Request Restraining OrderCal. Super. - 6th Dist.February 9, 2021CH 1 00 Request for Civil Harassment cm stamps dare hem when ram is med. " Restraining Orders Read ('cm u ('ix'i/ Humssmmt Restraining Order Help Me? (/brm ('H-100- INFO) before completing this form. Also fill out Confidential C'LETS I I L E Information (form CLETS-OOI) with as much infomation as you know. FEB ' 9 2021 YmPerson Seekin Protection® 9 Clerk f the Court K- “G a Your Full Name. Superior Coun ofizA o n‘y 0' Santa Clara Your Lawyer (Ifyou have onefor this case) Fill in court name $0 street address: Name: State Bar No.:___ gupeiiorcclourt of California, County of - . an a al'a Firm Name.Wd 191 N. First Street b. Your Address (Ifyou have a lawyer, give'vour [waver 's 191 N. First Street . . ‘ ‘ H l _ San Jose, CA 95113Information. [fyou do no! haw a lawyer and want (0 keep)0ur Civil Courthouse_ DTS home address private. you mav give a different mailing address instead. You do n0! have IE I've teiphonefifar 0r e- mail ) Coun fills in case number when form is filed Address: 57 9‘4 a V\ \e Y CT Case N : cny;_§ct_n731LSc__stme-CJA_zapji123_ fltflomsw Telephone: Fax: E-Mail Address: Person From Whom Protection Is Sought Full Name: \lv ts m' TH! 3v“ML Age: a 7 Address (ifknown): \ v‘ M g “l “a V b0 V W ad City: S “IA 1 088 State:CF Zip: 75]LL ® Additional Protected Persons a. Are you asking for protection for any other family or household members? DYes DNo (fives, list them: Full Name‘ E Ag; Lives with you? How are they related to you?CQSM CuwHO M H mYes DNO Sea V KN SS fl miwd F ‘7 myes DNO Od’uc\v\l¥x D Yes D No D Yes D No D Check here ifthere are more persons. Attach a sheer ofpaper and write “Attachment 3a-Additional Protected Persons "for a title. You may useform MC-025. Attachment. b. Why do these people need protection? (Explain below): D Check here iflhere is not enough space for your ans.wer Pu! vour complete answer 0n the attached sheet 0f apcr orform MC-025 and write "AI! ch en! 3b-Wh) Others eed Protection 'for a title. e kOS \Qee/m $i"\¥bva j nq ggvu e fobef 202-0wa AxA moi” \vaw u'\+}\U zlzlzrzl WNW (ME, flusg passeA \vth»H (A CALM l/Lbugc £1 gnu ‘ \ \‘mqgw(bqfinmg ‘\ MUH 4 W e V) ”(Loo d5 This is not a Court Order. "°‘°‘“§°““”'°'C‘o'"3'“'mm°°¥"‘7”°°" Request for Civil Harassment Restraining Orders CH-1oo, page 1 ore °°d°°' ""'P'°°°°”" §§ 5276“” (Civil Harassment Prevention) ROHC, [l PVERN9 SEW“ ”I Case Number: ® Relationship of Parties How do you know the person in ®? (Explain below): D Check here Iflhere is not enough spacefor your answer. Put your complete answer on the attached sheet of paper orform MC-025 and write "Attachment 4-Relalionshi ofParIies ”for a rifle. +hem; new W ® Venue Why are you filing in this county? (Check all that apply): a. E The person in® lives in this county. b. l was harassed by the person in® in this county. \ 0 y C c. a Other (specifi): TY “9g O °L§Sf ‘ \ m h /\+ U? L‘bu ?a kds® Other Court Cases mqgh' b“ h W? “/1 fiofl’k DP W -6 ma" \ ' a. Have you or any of the persons named in® been involved in another court case with the person in®? D Yes D No (Ifyes. check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in (Countv/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 Dependent Adult Abuse (6) D Eviction (7) D Guardianship (8) D Workplace Violence (9) D Small Claims (10D Criminal (l ID Other (specifi'): b. Are there now any protective or restraining orders in effect relating to you or any ofthe persons in @and the person in @1’ fl No DYes (lfyes. attach a copy [fyou 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. (1) When did it happen? (provide dale 0r estimated dale): (2) Who else was there? [See attached declaration for a Description of Harrassment] This is not a Court Order. R”"°"““" 2°“ Request for Civil Harassment Restraining Orders CH-1oo. Page 2 ote (mm (Civil Harassment Prevention)M [33m 9 Case Number: MH009858 ® a. (3) How did the person in® harass you? (Explain below):D Check here ifthere is no! enough spacefor vour ans.wer Put vour complete answer 0n the attached sheer ofpaper orform MC-025 and M rite 4ltachmen! 7a(3)-Describe Harass m "for a (i! e. E11202,l M fifasspasscé In Mon 00 ( oufie fl n4 ( «max ‘(ow OWW \fim Mashv ba’rM J openeé A001 aSKfld \ih’h 3? \C'QW M(aw acvrfisSe 4 Siveefi' covd-im/ed \-o maswdaoae an hay K(a g mm ScaveA avxgx wexe 04am *9 See \AWH m’asi-w lam he ran back +0 +N *Vovrk of ow hovse andUM m aswquhM ”a from} hr. mv M(dS Q Awe (4) Didthe personin®use orthreatento useagun orany other weapon? €U[IQ& WM. COP D Yes m 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 harmed or inj ured because of the harassment? D Yes ? No (lfyes, explain below): D Chec here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write “Attachmem 7a(5)--Harm 0r Injury ”for a title. (6) Did the police come? ¢ Yes D N0 If yes. did they give you or the person in ®an Emergency Protective Order?D Yes$ No If yes. the order protects (check all that apply): DMe D The person in ® D The persons in ® (Attach a copy ofthe order ifyou have one.) b. Has the person in ® harassed you at other times? D Yes $ No (lfyes, describe prior incidents and provide dates ofharassment below):D Check here ifthere is n0! enough space for your answer. Pu! your complete answer on the alrached sheet of paper orform MC-025 and write ”Attachment 7b-Previous Harassment "for a title. This is not a Court Order. Re uest for Civil Harassment Restrainin Orders CH-1oo, Page 3 orem g(m (Civil Harassment Prevention) 9Rawsod Jmuary 1. 2018 Case Number: Check the orders you want. E Personal Conduct Orders l 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. a Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy personal propeny of, or disturb the peace of the person. b. mContact 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. DOther (specify): 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-OIher Personal Conduct Orders, "for a mle. The person in ®will be ordered not to take any action to get the addresses 0r locations ofany protectedperson unless Ihe courtfinds good cause n0! to make the order. mStay-Away Orders a. l ask the court to order the person in ® to stay at least £01) _ yards away from (check all {hat apply: (1) $ Me. (8) $ My vehicle. (2) $ The other persons listed in@. (9)m Other (specifv): ‘ (3) m My home. MWU WWW v_ (4) D My job or workplace. W Al WSW (5) D My school. 'l' ‘I (6) D My children’s school. (7) D My children’s place of child care. b. 1f the coun 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? Q Yes DNo (lfno, explain below): D Check here iflhere is nor enough spacefor your answer, Put your complete answer on the attached sheet of paper orform MC-025 and write “Aflachmem 9b-SIay-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 $1 don't know Ifthejudge grants a protective order, the person in ® will be prohibitedfrom owning, possessing, purchasing, receiving. or attempling Io purchase 0r receive a gun, otherfirearm. and ammunition while the protective order is in eflect. The person in ®will also be ordered t0 turn in m law enforcement. or sell to or store with a licensed gun dealer. any guns orfirearms within his or lzcr imnmz’iule possession 0r control. This is not a Court Order. “WWW" " 2°” Request for Civil Harassment Restraining Orders CH-1oo. Page4 ore 013' dun Em“ (Civil Harassment Prevention) 9 Case Number: 2133009858 @ @Temporary Restraining Order l 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, Temporaw Restraining Order, for the court’s signature together with this Request. Has the persdn in ® been told that you were going to go to court to seek a TRO against him/her? DYes $No (Ifyou answered n0, 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 “Atrachment 1 I-Temporary Restraining Order "for a title. ® D Request to Give Less Than Five Days' Notice of Hearing 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-200-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) lf you want there to be fewer than five days between service and the hearing. explain why below: D Check here IfIhere is not enough spacefor your answer. Put your complete answer on the attached sheet 0f paper orform MC-025 and write “Attachment IZ-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 I 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 E Court costs. The amounts requested are:m Amount m Amount Eiling.Ene $ 435 $ $ $ $ $ D Check here iflhere are more items. Put the items and amounts 0n the attached sheet ofpaper orform MC-025 and write “Attachment 1 JiLaugver 's Fees um! Costs”for a title. This is not a Court Order. R“’°°J°"”"V"2°“ Request for Ciyi_| Harassment Restraining Orders CH-1oo, Page 5 ofe (IE ?amm'“ (CIVII Harassment Preventlon) 9 Case Number: D Possession and Protection of Animals 1 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 l own, possess, lease, keep, or hold, or which reside in my household. (Identifiz animals by, eAg., ape, breed, name, color, sex.) I request sole possession of the animals because (specifv good causefor granting order): D Check here ifthere is no! enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write "Attachment 15a-Possession 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. mAdditionaI Orders Requested I ask the coun to make the following additional orders (specifiz): a Check here iflhere is not enough spacefor your answer. Pu! your complete answer 0n the attached sheet 0f paper orform MC-025 and wr Ie ”Attachment l6-Addi1i nal Orders Requested, ”for a title "Y\A\% onq'n S anAs 00%st whue kQAS 03¢ 904:: 'g ¢\,« m Y-i/UN CdCO k°\ 0W; Smo KcM +(qu +0 *“\\L +0 J\~\*+\€ ‘4\ K5 WMA (on has ECQSJKQKQA" “(QAW f“\\¢-k'o VMYM Number of pages attached to this form, if any: Date: SemBemesented- - d } self-Bepzesented _ Lawyer 's name (ifany) Lawyer 's signature l declare under penalty of perjury under the laws of the State of California attachments is true and correct. Date:MM- Qi n-H/qu (“u(ltl “O Type 0r print your lame Sign your name . ion above and on all This is not a Court Order. Request for Civil Harassment Restraining Orders CH-1oo, Page 6 ofeQB{m (Civil Harassment Prevention) Revised January 1. 2018 10 11 12 13 14 15 v16 17 18 19 20 21 22 23 24 25 CASENAME:C""’_’O 3"“ 3"“91 CASH: ea GuggggfiflLast Name Last Name CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? N 9" ‘3)“ boy “eve Y mur \mn‘. b) Are you living with the person? D YES M NO c) Has the person U physically abuse you, D physically or verbally threatened you and/or m harassed you many times? (Please check aII 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, include dates and times): On 1/1/2024 mq Lugkank werfifi) wka b: 32 OJY] G.‘ aVOvnA 5.142 wajmfi (‘LWgCL ouxK chm W€n+ 0‘4 lSmw aman §¥wx$ov hex¥-¥O Vh\4\ MUSBLMAAS caY Ma$+V(bc\‘\XVL0\ \opent’a ‘\’W Aod OWXA %€\\€&@ \’k\m ~}o\A \n‘nn *0 \éww hf (an quoLsW skd‘4 cmA (on*\“ueé +6 mushxbuk \vokm/q Jmk) otré er\ VNVSC’ m“ 3m” Cescw Carr'.\\o:g) c\\ (ma AwgvAev Vomeissa V“ mama“ wfien wokg up unA saw “1m ACYo$5 -\\M Wefi* Mm$h m‘ m) 6‘ Swami m vasswaSSeA m fiom 0K mu WM? *ooV MSVf/mw 0w [{n WWW 0f W 6 wwj L(cLS +hr€£ JnWS pwaé ash Am New Lew wmmg Wadwmfl \ms pewé Wr mmem mm bwt ma 46 mykaw 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): W3 CH-1 00, Item 73(3) - DESCRIBE HARASSMENT Page__
