Request Restraining OrderCal. Super. - 6th Dist.February 16, 2021- Request fOr CIViI Harassment Clerk stamps date here when form is filed.CH'1 00 Restraining Orders Read ("cm a ('ivil Harassment Restraining Order Help Me? (form CH-I 00- INFO) before completing this form. Also fill out Confidential CLETS I L EInformation (form CLETS-OOI) with as much information as you know. F Person Seeking Protection FEB 1 6 2021 K. NGUYEN a. Your Ful Name: . V 0Y0“ \JQ\A{1 Age: Sr] Your Lawyer (ifyou have onefor {his case) Fill in court nam and street address: Name: State Bar No.1__ Superior Court of California, County of Firm Name: jelEReptesented santa Clara191 N. Flrst Street b. Your Address (Ifyou have a lawyer, give your lmvyer 's 191 N. First Street information. Ifyou d0 not have a lawyer and want t0 keep your giavql‘lcoosgrtfiéugssefl 3DTS home address private vou mav give a diflerem mailing address instead. You F105 not hav Krognoeéelefioaflmwc. or e- mai1.) Court fills in case number when form is filed. Address: V‘ - Case Nu r: City:Mfl _Sta;e:%le2LL T1 c H 00 98 6 4 Telephone: _‘ _ _ Fax- E-Mail Address:_.._ __v Q) Person From Whom Protection ls Sought Full Name: BV\CM\ w ‘\§O“ m Age:L Address (ifknowLn). _ (A/A L_tqyuj /\ . J . l aCity? ‘ State: . le: ® Additional Protected Persons a. Are you asking for protection for any other family or household members?D Yes DNO Ifyes. list them: Full Name $3 Ag; Lives with you? How are they related to you? D Yes D No D Yes D No D Yes D No D Yes D No D Check here ifrhere are more persons. Attach a sheet ofpaper and write “Attachment 3a-Addilional Protected Persons "for a title. You may useform MC-025, Attachment. b. Why do these people need protection? (Explain below): D Check here iffhere is not enough space for your answer. Pu! your complete answer 0n the attached sheet of paper orform MC-025 and write “Attachment 3b-Why Others Need Protection ”for a title. This is not a Court Order. fiamfi“?°"}‘6"°m"grgzgafig§g°gw Request for Civil Harassment Restraining Orders CH-1oo, Page 1 ore ° "" '°°° “'° §§ a (Civil Harassment Prevention) ROHCI n PVERN9CU3'FW Case Number: ® Relationship of Parties How do you know the person in®? (Explain below): D Check here iflhere is n0! enough spacefor your answer. Put your complete answer 0n the attached sheet 0f pa er orform MC-025 and writq “Attachment 4-Relationship ofParties "for a tille. hmx \J \\30 n \S mm nenhev)‘.. . J V .‘ G) Venue Why are you filing in this county? (Check all that apply): a. a The person in ® lives in this county. b. E I was harassed by the person in® in this county. c. D Other (specifiy: ® 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 w 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) (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 (10)D Criminal (1DD Other (spec‘g'fl’): b. Are there now any protective or restraining orders in effect relating to you or any of the persons in @and the person in®7 ENG 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. 0r 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. ‘ (l) When did it happen? (provide date or estimated date): w L9 ) 2Du 2 Wh l th ?( ) o e 5e was ere [See attached declaration for a Description of Harrassment] This is not a Court Order. “?“WJW’” 12°” Request for Civil Harassment Restraining Orders CH-1oo, Page 2 ore (IB'W (Civil Harassment Prevention) m... mm -) Ca_se Number:1094 ® a. (3) How did the person in® harass you? (Explain below):D Check here ifthere is n0! enough spaceforyour answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write "Attachment 7a(3)-Describe Harassment ”for a title. 9g, av‘MG/M-QMJ» 74(3) (4) Did the person in® use or threaten to use a gun or any other weapon? a Yes D No (Ifyes, explain below): D Check here ifthere is not enough spacefor vour answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write 4ttachmen! 7a(4)-Use 0f Weapons' for a tit] 50 mmer ”2-010 acme «Ammo h W house. hmai 09 (x 411nm Chmn ‘m a 4%er mnu manna mkddk 05; \Lhe hicmi- (mm? TJ (Am Serio'uw. (5) Were you harmed or injured because 0f the harassment? 8 Yes D No (lfyes. explain below): D Check here ifthere is n0! enough spacefor vour answer Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write‘ ‘4tlachment 7a/5)--Harm 0r lnjurv' ’for a title Emm Q 0N e. me (A mead ‘mfi +0 mu MA mosx M a \qc Magma mm xx veqm (ab wmrm’ akmfion w}W S+Hd1e$ Qmmumwfi mv veA *hv doywQONX 0AA meSQM‘ Gave, m6 g SJMCKe s J (6) Did the police come? aYes D No If yes, did they give you or the person in ®an Emergency Protective Order?D Yesa No If yes, the order protects (check all that apply): DMe a The person in ® D The persons in @. (Attach a copy offhe order ifyou have one.) b. Has the person in ® harassed you at other times?8 Yes D No (Ifyes. describe prior incidents andprovide dates ofharassment below): D Check here ifthere is nor enough spacefor your ans.wer Put your complere answer 0n the attached sheer of paper orform MC-025 and write “Attachment 7b-P ex ions Harassment 0r a title 106 “weakndx *0 \k\\\ mew 2007 03m,“ meandlMAMA lacem‘h'On \Iemomm toassxfloxma me, /Q0 o Wrouch doom a+ mam meizemm +0 Mrm 05 Tm‘x m #0 Mm! who Cm (1nd Caf& JCLH‘K‘WV 5c uh gm mu JGAOHM paYe/Ntf This is not a Court Order. “w““m'ymm Request for Civil Harassment Restraining Orders CH-1oo, Page 3 ore(mM (Civil Harassment Prevention)um 93E..." 9 Case Number: Check the orders you want. M a 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 @z 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. aContact 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 (specifi’): D Check here ifthere is.n01 enough spacefor your answer. Put your complete answer 0n (he attached sheet ofpaper orform MC-025 and write "Attachment 8c-Other Personal Conduct Orders, "for a title. The person in ® will be ordered nor to lake any action Io get (he addresses 0r locations ofany protectedperson unless the courrfinds good cause not t0 make the order. ® aStay-Away Orders a. I ask the court to order the person in ® to stay at least 1m- yards away from (check all rhat apply): (1)a Me. (8) My vehicle. (2) D The other persons listed in®. (9) Other (specifiz): (3) a My home. (4) a Myjob or workplace. (5) D My school. (6) D My children’s school. (7) D My children‘s place of child care. b. 1f 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, orjob? a Yes DNo (Ifno, explain below): D Check here ifthere is not enough spacefor your answer. Put your complete answer 0n Ihe attached sheet of a er or orm MC-025 and write “Attachment 9b-Sla ’-Awa V Orders, " or a title.p p (‘Af‘mafio‘ 9mg“ VJ \uo n k); )Sétav mg pimflhere. U0?sum whore ’ J Guns or Other Firearms and Ammunition Does the person in ®own or possess any guns or other firearms? DYes DNo a] don‘t know Iflhejudge grants a protective order. the person in ® will be prohibitedfrom owning, possessing. purchasing, receiving. 0r attempting to purchase or receive a gun, oll1erfirearm, and ammunition while the protective order is in eflecr. The person in ®will also be ordered to (urn in I0 law enforcement. 0r sell to or store with a licensed gun dealer, any guns orfirearms within his or lm- immcdiate possession or control. This is not a Court Order. Rem‘jmm 1- 2°” Request for Civil Harassment Restraining Orders CH-1oo. Page 4 of6 thm'm (Civil Harassment Prevention) 9 Case Number: ZICH009864 ® E Temporary Restraining Order l request that a Temporary Restraining Order (TRO) be issued against the person in ® to last until the hearing. l am presenting form C H-l l0, 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 8N0 (lfyou answered no. explain why below): D Check here {fllwre is not enough space for your answer. Pu! your complele answer on the attached sheet of paper orfbrm MC-025 and write “Attachment II-Temporarjv Restraining Order "for a title. SCQYOA‘ n; \mm ® D Request to Give Less Than Five Days' Notice of Hearing You mus! have your papers personally served on the person in® at leastfive days before the hearing, unless the court orderx u shorter timefor service. (Form CH-2()0-I.VF() explains What Is "Proof of 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 [fillere is not enough spacefor your answer. Put your complete answer 0n the attached sheet of paper orform MC-025 and write "Attachment 12-Reques! Io Give Less Than Five Days' Notice "for a title. ® E No Fee for Filing or Service a. 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. 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 ofviolence, 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 complete andfi/eform FW-001, Application for Waiver of Court Fees and Costs.) E Lawyer's Fees and Costs l ask the court to order payment of my D lawyer's fees‘ m Court costs. The amounts requested are: ltfl Amount I_te_ Amount Eilingiee $ 435 s $ $ $ $ D Check here ifrhere are more iremx. Pu! tlzc ircmx um] amounts on the attached sheet ofpaper orform MC-025 and write ”Altachment 14g-Luu1wr 'x l’ucx uml ( 'u.\'Is”_/br a lille. This is not a Court Order. “°“’°“‘"“"‘ "2°” Request for Civil Harassment Restraining Orders CH-1oo, Page 5 oreGB Ema "u (CivilHarassment Prevention)m. ,2_Fot_mt '9 Case Number: D Possession and Protection of Animals l ask the court to order the following: a. D That 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., Iype, 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. Pu! your complete answer 0n the attached sheet ofpaper orform MC-025 and write "Attachment 15a-Possession ofAm'mals "for a Iirle. 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. DAdditional Orders Requested I ask the court to make the following additional orders (specifiy: D Check here (flhere is not enough spaceforyour answer. Put your complele answer 0n the attached sheet 0f paper or/brm MC-025 and write “Attachment I6-Addili0nal Orders Requested, ”for a title. @ Number of pages attached t0 this form, if any: Date: Seltfiepmsemed- .. d - Lawyer 's name (ifany) Lawyer 's signature l declare under penalty of perjury under the laws 0f the State of California that the information above and on all attachments is true and correct. 1- Iva} AQVQAWWO MVM Type or print your name ’Sign your name Date: This is not a Court Order. Revused January 1. 2018 Request for Civil Harassment Restraining Orders CH-1oo, Page s ots(mm (Civil Harassment Prevention) 1O 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASENAME: (A and \ n CASH: ZICH009864 as ame 35 ame CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? x xfl 4! i i ‘fl '35) b) Are you living with the person? D YES E NO c) Has the person a physically abuse you. a physically or verbally threatened you and/or fl harassed 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): D&C (0% 2010 Brian \Jx \Son 5+ar¥€d CMSn1% flan Gave m£ a hohi hem] bfi’k +0 mu eqebrbw aYea and blood 5+0H€A QuShum 061’ ufivck Yfao‘xwd W’wca. aHeM'I 0!] «(mADm L4 6m Cpuuom monHu asses fid mf and eldermWama Hwoucm W\home aqi mWr MW ox Wham mm mamaJWm \(\€ .5 \Y\ Chan“, SCQHYMJ €U€m Ofle qu n‘x nu A318 house, ajfifin fm Dunde/j Q \oo {\ch o? whim; m mom; and k n Hue Gama?“ brmeol SJmQfln WK muse J R4 {ln/hms armlJham: 201? Hm“ Lena] YM“ me“ ZOO“? nmhflj mL \n 41}? £aca (mA \(Ln/ QnD/Mr [a(emHOn. [\) CH-100, Item 7a(3) - DESCRIBE HARASSMENT Page MC-OZO SHORT TfTLE: CASE NUMBER_ V(ugsdgez. and g WNxambon 21cu009864 1 2 B man ha: a r\ {u a fihfi moldiuhom I a $00M a (Jag! )0 ' fl) m HM 310mm; 4 "I’m k rm 4‘0 Conlrro ' mm can‘JJr‘ Co n5? 0 Ue/r 5‘ ~PM hike, nnA who we (an 4m\K +09 e T‘m x \w ?VD {QHJWOl Hm hooxhdd Bfl an dog 7 i a ~Cor 033mm nh’ m m wider 9 r 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 s‘ated 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- Jmé‘gffngmgvamm ADDITIONAL PAGE CRC 201 501 MwZO New memt 1987] Attach to Judicial Council Form or Other Court Paper Mann Dean's Essential Forms TM 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 ‘ 1 C H 00 98 6 4 CASE NAME: thtlkdfic‘Land SQ t3 gSOh CASE #: 2 e) Were any guns or other weapons used or threatened to be used during any abuse in the past three months? a YES D NO "WES". describe- NQWWA QNDQQM ”vhe, \DOSQ/ kn Hm (NAM: o9W \m\?r\dw NH (x \<\\\( K Chm n wmoyed 00f 00 N) ‘N; 593mdfirs f) Were there any injuries uring abuse'In the past three months? I YES D NO lf“YES", describe. \(He/{ffiOfl +0 mg l?£"’ ?%6bfou) {)6}: Lo 2020 g) Did the police come to any of these recent events? E YES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES fl NO If “YES". please attach a copy. i) Is the person you want to restrain in jail right now for violence against you? m YES {:1 No If “YES", where: S’m’ra Clam (Annulu j) Has the person you want restrained ever been in jail for violence agaiEgt you or your children? gYES DNO lf"YES",when: Describe what the person did to you or your children that caused them to go to jail. FAQ \7, 9020 Bum ma; yellina and \OCPQKWN Obxerh \H Hm GOIYCIOE “j: UH? SCQMMN wouh‘ flwmfi mSide howe rmA 514+mi/ me Mwe mrtwd 0nd Samar) m had Ztnowamlx 40>» \{\x S F1 VVQS‘F. CH-100, Item 73(3) - DESCRIBE HARASSMENT Page_ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAMEN O\\(\.(}land\,d'\\mn CASE m 2 1 C H 00 9 8 6 ’4 Last Name 'Last Name k) Do you have a criminal protective order (restraining order from criminal court)? D YES I NO If “YES", please attach a copy. I) Describe the worst abuse and when it happened: E] The most recent abuse i_s the worst abuse OR E The worst abuse was (approximate date) {k g. k 99202 and the person I want a restraining order against (aescnbe what mey ma to you): (AQNM Wwegh Hm Mom m a HE (“\Aak Ogr 4}“? “\Oh‘F [0014qu UCYH HHCHM. §+UY3WA CQQSxMJ a+ WW Jihad qafiJ Me a Wrm WHM) \er 39102311 QVShmm 00+. \J \J 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-100, Item 73(3) - DESCRIBE HARASSMENT Page_
