Request Restraining OrderCal. Super. - 6th Dist.February 19, 2021m Request for Civil Harassment Restraining Orders Read Can a Civil Harassment Resrraining Order Help Me? (form CH-100- INFO) before completing this form. Also fill out Confidential CLETS Information o’orm CLETS-OOI) with as much information as you know. Person Seeking Protection a. Your FullName: Lan Hinh Age: 6] Your Lawyer (ifyou have onefor this case) Name: SeIf-Rgpresented State Bar No.2 Firm Name: Self-Represented b. Your Address (Ifyou have a lawyer, give your lawyer 's information. Ifyou d0 not have a lawyer and want to keep your home address private, you may give a difleren! mailing address instead. You do no! have Io give telephone, fax, or e-mail.) Address: 1265 Runshaw Pl State: CA Zip: 95121 Fax: City: San Jose Telephone: (408)43 1 -3864 E-Mail Address: tienquocnguven22@2mail.com C2) Person From Whom Protection ls Sought Full Name: Davis Han Address (ifknown): 1265 Runshaw Pl. City: San Jose ® Additional Protected Persons State: CA Clerk stamps dale here when form is filed. FILE FEB 1 9 2021 Cl k of the ourt Superior ol oum olSama Clammm Fill in court name and street address: Superior Court of Califomla, County of Santa Clara 191 N. First Street 191 N. Flrst Street Sgn Jose, CA 951 1 3 CIVII Courthouse - DTS Coun fills in case number when fonn is filed. c'” "“Z'T'C H 00 98 7 2 Age: 70 Zip:95121_ a Are you asking for protection for any other family or household members? DYesflNo lfyes, list them: Full Name §g 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 if(here are more persons. Atrach 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. Put your complete answer on the attached sheet of paper orform MC-025 and write “Attachment 3b-Why Others Need Protection ”for a title. $$$me""°'1Wfl’éin“ 9°" ‘casmmrcnuu 98 I Z I-_ ® Relationship of Parties How do you know the person in @7 (Explain below): D Check here ifthere is no! enough spacefor your answer. Put your complete answer on the atrached sheer of paper orform MC-025 and write “Attachment 4-Relalionship ofParn'es "for a title. He is (he owner oflhe property l 'm rentingfiom. CED Venue Why are you filing in this county? (Check all that apply): a EThe person in ® lives in this county. b. El was harassed by the person in ® in this COUmY- c UOther (specifia): © Other Court Cases a. Have you or any of the persons named in© been involved in another court case with the person in @? D Yesfl No ([fyes, check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in (Couan/Stateg Year Filed Case Number (it knownz (1) D Civil Harassment (2) D DomesticViolence (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 (l DD 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®?mo D Yes (lfyes. 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 C2) harassed you. (1) When did it happen? (provide date or estimated date): Wh l h ? (2) 0 e 5e was‘ ere [See attached declaration for a Description ofHarrassment] This is not a Court Order. “WWW” Request for Civil Harassment Restraining Orders CH-1oo, Pagez ate ‘CaseNumberz 1 cHUO 98 72 l D Check here iflhere is not enough spaceforyour answer. Put your complete answer on the anached sheet ofpaper orform MC-025 and write "Attachment 7a(3)-Describe Harassment "for a title. ® a_ (3) How did the person in harass you? (Explain below): (4) Did the person in® use or threaten to use a gun or any other weapon? Yes DNO (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 "Altachmem 7a(4)-Use of Weapons "for a title. He used a broom stick and threatened Io hit me. He proceeded to hi1 me. and I used my hand Io block. Then. l was pushed. and I ran Outside. (5) Were you harmed or injured because of the harassment? fiYes DNo (Ifyes, explain below): D Check here ifthere is n0! enough spaceforyour answer. Put your complete answer 0n the atlached sheet ofpaper orform MC-025 and write "Attachmen! 7a(5)-Harm or Injury "for a title. Yes. she was trying lo defend herself and herfingers were hurtfi-om catching (he broomslick Then. he pushed her to the ground. She caught herselfby extending her hand and (hat hurt her. (6) Did the police come? “Yes DNo If yes, did they give you or the person in an Emergency Protective Order?DYeswo® If yes, the order protects (check all that apply): D Me D The person in ® D The persons in ®. (Attach a copy oflhe order ifyou have one.) b. Has the person in ® harassed you at other times? Yes D No (lfyes. describe prior incidents andprovide dates ofharassmen! below):D Check here iflhere is n0! enough spacefor your answer. Put your complete answer on the attached sheet 0f paper orform MC-025 and write "Allachmem 7b-Previous Harassment "for a title. Yes. the person has verbally harassed me al other times. He has yelled a! me. He has done things like prevent mefrom using the microwave. the kitchen table. and (he sink. He turned ofllhe hot water in (he sink and (old me that ifl don 't like i! (hen l can leave. This is not a Court Order. ""“m1-m‘8 Request for Civil Harassment Restraining Orders cmoo. Page 3 ofsQB ‘CaseNumberzz 1 GHOO 98 7 2 I Check the orders you want. E m Personal Conduct Orders I ask the coun to order the person in ®not to do any of the following things to me or to any person to be protected listed in @2 a Watass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy personal property of, or disturb the peace of the person. b EContact 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 (specifiz): D Check here ifthere is not enough spaceforyour answer. Pu! your complete answer on the attached sheet ofpaper orform MC-025 and write "Attachment 8c-Other Personal Conduct Orders, "for a title. The person in ®will be ordered not to take any action to get the addresses or locations ofany protected person unless the courtfinds good cause not to make the order. @ dStay-Away Orders a l ask the court to order the person in ® to stay at least 1.5 yards away from (check all that apply): (1)6 Me. (8) D My vehicle. (2) D The other persons listed in®. (9) D Other (speczfii): (3) D My home. (4) D My job orworkplace. (5) D Myschool. (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 all the places listed above, will he or she still be able to get to his or her home, school, or job? Yes D No (lfno, 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 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 w don‘t know Ifthejudge grants a protective order, the person in ® will be prohibitedfrom owning, possessing, purchasing, receiving, or attempting Io purchase 0r receive a gun, otherfirearm. and ammunition while the protective order is in eflect. The person in ®will also be ordered to turn in m law enforcemenl, or sell Io or store with a licensed gun dealer, any guns orfirearms within his or her immediate possession or control. This is not a Court Order. “mmmm‘a Request for Civil Harassment Restraining Orders CH-1oo. Page4 ofs (mEm (CIVII Harassment Prevention) 9 Case Number: I E] 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, 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? Yes DNO (lfyou answered no, explain why below): D Check here ifthere is not enough spaceforyour answer. Put your complete answer on the attached sheet of paper orform MC-025 and write "Attachment I I-Temporary Restraining Order ”for a title. ® D Request to Give Less Than Five Days' Notice of Hearing You must have yourpapers personally served 0n the person in ® at Ieastfive days before the hearing, unless the court orders a shorler 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.) If you want there to be fewer than five days between service and the hearing, explain why below: D Check here iflhere is not enough spaceforyour answer. Put your complete answer on Ihe attached sheet of paper orform MC-025 and write “Attachment IZ-Request to Give Less Than Five Days’ Notice "for a tille. ® flNo Fee for Filing or Service a. iThem 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 sheriffor 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 complete andfileform FW-001, Application for Waiver of Court Fees and Costs.) m Lawyer’s Fees and Costs I ask the court to order payment ofmy D lawyer's fees Rom costs. The amounts requested are: PM:7oBm Amount Filing Fee $ 435 S $ $ $ $ D Check here ifIhere are more irems. Pu! the items and amoums on the attached sheet ofpaper orform MC-025 and write ”Attachment I4-Lawyer ’s Fees and Cosls"f0r a title. This is not a Court Order. RMIodJmuay 1, 2018 ‘caswzm 00 98 7 2 I ® D Possession and Protection of Animals I ask the court to order the following: a DThat I be given the sole possession, care, and control ofthe animals listed below, which l own, possess, lease, keep, or hold, or which reside in my household. (Identifil animals by, e.g., type, breed, name, color, sex.) I request sole possession of the animals because (specifiz good causefor granting order): D Check here ifthere is no! enough spacefor your answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write “Atlachment 15a-Possession ofAnimaIs "for a title. b. UThat 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 (specifiz): D Check here ifthere is no! enough spaceforyour answer. Put your complete answer on the attached sheet of paper orform MC-025 and write "Attachment I6-Additional Orders Requested, "for a title. @ Number of pages attached to this form, if any: Date: Self-Regresented SeIf-Regresented Self-Regesented 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: 02/ l 8/2021 Lan Hinh AmpWM Type or print your name Sign your name This is not a Court Order. Rmud January 1. 2018 Request for Civil Harassment Restraining Orders cmoo. Page 6 om (IEm (Civil Harassment Prevention) 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 and 216H009872 CASE NAME: Hinh Han CASE #: CH-100, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? The restrained person is the owner of the propertv that I rem from b) Are you living with the person? {YES D NO c) Has the person {physically abuse you, thysically or verbally threatened you andlorfiarassed 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): In the past three months. the person has threatened to hit me as well as hitting me with a broomstick. I blocked the stick with my hand, and I was pushed down to the floor. This happened on February 18. 2021 at around 10 AM. Before this, he has done thirggg like turning off the hot water and telling me that if l don’t like it then l could leave. He has told me that I can’t use things like the kitchen table or the sink. Afier the hitting incident and the constant verbal harassment, l absolutely do not feel safe. CH-100, Item 73(3) - DESCRIBE HARASSMENT Page 10 11 12 13 14 15 16 18 19 20 21 22 23 24 25 and 21CH009872 CASE NAME: Hinh Han CASE #: e) Were any guns or other weapons used or threatened to be used during any abuse in the past three months? {YES D NO If “YES", describe: He used a broomstick to threaten and hit me. He also verballv abused f) Were there any injuries during abuse in the past three months? D YES E’NO If “YES", describe: l g) Did the pofice come to any of these recent events?WYES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES gNO If “YES”, please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? DYES E’NO |f"YES“,where: j) Has the person you want restrained ever been in jail for violence against you or your children? DYES fiNo If"vES",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 and 21011009872 CASE NAME: Hinh I Ian CASE #: k) Do you have a criminal protective order (restraining order from criminal court)? D YES E’NO If “YES", please attach a copy. l) Describe the worst abuse and when it happened: {The most recent abuse jg the worst abuse OR D The worst abuse was (approximate date) and the person | want a restraining order against (describe wnanney dim you): The worst abuse was of him hitting me with a broomstick and pushing me down to the floor. 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): Yes a few daysggo, Iwanted to talk to him about what I was experiencing. I wanted to talk about how he was treating me. and he said he didn‘t want to talk. I stood there asking him. but he refused and became irritated. He told me that if I didn‘t leave, he was going to hi! me. | said, “go ahead you wouldn‘t dare“. He then said he was going to get his kids to drag me out by my hair. He stated that | had until March to move out. and ifl didn‘t, he would throw away all of my belongings. CH-1 00, Item 73(3) - DESCRIBE HARASSMENT
