Request Restraining OrderCal. Super. - 6th Dist.February 16, 2021Request fOl' CIVII Harassment Clerk stamps date here when form is filed.CH4 00 Restraining Orders Read Can a Civil Harassment Restraining Order Help Me? (form CH-IOO- F I L E DINFO) before completing this form. Also fill out Confidential CLETS Informalion (form CLETS-OOI) with as much information as you know. FEB 1 6 2021 Person Seeking Protection a. ourFul] am}. | ‘ ‘ ‘ A AgeziL Your Lawyer ({fyou have onefor this case) Fill in coun name and street address.- Name:Wanted- State Bar No.: ______ gupeilaorcclourt of California County of ~ . an ara Fnrm Name._&ejf:Repr_esen1ed 191 N First Street b. Your Address (Ifyou have a lawyer, giveyour lawyer 's 191 N. First Street . . I V , San Jose, CA 95113 Information. [fyou do not hm e a lawyer and want t0 keepyour Civil Courthouse_ DTS home address private you mav givle a different mailing address instead. Y0 d0 6lgvrow give Whom far, 0r e- mail.) Court fills in case number when form is filed. Addre : MAM“\ #36 Case N City:%WL_StateaZipzflL Telephone: g)(fla7 354 l Fax: . E-Mail Address: t 4| 1 m ® Person From Whom Protection ls Sought Full Name: C’lnbflp \ Amq 6‘ (nflrmm/ A e-_2L Address (ifknonn) M firm City \r/m 305$ State: PA Zip: @57/9 G) Additional Protected Persons a. Are you asking for protection fora other familyeor household members? DYes DNO vaes list them . Ff]; ?gme_ [Jagfi Lives with you? How are they related to vou?jmmn I flsauetm D Yes dNo {IAN {4EB ’ r D Yes D No D Yes D No 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 MC-025, Attachment. b. Why do these people need protection? (Explain below): D Check here ifthere is not enough spacefor your answer Pu! your complete answer on the attached sheet 0f pap r orform MC-025 and write “AlrachrWrcm 3b W71} Others Need Protection" for a title. r 10mm hagaxomgcm VL Come mm Omar mm M SmnFfimM ner WM Jmm wax meA ommud merw VHN .ufl' .NM_0 v ; 4g 15mO o W\mmmm.w u u £ m' W1Mmm0” W35 f¢°§2'a°2:322y°¥Czacfiq‘ém'inwawmwwymwv Re uest for Civil Harassment Restrainin Orders CH-1oo, Pa e 1 ofe Code of ml Procedure. §§ 527. 60wand 527 9 - - - g (CIVII Harassment Prevention) ROHCI [l PVERN9(IB‘ Smut“um Em Case Number: ® C5) Relationship of Parties How do you know the person in ®? (Explain below): D Check here ifthere is not enough spacefor your ans.wer Put your complere answer 0n the attached sheet 0f a er 0r o m MC-025 and write' Atachment 4-Relati0nshi fumes r a title. ,pp {éoommm (no Dqur/ma Dmmp 0F WM {DNQ- Venue J 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 count c. EOIher (Specifi). 01L (AIM ”W‘Cfl Ii“ MMfld mm‘s mm[kba‘ MW‘C Other Court Casesmm Iom& 0n ffipem‘” OCMUDI’M, a. Have you or ny of the persons named in® been involved 1n another court case with the person in Q)?D Yes $No (Ifyes, check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in (Countv/State) Year Filed Case Number (ifknown) (I) 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) a Small Claims (10)D Criminal (1 I)D Other (specz'fil): b. Are there now an protective or restraining orders in effect relating to you or any of the persons in @and the person in® ? o DYes (Ifyes, 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 yo (1) When did it happen? (provide date or estimated date). Dace”)bar Q 6! 3030/rjanuary 92/2 l902 Wh l l ?( ) O e 5e was Here [See attached declaration for a Description of Harrassment] 0n fin Am 0; 321mm 3 mm) mu S Was WM, gt w Wm Mmmdzwmr occurrg . This is not a Court Order. Revused January 1 2018 Request for Civil Harassment Restraining Orders CH-1oo, Pagez ote r-m (Civil Harassment Prevention) 9 Case Number: 210H009862 ® a. (3) How did the person in® harass you? (Explain below):D Check here ifthere is not enough spacefor vow answer Put vour complete answer on the attached +1 shee: pfofp aformLMC-025 and n rite‘ 4tlachment 7a(3)-Describe Harassment 'fo a title.MOM {W, {QYUQMDM v wan 4m 00M 393 a {JMWd An gifl‘ mld’C’r Pd‘mp 10 Dr d MIA vx'rAHwaA/L mihmm mmm OWE 1m; phumcu Wrde' on W” PM una W Dum 9X ’YJ’IDHAQ vpplml’Vd Amalia +0 NNN dUCDMdhm MIMI? AMLM' afixwm' md cl’ an wh ‘ Du) _ v DNHAW M arm? PAM VM WA (1(1‘65"MILM ( n-th Md) DLKhIrIaH/w 61 DWI”! “IO J‘HAQ )pmplmj, (4) Did the e on in® use 0r threaten to use argun or any other weapon?M YfiéjmnaJam vervD Yes No (Ify,es explain below). fmWM ‘ g LSCL‘f‘d .Fpr mgSwewa Check here ifthere is not enough space 0r vour answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and M rite “Attachment 7a(4)--Use of Weapons’'for a title. ‘ (5) W re you harmed or inj ured because of the harassment? aYes D No (Ifyes. explain below): D Check here ifthere is n0! enough space for voul answer. Put vour complete answer on the attached sheer ofpaper orform IC-025 and write Attachment 7a(5{-Harm 0r Injury” 0r a title. mmov wmslm mmwm muamwfm x) andeoK mm mama 0WJ4 bsc mmrm WE mm c1 ham a 01M Jon mm {00+ 0+4 (6) Did the police come? lf yes, did they give you or the person in ®an Emergency Protective Order?D Yes flfio [f 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 a No (Ifyes, describe prior incidems and provide dares ofharassmenr below): D Check here ifthere is n0! enough space for your answer. Put your complete answer 0n the artached sheet 0f paper o‘rform MC-025 an write “Artac; men! 7b-Previ0us Harassment 0r a ' l). I “CfM Mg l . 2; D 0 M(LV a drunljfl H£+ n mawodv‘v mm“Muaa A D‘AKIU 'WKSh’la’ . I I ‘ MI “1‘1 ,"A‘ ve hardtum Mmm ‘W’éMp mama madamMm This is not a Court Order. ‘ ‘0 \Qg‘qufim dnvpNW Th0; “M“am'y‘ 2°15 Request for Cciyi: Harassment Restraining Orders CH-100, Pageantsgww mad OMK,“ ( IVI Harassment Preventio ) I v I 9m“ m hmggm/ waw q DD‘ 430%.MY fiw’K/u Sew Wm“ Wu; OLu/q'n/y (makeWNW W‘ CW1 L fiLw e N\ mma MW“ W 61W“ Unnd (DNFDKZH[IA OEWMA mWa‘s/[i marlgnaery} flag” WHVI Case Number: ® Check the orders you want. 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® : 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 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. D Other (specifir): D Check here ifthere is no! enough spacefor your answer. Put your complete answer on the attached sheet afpaper orform MC-025 and write "Attachment 8c-0ther 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 no! lo make the order. $Stay-Away Orders , 00a. I ask the court to order the person in ® to stay at lgastL yards away from (check all Ihat apply: (1) Me. (8K My vehicle. (2) The other persons listed in@. (9) fl Otiier (spgcéfiz): v » _ (3) My home. _ l”! ct" L en T Vow fix u 4 5+5}7- 4 M ' b k 1 ' A ‘ “ ' " ' "' 5() yJo orwor pace. n1 (ul‘fl‘, 4; (5) D My school. <7 1.; r‘r/M L n X1 I ' V (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 l the places listed above, will he or she still be able to get to his or her home, school, orjob? m Yes No (Ifno, explain below): a Check here ifthere is nor enough spacefor your answer. Put your complete answer on the attached sheer 0f ‘ [gaperpgfqr/n MCI‘5925 and write :‘Atrachment Oh-Stnv-Awav Orders. ” for a title. w... ur- ~-\.. I'luymux . yw'n-v/w-L/IW Guns or Other Firearms and Ammunition Does the person in @own or possess any guns or other firearms? DYes DNO wdon’t know Ifthejudge grants a protective order, the person in ® will be prohibitedfrom owning, possessing, purchasing, receiving, or attempting to purchase or receive a gun, otherfirearm, and ammunition while the protective order is in effect. The person in ®will also be ordered Io turn in t0 law enforcement. 0r sell r0 0r store with a licensed gun dealer, any guns orfirearms within his or her immediate possession or control. This is not a Court Order. RWMJW‘” ‘- 2°” Request for Civil Harassment Restraining Orders CH-1oo, Page 4 ofe (IE {?Fm'm (Civil Harassment Prevention) 9chm CaseNumbfil cHoo 98 62 ® mTemporary Restraining Order l request that a Temporary Restraining Order (TRO) be issued against the person in ® to last until t_he hearing. I am presenting form CH-l IO, Temporary Restraining Order. for the court’s signature together with thls Request. Has the person 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 he {fthere is not enough spacefor your answer. Put your complete answer on the attached sheet 0f paper orform MC- 25 and write "A(tachmem ll-TenW Restrai ing Olrder 'fr a Iirle. Q MMHZ, 0V) Ifl 6m :9 , ,Mfiml h! Ml! v10 wmw’hna vplm‘ warmmmflmg o M rofimm'x . 150 +0 ma H’og {mmm gm, VLW} man. ® D Request to Give Less Than Five Days' Notice of Hearing You mus! have your papers personally served on (he person in® a! leastfive days before the hearing, unless the court orders a shorter timefor service. (Form CH-200-INFO explains What ls “Proof of Personal Service"? Form CH-200. Proof of Personal Service. may be used (o show (he cour! 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 t_‘fthere is n0! enough spacefor your answer. Put your complete answer 0n the attached sheet of paper orform MC-025 and write "Attachment l2-Reques! to Give Less Than Five Days' Notice "for a title. ® D No Fee for Filing or Service a. m There should be no filing fee because the person in®has used or threatened t0 use violence against me, has stalked me, or has acted or spoken in some other way that makes me reasonably fear violence. b. D 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. D 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 complere andfile/brm FW-001, Application for Waiver of Court Fees and Costs.) m Lawyer's Fees and Costs l ask the court to order payment of my D lawyer's fees E Court costs. The amounts requested are:m Amount lte- Amount Eilingfiee $ A35 $ $ $ $ $ D Check here iflhere are more items. Put the items um! amounts 0n the attached sheet ofpaper orform MC-025 and write ”Attachment [Jiluu'yur 's Few um! ('0s!s"for a rifle. This is not a Court Order. "““Jmm‘2m Request for Civil Harassment Restraining Orders CH-1oo, Page 5 oreOBmm (CIVII Harassment Prevention) 9 Case Number: D Possession and Protection of Animals l ask the court to order the following: a. DThat l 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. (Identifi' animals by, e.g., 072e, breed, name, color, sex.) l request sole possession of the animals because (specifv 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 l5a-Possession ofAm'mals "for a Iitle. 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. D Additional Orders Requested l ask the court to make the following additional orders (specifiyz D Check here iflhere is not enough spacefor your answer. Pu! your complete answer 0n the attached sheet of paper orform MC-025 and write "Alrachmem 16-Addin’onal Orders Requested, "for a tille. @ Number of‘pages attached to this form, if any:L Date: Seli-Beplesenled- - d p self-Bepzes‘antedLawyer 's name (ifany) Lawyer 's signarure l declare under penalty of perjury under the laws of the State of California that the information above and on all attachments is true nd correct. “Date: 02 /é 2 l | _ flLU/M WW p Wwfi Type 0r print your name Sign your name ‘ This is not a Court Order. mmm‘“ 12°” Request for Civil Harassment Restraining Orders CH-1oo. Pages otsGB. ?me (Civil Harassment Prevention) Q) 'coooxxoamh 10. 11 12.. ' 13 V 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME:( gagflamtfle w“ Qlflfagmfiem CASE g; 2 1 C H 00 98 6 2 CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? mmmfl’fl b) Are you living with the person? fiYES D NO c) Has the person ?Ghysically abuse you, gphysically or verbally threatened you and/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 (please start with the most recent event and explain exactly what happened in detail. include dates and times): W bir‘mc 9'92 9020 MW»W m mmmgt cuan {mm mm; such cu (am 3551mm, uh?“ he MIMImm WWW“ Aesm me flmfimlu mama mfiwhmf} m [calm mm me Nave?’dw 1926M mmm W nWA [UWI [U Mdflm WCOWMI Wm; evmhme .01mWm :SMLh M hm gramMM {orawm a pm Wdoww -b VLF de/wwm mm fiW’kiVWW} MWMM .yeu/em/t --fim£A IWWdafim \NMMSS'MCUJ YYLQ, gnaw mm WH/ Mule W): jM 1w WW6 bewmz WWQZ, quwwe wwmaowmvflmflfi’m a} 90' gayzy er/awmfiWm MHn hi5 bemwvr. 41.1; ("an I5 Vanot, é t film“? CH-100, Item 73(3) - DESCRIBE HARASSMENT Page_ MC-OZO SHORT TITLE. CAse NUMBER QQMVPMA and Cmma 21cH009862Wm ”eZL 7'12 ”Lama mquAfl 0,7 7%! mepertw pmwfi/ri WM Flange; Wu narm 7bWMMMo! 06mmWm My rvmmm‘é 4’ P fit; had 0mmNW 7‘44» mgkeMfl/e WW moi?! 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DWW Wlm WDWLMWMH HAP fl, 24 Dfifmwmi’ FEWWVWA oroLw,WMI'S W4, Dbleczhw . 25 MWCW WMM‘H/MYWL he WWWWVZSW \Ofl/Cb \‘d‘T‘D WM \ P(flfwé ml? 26 (Required for verified pleading) The items on this page stated on information and belief are (specify item numbers, not(line' numbers). A w N -‘ (D m V m w ‘ W 27 This page may be used with any Judicial Council form or any other paper filed with the court. Page Fonn Appovo ed by me ADDITIONAL PAGE CRC 201. 501 Jud. alCouncII ofCaHoma M0020 9:43:nugg‘t 19871 Attach to Judicial Council Form or Other Court Paper Mamnnooa snmEssen/anm .l 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 210H009862 CASE NAMEQQWW am glam“ CASE #z Last Name Last Name e) Were any guns or other weapons used or threatened to 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?#YES D NO If “YES”. describe: g) Did the police come to any of these recent events?#YES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES 4N0 If “YES", please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? DYES iNO lf“YES",where: j) Has the person you want restrained ever been in jail for violence against you or your children? DYES «iNo If"YES",when: Describe what the person did to you or your children that caused them to go to jail: 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 1 C H 00 98 6 2 CASE NAMEQW’W’ 3"“ glam“ CASE #: Last Name Last Name k) Do you have a criminal protective order (restraining order from criminal court)? D YES #NO If “YES", please attach a copy. l) Describe the worst abuse and when it happened: $he most recent abuse i_s the worst abuse OR D The worst abuse was (approximate date) and the person I want a restraining order against (describe wna: they ma to you): 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): CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT Page_