county? (Check all that apply): a. The person in ® lives in this county. b. l was harassed by the person in® in this county. c. D Other (specifi’): ® Other Court Cases a. Have you (finy of the persons named in® been involved in another court case with the person in®7 D Yes N0 (Ifyes, check each kind ofcuse and indicate where and when each wasfiled.) Kind of Case Filed in {Countv/State) Year Filed Case Number (iflmown) (l), D Civil Harassment (2) D Domestic Violence (3) D Divorce, Nullity, Legal Separation (4) D Paternity, Parentage, Child Custody (5) D Elder or Dependent Adult Abuse (6) D Eviction (7) D Guarciyiapship (8) D Workplace Violence (9) D Small Claims (10)D Criminal (1DD Other (specifiz): Y person in®? 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 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. q Ednk(I) When did it happen? (provide date 0r estimated date):5 - l 2 Who else was there?( ) [See attached declaration for a Description of Harrassment] mm OJmlOLvefl (Lnd some-Hmas mm _L 0mm a 10M ”3mm Hm fl 08m Dior OEQUJY‘S‘ This is not a Court Order. Request for Civil Harassment Restraining Orders CH-1oo, Pagez otsQBm (Civil Harassment Prevention) 9 b. Are there now anyirotective or restraining orders in effect relating to you or any of the persons in @and the Revised January 1. 201B Case Number: 07101460686; ® a. (3) How did the person in® harass you? (Explain below):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 7a(3)-Describe Harassment "for a title. D Yes No (Ifyes, explain below): D Chec here ifthere is not enough spacefor your answer. Put your complete answer on (he attached sheet ofpaper orform MC-025 and write “Attachment 7a(4)-Use 0f Weapons ”for a title. (4) Did thegn in® use or threaten to use a gun or any other weapon? (5) Were you med or injured because of the harassment? D Yes No (lfyes, explain below): D Che e ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write “Attachment 7a(5)-Harm 0r lnjwy "for a title. (6) Did the police come? D Yes $No If yes, did they give you or the p rson in ®an Emergency Protective Order?D Yes D No If yes, the order protects (check all that apply).- DMe D The person in ® D The persons in @. (Attach a copy ofthe order {fyou have one.) b. the person in ® harassed you at other times? EIYes D No (Ifyes, describe prior incidents (mdprovide dares ofharassmen! below): D Check here ifthere is n0! enough spacefor your answer. Put your complete answer 0n the attached sheet 0f a er orform MC 025 and.write ”At ach em 7b-Previ.u.s Har ssment for a ' 1e. m L IA . .L not. . u .EL. J, .e u 9!... &Mm, MHM flfli/f, D Jr -//U This is not a Court Order. Rawsod Janua'y 1. 2018 Request for Civil Harassment Restraining Orders CH-1oo, Page 3 ote (IE Elm“ (Civil Harassment Prevention) 9 Case Number: a/C/plowas/ Check the orders you want. E 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® : a. E 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. Contact the person, either directly or indirectly, in any way, including, but not limited to, in person, by elephone, in writing, by public or private mail, by interoffice mail, by e-mail, by text message, by fax, or by other electronic means. c. D Other (specifiz): D Check here ifthere is n0! enough spacefor your answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write "Attachment 80-Other Personal Conduct Orders, "for a rifle. The person in ®will be ordered not to take any action to get (he addresses or locations ofany protectedperson unless the courtfina’s good cause not to make the order. ® DStay-Away Orders [Oa. I ask h oun to order the person in ® to stay at lc t- yards away from (check all that apply): (1) Me. (8) My vehicle. (2) The other persons listed in@. (9) D Other (specifiz): (3) My home. (4) D My job or workplace. (5) My school. (6) My children’s school. (7) D My children’s place of child care. b. 1f the court orders the person in ®to stay a y from all the places listed above, will he or she still be able to get to his or her home, school, or job? Yes DNO (Ifno, explain below): D Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet 0f paper orform MC-025 and write "Attachment 9b-Stay-Away Orders, "for a title. Guns or Other Firearms and Ammunition Does the person in ®own or possess any guns or other firearms? DYes DNo wdon‘t know Ifthejudge grams a protective order, the person in ® will be prohibitedfrom owning, possessing, purchasing, receiving, or atlempting to purchase or receive a gun, otherfirearm. and ammunition while the protective order is in effect. The person in ®will also be ordered I0 mm in Io law enforcement, or sell to or store with a licensed gun dealer, any guns orfirearms within his or Izur z'mnmliule possession 0r conrrol. This is not a Court Order. , Request for Civil Harassment Restraining Orders CH-1oo, Page4of6 (IB ‘ 5'3"“ (Civil Harassment Prevention) 9um m_m Revued January 1, 2018 Case Number: J/MDO‘Eé/ ® E 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 fom1 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? DYes @0 (Ifyou answered no, explain why below):D Check here i there is not enough spacefor your answer. Put your complete answer on the attached sheet 0f pa er orfori M -025 and write " Ila hment II-TemporatyRes ain'n 0rde "foratirleA ' 142' 44¢! 5 Mg m? kas mpmdzMfr Ma‘y/ofl A ' 1 . ‘ . 1 I I . . l . #jdanzs 5412f) Mhevzoé, ('mzsflwfm éflkmax mm: Mm fl on ® D Request to Give Less Than Five Days' Notice of He rlng L/ You must have your papers personally served 0n the person in® at leastfive 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 to 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 tfthere is not enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write “Attachment IZ-Request to Give Less Than Five Days' Notice "for a title. There should be no filing fee because the person in®has used 0r threatened to use violence against me, @ fig Fee for Filing or Service a 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 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 Court costs. The amounts requested are:m Amount ItL Amount Eiling_Eee $ 435 s $ $ $ $ D Check here ifrhere are more items‘ Put rhc items and amounts 0n the attached sheet ofpaper orform MC-025 and write ”Attachment 1 4 Lmvycr 's Fees and ('0sts"f0r a rifle. This is not a Court Order. mmmw’ "2°” Request for Civil Harassment Restraining Orders CH-1oo, Page 5 ofe(m ‘ Emu (Civil Harassment Prevention) 9 Case Number: 07/3/400255/ Possession and Protection of Animals I ask _e court to order the following: a. That 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. T23"? anim by ef ope bra/eeyaF%clor'gfik b/dé, oflfi Wl/flzd Q/Yl pl one 11mg: I ') d I request sole possession of the animals because (specifiz good causefor granting order): D Check here ifthere is not enough spaceforyour 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. dditional Orders Requested l ask the court to make the following additional orders (specifiz): D Check here ifthere is not enough spaceforyour answer. Pu! your complete answer on the attached sheet 0f @ Number of pages attached to this form, if any: Date: Salfzflemesenmd- Lawyer 's name (ifany) ’ 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: Kfl/fiq 4mm} Type orprifljIy ur name your nam This is not a Court Order. Request for Civil Harassment Restraining Orders CH-1oo, Page eofe (IB {533W (Civil Harassment Prevention) . ' Revised January 1. 2016 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: Van'l' 3"“ [I A ' 6L2 560655 #z J/C’fi’wqg5/ as ‘ ame 5' ‘ ame v CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? [Qy [Z 120/3; b) Are you living with the person? D YES $10 c) Has the person D physically abuse you, D physically or verbally threatened you and/orflarassed 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, [21/6 Mm curl éh/L knee»!J M l) ‘ d/aoom pom m (Eus A45 flmmqj p 4/77 {2/ ébfl fhtéflM //€9®/ 4F7/54m Hg owa/ 0171/6 WIW 19-7, me; [g?fiaa xa-n raoao IQ J8 wad, /9-//r90301 flflkflqfif 7'96 "20,30 (v/c/Zos of 4,04 5M6) ' [Ly 20520 Q 9- 9030 6’ 30 9090 ?Déaoac $24 Logo 3 /gao, /2v QC» 30/9, /9 7’7 20/9 I / include dates and times): wbm mfi Ip / , ‘ \k) U \V‘ CH-100. Item 7a(3) - DESCRIBE HARASSMENT Page MC-020 SHORT TITLE:- [\va CASE NUMBER 92/ C#00956/v ngfmeM/mg moa lffist Na andgl/Msfiz H?OS ball Hy; 4 mdqlos Ha .ué- "1/47/44 . I/l a II hm; vlflliJm/vx y \naéCE/m mvmpjh wdpo bts‘ fl douomm: 4J1 ‘ v] 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 (Required for verified 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 Approved by the Judicial Council of Calkfomia M0020 New January 1, 1987] tional Form Mamn Dean‘s Essential Forms TM ADDITIONAL PAGE CRC 201, 501 Attach to Judicial Council Form or Other Court Paper 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 $2 .CASE #z 59/C#00?85/ e) Were any guns or other weapons used or threatened to be used during any abuse CASE NAME: Last Name in the past three months? D YES @O If “YES”. describe: f) Were there any injuries during abuse in the past three months? D YES {ho If “YES", describe: g) Did the police come to any of these recent events? D YES {NO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES NO If “YES". please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? DYES DNO lf“YES".where: j) Has the person you want restrained ever been in jail for violence against you or your children? DYES %O If“YES",when: Describe what the person did to you or your children that caused them to go to jail: /’ ///R//// .C CH-100, Item 73(3) - DESCRIBE HARASSMENT Page__ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 £2. ”smalcagoaw k) Do you have a criminal protective order (restraining order from criminal court)? CASE NAME: Avail Last Name U YES $0 If “YES", please attach a copy. l) Describe the worst abuse and when it happened: D The most recent abuse i_s the worst abuse OR flThe worst abuse was (approximate date) [2'7 ~ 7 ”90am the pe son | want a restraining order against (describe whanhey dad to you): ' l ' '01 0. “:42- “.7, ll. un 1mg. I . S ‘ , . v ‘ ‘ r . I y, [n t. a . l . I a S .l I._ .. I.“ \n: ___.'v, ' a 0' .‘o m" . Ill,n1m . ...: ms, Lg. HI. ”.3 55 14.. '_ J_‘Vus 'I I .3: ‘.A‘ n III, n_ '. 'JI! . l ‘ f... 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): Lo CH-100, Item 7a(3) - DESCRIBE HARASSMENT Page