Request Restraining OrderCal. Super. - 6th Dist.February 22, 2021CH 1 00 Request for Civil Harassment clerk stamps date hem when form is med. 7 ' _,__ Restraining Orders Read ('un u ('ivi/ llclr'u.s‘.\'/nw1! Restraining Order Help Me? (form (V'H-IOO- I L E INFO) before completing this form. Also fill out Confidential CLETS Information (form ('LETS-OOI) with as much information as you know. FEB 2 2 2021 _ C K. NCIUYEN - - f the oun Person Seeking Protection 5.9.599 o. Wwammm a. our Full Name: "k BY DEPUTY (,MLCA/6‘ ‘51:) Age: 36 Your Lawyer (Ifyou have onefor this case) Fill in court name and street address.- Name:Samma- State Bar No.2- gupeiiorccfurt of California, County or . . an a ara Flrm Name.Wd 191 N_ First Street b. Your Address (lfyou have a lawyer, giveyour lawyer 's 191 N. Flrst Street information. lfyou do n0! have a lawyer and want Io keep your g?vr}lJcoosghfiéussf’e1 j 301-5 home address private. you may give a different mailing address instead. You d0 n0! have to give tele hone, fat. 0r e-mail.) Court fills in case number when form is filed. Address: Io 04 AQMM) W __ Case Nat“ 00 98 7 a City: State2Cfi ZipzflSD_SCL Telephone: Fax: E-Mail Address: ® Person From Whom Protection ls Sought Full Name: mrm MMUJIQ WWIHQ Age:L Address (ifknown): U (A fl [C hm, V\ City: State: Zip: GD Additional Protected Persons a. Are you asking for protection for any other family or household members? DYes 8N0 Ifyes. Iis! them: Full Name E Agg 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 ifthere are more persons. Attach a sheet ofpaper and write “Attachment 3a-Additi0nal Protected Persons "far a title. You may useform MC-025, Attachment. b. Why do these people need protection? (Explain below): D Check here iflhere is nor enough spacefor your answer. Pu! your complete answer on the attached sheet of paper orform MC-025 and write “Attachment 3b-Why Olhers Need Protection ”for a title. This is not a Court Order. $$fi$fifl§°§$¥afi§¢fim§fifi¥$§w Request for Civil Harassment Restraining Orders CH-1oo. Page 1 ote °°°°°' ""' °°°°“'°'§§52 ““52 ’ (Civil Harassment Prevention) ROHC, [l PVERN9(113' Emmi ana- film Case Number: GD G) Relationship of Parties How do you know the person in @2’ (Explain below): D Check here ifthere is not enough spacefor your answer. Put your complete answer on rhe attached sheet 0f paper orform MC-025 and write “Attachment 4-Relari0nship ofParties "for a title.(W (xhud' Venue Why are you filing in this county? (Check all that apply): a. MThe person in ® lives in this county. b m I was harassed by the person in ®n1n thisIcounW- caOther (speczfl). ’E ”OIK 6W 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 a No (lfyes, check each kind ofcase and indicate where and when each wasfiled.) Kind of Case Filed in (CounQMSratez Year Filed Case Number (ifknown) (1) D Civil Harassment (2) D Domestic Violence (3) D Divorce, Nullity, Legal Separation (4) a 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®? m No 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 you. (l) When did it happen? (provide date or estimated date): (2) Who else was there? [See attached declaration for a Description of Harrassment] This is not a Court Order. “WWW“ "2°“ Request for Civil Harassment Restraining Orders CH-1oo, Pagez oreEmu“(IB'hm (Civil Harassment Prevention) 9 Case Number: 210H009874 ® a. (3) How did the person in® harass you? (Explain below):D Check here ifthere is n0! enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write “Attachment 7a(3)-Describe Harassment "for a title. (4) Did the person in® use or threaten to use a gun or any other weapon? fl Yes D No (Ifyes, explain below): D Check here ifthere is not enough spacefor your answer. Pu! your complete answer on the attached /sheel ofpaper orform A C 025 and write “Attachment 7a(4)-Use of Weapons’’for a titl W14] DW.WYW 19 mum MJr Q&VnWwIDW QWNLMW opmw elm) w wfa mm (5) Were you harmed or injured because of the harassment? J D Yes a No (Ifyes, explain below): a Check here ifthere is not enough spacefor your answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write "Attachment 7a(5)-Harm or Injury "for a title. (6) Did the police come? EYes D No If yes. did they give you or the person in ®an Emergency Protective Order?D Yes mNo If yes, the order protects (check all that apply): D Me D The person in ® D The persons in ® (Attach a copy OfIhe order ifyou have one.) b. Has the person in ® harassed you at other times?m Yes D No (Ifyes, describe prior incidents andprovide dares ofharassment below): D Check here ifthere is n0! enough spacefor your answer. Put your complete answer on the attached sheet of aper orform MC-025 and write ‘Artachment 7b-Preu'ous Harassment ’forw/afi¢MM» lLfv‘ A WMLMM 1m 1M MI/caoé/ m M fliM 1/9/7/ll7l. HL wao 6W 40 44v. 62/0 ?oafim 1/2494. This is not a Court Order. EEWM "2°13 Request for Ciyil Harassment Restraining Orders CH-1oo, Page 3 ore rimjm"m (CIVII Harassment Prevention) 9 Case Number: ® Check the orders you want. E E Personal Conduct Orders I ask the court to order the person in ®not to do any of the following things t0 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. 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 (speafi): D Check here iflhere is not enough spacefor your answer. Put your complete answer 0n the attached sheer 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 (o ge! the addresses or locations ofany protectedperson unless the courtfinds good cause not to make the order. .Stay-Away Orders a. l ask the court to order the person in ® to stay at leastfl. yards away from (check all that apply: (1) $ Me. (8) m My vehicle. (2) D The other persons listed in@. (9) D Other (specifiz): (3)Q My home. (4) $ Myjob or workplace. (5) a My school. (6) D My children’s school. (7) D My children’s place of child care. b. If 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, orjob? m Yes DNO (Ifno, explain below): D Check here ifthere is nor enough spacefor your answer. Put your complete answer 0n the attached sheet 0f paper orform MC-025 and write ”Attachment 9b-Sray-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 Bl don’t know Ifthejudge grants a protective order, the person in ® will be prohibitedfrom owning, possessing. purchasing, receiving, or atlempting to purchase or receive a gun. orherfirearm, and ammunition while the protective order is in eflecr. The person in ®will also be ordered I0 turn in Io law enfbrcemem, 0r sell t0 or store with a licensedgun dealer, any guns orfirearms within 111's 0r her immediate possession 0r control. This is not a Court Order. Revused January 1. 2018m Request for Civil Harassment Restraining Orders CH-1oo, Page4of6W (Civil Harassment Prevention) 9yam; Case Number: 2 1 g H [m 93 2 4| ® E Temporary Restraining Order I request that a Temporary Restraining Order (TRO) be issued against the person in ® to last until the hearing. l am presenting form CH-l IO, 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 a No (Ifyou answered no, explain why below):D Check here ifthere is n0! enough spacefor your answer. Put your complete answer 0n the artached sheet 0f pa er orform A C-025 and wrile “Attachment 11-Temporary Restr ining Order ”for a title. :E WLV [Val QMMfZWIM/VW WVM lug flaw fl? vap o» Mpmégwl ® 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 timefar service. (Form ('H-ZOO-INFO explains What Is “Proof of Personal Service”? Form CH-200. Proof of Personal Service, may be used Io 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 ifthere is n0! enough spacefor your answer; Put your complete answer on (he atrached sheet of paper orform M0025 and write “Attachment 12-Reques! Io 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 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 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 l am entitled to a fee waiver. (You must complete andfileform FW-001, Application for Waiver of Court Fees and Costs.) a Lawyer's Fees and Costs I ask the court to order payment of my D lawyer's fees m Court costs. The amounts requested are: _[te_m Amount ltL Amount Eiling_Eee $ 435 $ $ $ $ $ D Check here ifthere are more items. Pu! Ihc items and amounts on the attached sheet ofpaper orform MC-025 and write "Attachmenl I47 Lawyer 'S Fees and ('1)S!S"fl)r a rifle. This is not a Court Order. “m“m" “2°” Request for Civil Harassment Restraining Orders CH-1oo. Page 5 ote (I3w (Civil Harassment Prevention) 9au- VJ- Case Number: D Possession and Protection of Animals l ask the court to order the following: a. D That I be given the sole possession, care, and control ofthe animals listed below, which I own, possess, lease, keep, or hold, or which reside in my household. (Identifi’ animals by. e.g., ape. breed, name, color, sex.) l request sole possession of the animals because (specifv good causefor granting order): D Check here ifthere is n0! enough spacefor your answer. Pu! 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 conceal. molest. attack, strike. threaten. harm, or otherwise dispose of. the animals listed above. yards away from, and not take. sell. transfer. encumber, D Additional Orders Requested l ask the court to make the following additional orders (specifiz): D Check here iflhere is n0! enough spaceforyour answer. Put your complete answer on the anached sheet of paper orform MC-025 and write “Attachment 16-Addiri0nal Orders Requested. "for a title. @ Number of pages attached to this form, if any: Date: - d p self-Bepzesenteg Lawyer 's name (ifany) Lawyer ’s signature l declare under penalty of perjury under the laws of the State of California that the information above and on all attachments ist ue and correct. Date: ‘DLWWIM Type or print your name "" This is not a Court Order. “w““m””m Request for Civil Harassment Restraining Orders CH-1oo, Page sacs um; ?.go' mm (CivilHarassment Prevention) 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASENAMEmngg/HD CASE m 2 1 c H 00 98 7 ’4 CH-1 00, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain?{MW CVDAk firm MW) grab. b) Are you living with the person? D YES MO c) Has the person D physically abuse you, E physically or verbally threatened you and/or E 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): Mg. ,Saflmrl/a m 4&4ng «cram am, «éWW5WW a4 Ins be/vmm "71:6 WM/ m ('nr‘lhéd zazflz ad é)n” b5 difléflmp W Mn 3ar~wwuo MWQWWW 6 d 1‘0 l bun FWAOMUQ. m JMHWIEII )8; 30d! I QU/AJ 'L Wluml (m mm M/ICWW vfi’m MndwmmJ/p In Mvmuflni MN, u)” swm w, Wmd M Mwawh/ +9 \L’i'dk'loww.swuw A9 sou: mm WW Toamfm swansd. Tmfinml mg WWWW "KLWMWW”MMAM 1M 051ml kw HDMW 1:1me MWWMJV] Nu.M Mr Jurammo M WW /0:v/7‘Wv6 Ml I/lérw/WWWWM r? ulevw“ pw‘q MW wrw‘ WQMMJI MAMA» oxoirn/h S/ww «70WH’hK 5, l CH-100, Item 7a(3) - DESCRIBE HARASSMENT Page_ 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: baélun andémmmo CASE m 2 1 C H 00 98 74 Last Name Lasx Name e) Were any guns or other weapons used or threatened to be used during any abuse in the past three months? fl YES D NO If “YES". describe: M. JaroxMF/h infirm»! k.WMW 34F k».«2wMMIAWMVMMMWWM f) Were there any injuries during abuse in the past three months? D YES N NO If “YES". describe: 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) ls the person you want to restrain in jail right now for violence against you? DYES HNO lf“YES",where: j) Has the person you want restrained ever been in jail for violence against you or your children? DYES mNO 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 210H00987 k CASE NAME:wé and 3mm‘gnp CASE #zLast a LastName k) Do you have a criminal protective order (restraining order from criminal court)? D YES mNo If "YES". please attach a copy. I) Describe the worst abuse and when it happened: fl The 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 what mey 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 73(3) - DESCRIBE HARASSMENT Page
