Request Restraining OrderCal. Super. - 6th Dist.February 4, 2021‘ CH 100 Request for Civil Harassment C/erk Stamps date here When form iS filed. Restraining Orders Read Can c1 Civil llurasis'mwzt Restraining Order Help Me? (form CH-l 00- INFO) before completing this form. Also fill out Confidential CLETS Information (form CLETS-OOI) with as much information as you know. Person Seeking Protection Clerk of the Court a. Your FullName: SumriorCou o ounty {Santa ClarakwmmMW Agei $3 DEPUTY 5% ILED FEB ' 4 2021 Your Law 'er [)0 lun'UbJUfiN' 111's 'zzsc) Name: State Bar NO; Fill in cour! name and street address. Firm Name: - -__‘ Superior Court of California, County ofd_- Santa Clara b. Your Address (Ifynu lure (I lam'cr, girgyour lauj'er's Civil Division information. Ifyou (/0 not have a luuycr and want (0 keep your 191 North First Street home address private, you may give a different mailing address San JOSC, CA 951 13 instead. You d0 not have t0 give Icleplmne, fat. 0r c-mail.) City: Addre z 415mm wm% l8 A Court fills in case number when form is filed.MW 993m; ‘ EB Zip;m Case Number: E-Mail Address: ® Person From Whom Protection Is S ght Telephone: ‘ ‘ Fax: 2 1 c H 00 98 5 1 Age: ‘ g 2Full Name: J K . Addre (Iflmcmn): 416 L City: \ State:m Zip:mg ® Additional Protected Persons a. Are you asking for protection for any other family or household members? YCS D NO Ifyes, list them: Sex Age Ijves wit ' ? f- flfifi'es D N0m£ fiYes D N0 D Yes D No U Yes D No w are the re t " D Check here ifthere are more persons. Attach a sheet ofpaper and write "Attachment 3a-Additi0nal Protected Persons "fora title. You may useform MC-025, Anachment. b. Why do these people need protection? (Explain below): D Check here [fthcre is not enough spuc L f)r vour (mm cr Put vour complete ansu er (m the attached sheet 0f papcra0r bnn MC- 0.75 an“Hunk ‘W"?!WIDE“: :t‘Au hen. I 1-1! udzmuzl b- Hm Others N‘ud Protecnon' ’_/m a tirfe. This is not a Court Order. J“°'°a'c°“"°"°’°a"'°'"“‘ W°°""“9°“ Request for Civil Harassment Restraining Orders CH4”: 93991 0’6 Revused January 1, 2018. Mandatory Form Code of Civil Procedule. §§ 527 6 and 5279 (Civi' Harassment Prevention) a CaseNumb§21cH0098 51 ® Relationship of Parties How do you know the person in ® 7 (Explain below).- D Check lzcrc {/‘rlzcre is not enough spaceforyour answer. Pulyour complete answer on the attached sheet 0f paperWAIVC§5 and write “Anachmen! 4-Relari0nship ofParties "for a title. G) Venue Why are you filing in this county? (Check all 111a! apply): a. The person in® lives in this county. b. I was harassed by the person in® in this county. c. D Other (spccz'jfi'): ® Other Court Cases a. Have you or any of the persons named in® been involved in another court case with the person in ®7 D Yes (1) (2) (3) (4) (5) (6) DDDDDDDDD (10) D (11) D No (lfyes, check each kind ofcase and indicate where and when each was filed.) Kind ofCase Filed in (Cozmnt/Smre) Year Filed Case Number (ifknmm) Civil Harassment Domestic Violence Divorce, Nullity, Legal Separation Patemity, Parentage, Child Custody Elder or Dependent Adult Abuse Eviction Guardianship Workplace Violence Small Claims Criminal Other (speczfi'): b. Are there now a protective or restraining orders in effect relating to you or any of the persons in© and the person in@? N0 D Yes (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 ofconduct is more than one act. (2) a. Tell the coun about the last time the person in® harassed you. I (1) When did it happen? (provide (lure 0r cylimulczl (lulu): . This is not a Court Order. Rewsed January 1, 2018 Request for Civil Harassment Restraining Orders CH-100. Page2 of6 (Civil Harassment Prevention) -> Case Number: 216H009851 ® a. (3) How did the person in ® harass you? (Explain below):D Check here (fthere is n0! enough .S‘paceforyom‘ answer. Putyour complete answer 0n the attached sheet ofpaper orform MC-025 and write “.»ltruclmzent 7a(3)-Describe Harassment"f0r a title. (4) Did the person in® use or threaten to use a gun or any other weapon? D Yes No (Ifyes. explain below).- D Check here ifthere is no! enough spaceforyour answer. Putyour complete answer on the attached sheet ofpaper orform MC-025 and write “Attachment 7a(4)-Use 0f Weapons "for a title. (5) Were you harmed or injured because of the harassment? D Yes 0 (Ifyes. explain below): D Check here ifthere is n0! enough spaceforyour answer. Putyour complete answer 0n the attached sheet ofpaper orform MC-025 and write “Attachment 7a(5)-Harm or Injury "for a title. (6) D1d the pohce come” D Yes p0 Ifyes, did they give you 0r the p son in® an Emergency Protective Order? D Yes D No If yes, the order protects (check all that apply): D Me D The person in® D The persons in© . (Attach a copy 0fthe order ifyou have one.) b. s the person in® harassed you at other times? Yes D No (Ifyes, describe prior incidents and provide dates ofharassment below): D Check here Ifthere is n0! enough spuccfbryom' answer. Putyour complete answer 0n the attached sheet 0f paper 0r fin'm MC-025 and write “Alluc‘lzmcm 7})7172'0'1'0113 H1 ruysmcnt " fbr a I" lc. ‘ “.-' 3. ‘ L Wiq\md‘lfimmm5mfiw.fl 7W‘Wflm aImmwm?Mimmk This is not a Court Order. “°“5“J’””°'Y‘-2°‘3 Request for Civil Harassment Restraining Orders CH-100. Page 3 0'6 (Civil Harassment Prevention) 9 AI Case Nurfiirc H 00 98 51 ® Check the orders you want. M Personal Conduct Orders I ask the coun to order the person in® not to do any 0f the following things to me or to any person to be prot cted listed in®z a. fl Harass, intimidate, molest, attack, strike, stalk, threaten. assault (sexually or otherwise), hit, abuse, destroy personal property 0f, 0r 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 0r private mail, by interoffice mail, by e-mail, by text message, by fax, or by other electronic means. C. D Other (specifi'): D Check here ifthere is n0! enough spaceforyour answer. Putyour complete answer 0n the attached sheet ofpaper orform MC-025 and write "Atlachment 8c-01her Personal Conduct Orders, "for a title. The person in ® will be ordered not 10 take any action to get the addresses or locations ofany protected person unless the courtfimls good cause n01 I0 make the order. D Stay-Away Orders a. I ask the court to order the person in® to stay at least SO yards away from (check all that apply): (1)m Me. (8) m My vehicle. (2)Q The other persons listed in ©. (9) D Other (specifi'): (3) fl My home. (4) D My job or workplace. (5) D My school. (QE My children’s school. (7) D My children’s place of child care. b. Ifthe court orders the person in® to stay ay from all the places listed above, will he or she still be able to get to his 0r her home, school, orjob? fiYCS D N0 (lfno, explain below): D Check here ifthere is not enough spaceforyour answer. Putyour complete answer on (he 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 fireanns? D Yes D No fl I don‘t know Iftlzejudge grants a protective order, I/w person in® will be prolzibitedfrom owning, possessing, purchasing, receiving, 0r attempling t0 purchase 0r receive a gun, ot/zerfirem‘m, and ammunition while the protebtive order is in eflect. The person in ® will also he ordered Io turn in m lun' enforcemenl, 0r sell 10 0r store with a licensed gun dealer, any guns orfircarmx u'iI/u'n his 0r llcr inmmliulc possession 0r control. This is not a Court Order. Rwsmmam-m” Request for Civil Harassment Restraining Orders CH-100, 93964 0‘6 (Civil Harassment Prevention) '9 CaseNum eicHOogs 5]: ® fiTemporary 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-I 10, Temporary Restraining Order, for the coun's signature together with this Requesl. Has the person in®been told that you were going to g0 t0 court t0 seek a TRO against him/her? D Yes o (Ifyou answered r10, explain why below): D Check hen [/‘t/Iw'e 1's no! enough .s‘paccfifin'your answer. Putyour complete answer 0n Ilze attached sheet 0f paper rf r2 MC-025 and write "A! uclzment 1 l-Tcmpomrv R s‘mu' mo Order'for a title. {3&1M N \ a l . .1? 'g‘ 3:..9 " 0)-“. 9' 1 '~ 51'". '0 m' w@mmamamww ‘ sw - .‘ . D Keuquest to Give Less Than Five Days' Notice of H- ring \J O You must have your papch personally served 0n the person in® a! lcastflve days hdén‘c’ the hearing, unless the court orders a shorter timefor sen'icc. (Form CH-200-INFO explains What Is “Proof of Personal Service”? Form CH-200, Proof 0f Personal Service, may bc 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 ift/zere is not enough spaccforyour answer. Putyour complete answer 0n the attached sheet 0f paper orform MC-025 and write ”Altuclmzent 12-Request t0 Give Less Than Five Days ' Notice "for a title. ® flNo Fee for Filing or Service a. Where should be n0 filing fee because the person in ® has used 0r 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. Wm: 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. oflThere should be no filing fee and the sheriff 0r 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 ofCourt Fees and Costs .) D Lawyer's Fees and Costs I ask the court Io order payment of my D lawyer’s fees i Court costs. The amounts requested are: , _I_t_e_n_1 Amount It_e_ Amgum guy) Em. s 7-536 r s S $ mm D Check here ifthere are more ilc'ms. Put Ilze items and (unozmls (m the attached sheet ofpaper orform MC-025 and write ”Attac/mwnl l4 ~Lauycr '5‘ l’cux uml ('osls "fin' a title. This is not a Court Order. ““WJWM-m‘a Request for Civil Harassment Restraining Orders CH-100, P3985 0'6 (Civil Harassment Prevention) -9 Case Numbér' 1CH009851 ® ossession and Protection of Animals l 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. (Idcmgfi' animals by, e.g., typo, breed, name, color, sex.) I request solc possession 0f the animals because (specifi' good causejbr granting order): D Check here {ftlzere is not enough spaceforyour answer. Put your complere answer 0n the attached sheet ofpaper orfbrm MC-025 and write "Attachment 15(1-Possessi0n ofAnimals "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. Additional Orders Requested I ask the court to make the following additional orders (specifi): D Check lwre ifflzcrc [S not wmug/z spuccjbryour answer. Pulyour complete answer 0n the attached sheet 0f pap 'r nr {Emu MC-(L‘J' my! m‘m' "Armu/m cm 16 .-H¢ {liar u/ Orders Requcslcd \ ® Number of pages attached to this fonn, ifany: Date: b Lawyer 's signatureLawyer '5 name (ifcmy) Ideclare under penalty 0f perjury under the laws of the State of California that the information above and on all attachments is true and correct. \9\ - 90$Mmmm; Typebrprin 1r name This is not a Court Order. Request for Civil Harassment Restraining Orders CH-100. Page60f6 (Civil Harassment Prevention) Revtsed January 1‘ 2018 1O ‘11 13 15 16 17 18 19 20 21 22 23 24 25 ICZCASH: 21CH009851 CH-100, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? kg SQN; H 2! b) Are you living with the persoh? D YES m0 CASE NAME: c) Has the person D physically abuse you, U physically or verbally threatened you and‘l’orfiharassed 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 (aple se start with the most recent event and explain exactly what happened in detail. Inc ude dates and times)m aux mWk ”vat «A r 42mm oer 9m“ mt 90m cake; 36mm \ H 909% 0+1 firm Hg 90w numbWm when 1 40E mm Mr \~ov\¥ ofMéWiizg-Z‘R lg m 3690 (a 19> 9090 (~51 H aoao b\ovlmL gmmkwwmwng 9090 Mfiog 0C WWM¥3~ mwalaoaoywqaoaotlzo 2030 4289090 4/- a4 swam, 3 H 9090,.3 H aoao,3 ‘7 9039f o'l-Ia 4°30, 51-54095; 3-4- swam, 524-90304 /- 86-4090; #240405; la-IV-zo/i I bu; CH-100, Item 73(3) - DESCRIBE HARASSMENT x 2o 96m Q \X Hem (mmmb § 909-6 SHORT TITLE: MC-OZO 1O 11 12 13 14 15 18 17 18 19 20 21 22 23 24 25 27 u‘. La'st \‘arr L- U“; s3 4135 13’ t,th . ‘A y‘ ‘J.’ o VJ.- and Cqmquctz i H [”5321CH009851 ' (i0K uh‘ AlL..| i4 1 LL 9x ??BNQ}W mm, «loo I .. .a m pfiu~uMu- .y numbers) (Required for ven'fled p Idea Inc) The it=rrs cn this paga- stated c“. iifsrmaticw 25d beliefare (51:95." '/ ‘em numb:-rs notlne This page may be used with any Judici 5' C: ‘ .cil f0 m cr any czrer paper 7'iled w:-:h ‘r= court, Page ADDITIONAL PAGE cacmjmFc'm Axro. e: c the Jufca: Camel :1 Cal‘swa MC-CZ) {New Jamar; 1_ 135a Oman] =o-rr. Mamr Bear‘s Esse-my :om's 7M Attach to Judicial Council Form or Other Court Paper 16 17 18 19 20 21 22 23 24 CASE NAME: 5N lam”: 21CH00985 F3 Last Name ast Name e) Were any guns or otherweapons used or threatened t0 be used during any abuse in the past three months? D YES fiNO If “YES”. describe: f) Were there any injuries during abuse in the past three months? D YES $NO If “YES", describe: g) Did the police come to any of these recent events? D YES fiNO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES $50 [f “YES", please attach a copy. i) Is the person you want to restrain in jail right now forviolence against you? DYES DNO If“YES”,where: j) Has the person you want restrained ever been in jail for violence against you or your children? DYES *NO if”YES",when: Describe what the person did to you or your children that caused them to go to jail: CH-‘IOO, Item 7a(3) - DESCRIBE HARASSMENT Dan: 21cH009851 CASE NAME: k) Do you have a criminal protective order (restraining order from criminal court)? D YES WC If ”YES", please attach a copy. l) Describe the worst abuse and when it happened: D The most recent abuse 1; the worst abuse OR kins worst abuse was (appmmaze daze) ' ’ ’ and the person | want a res aiming orde regai. stw--s;. haw a: :..eyc::a_v:»: ‘ \. S Kr \Jn)\\k(\/W x.‘ J...J\ .n \J. . \m $ \R B“, o ‘3. . ‘4; \91; .' Mug MKYL.‘t. A .94. Um...“ ‘Am } MW QEPDLAAA A ' tax \L‘ ‘u' Luz... .H . m) Des:nbe any_othe~rprevious (past ) violence or threats cf vfobnce that you haven't alreadyxwritte n about he re (include dates or estimates as to when it happened): \ t CL wmoumv mm¢Ld‘ch3 ¥%um£aio \vxx Guk&_\Lnum> MSKQM»éfluLUuaé Vmflled *4 CH-100, Item 72(3) - DESCRIBE HARASSMENT