Request Restraining OrderCal. Super. - 6th Dist.February 22, 2021Restraining Orders Read Can a Civil Harassment Restraining Order Help Me? dorm CH-100- INFO) before completing this form. Also fill out Confidential CLETS I L EInformation (form CLETS-0()l) with as much information as you know. . . FEB 2 2 2021® Person Seeking Protection a. Y r Full Name: C'er f m counK NGUYEN . Supenor Court C Co nty o! Santa Clara rifiilfl MY Vaza i Agc' $- Ev :1 g DEPUTY Your Lawyer (Ifyou have onefor thts case) Fill in coun name and street address: Name: State Bar No.: Firm Name. "--_ Superlor Court of Callfomla, County of 5mm CUMU- b. Your Address (Ifyou have a lawyer, give your lawyer '5 Sgpen'or Court information. Ifyou d0 not have a lawyer and want to keep your CW“ DiVi§i0n home address private, you may give a different mailing address 191 N' F“! St. _ , . San Jose, CA 95113 Instead. You d0 not have t0 give telephone fax, 0r e-maIl.) AddreSS' [(0 1 l f “(4H nae r Aye Court fills in case number when form is filed. City: 54M \M U State- Zipqg [bl Case Number: Telephonelfllxd gig (Qllg Fax CiL ZICHOO 9875 E-Mail Address: ® Person From Whom Protection ls Sought FullName: XCCLH Hflfl {filaz m, Age:fl Address(fknown) H%\ Aroma Ava City; Lag ?\“WOS State: [Q Zip: fl §(e©( ® Additional Protected Persons a. Are you asking for protection for any other family or household members? D Yes U N0 lfyes, list them: Full Name & m Ljvgs with mg? Howmthgy relgxgd 19 mu? Asyana Pvumla Hmhnm r z g Yes D No .Dcmama D Yes D No J 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 d0 these people need protection? (Explain below): D Check here ifthere iv not enough spacefor vour ans.wer Putyour complete answer 0n the attached sheet 0f paper orform MC-()25 and write “Attachment 3b-Whv Others Need Prot cti 'for a title. 3mm Salaww Wis Harman #0 lad ma 04 iuffl af 5 5’1 0m ma MUM 0M. jflbrma éa 41W Ms a! 50 H’liad-en h beézl ma n fiat mumwnzv 0F M éflbvlm émlaMr Domed m eacmk méolm W0 Ms m A a) at Other 6m Wreafen' n14 This is not a Court Order. wawmmflffommww Request for Civil Harassment Restraining Orders °""°°v P399 1 0'5 0°40 0' CM Pm”. §§ 527-6W 527-9 (Civil Harassment Prevention) 9 Case NuzTrc H 00 98 7 5 ® Relationship of Parties How do you know the person in ® ? (Explain below): D Check here ifthere is n01 enough spaceforyour answer. Put your complete answer on the attached sheet of paper orform MC-025 and write "Attachment 4-Relationghip ofParties "for a title. Sabvma Maw“ lb mv 06’s waFe/ G) Venue Why are you filing in this county? (Check all that apply): a. E The person in® lives in this county. b. D I was harassed by the person in® in this county. c. D Other (specifiz): © 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 fl N0 (Ifyes. check each kind ofcase and indicate where and when each wasfiled.) (1) 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) [j Criminal (1 l) D Other (specifiz): b. Are there now any protective or restraining orders in effect relating to you or any of the persons in® and the person in®? XNO 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® harassed you. ( l) When did it happen? (provide date 0r estimated dale): 2.‘OJ \2 \ 4* 25731 Pm (2) Who else was there? j. lpfls \m mvbd? M mxj car cum 4abvinm Salazar mum my WW. This is not a Court Order. “mmmmmm Request for Civil Harassment Restraining Orders CH'100- P896 2 0'6 (Civil Harassment Prevention) 9 Case Number: 21CH009875 ® a. (3) How did the person in® harass you? (Explain below):D Check here t_‘fthere is not 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. On 2 111m 1H 3‘51 m Sabnm Sammy CHM WgmHawtmmna +n la: n11. 1,43: wads Lump “1/1“ [JJLU zud-H/mfk blfl‘h” (M 15M 5mm Jaw 27. 2| \abunq \Valazaw pom A Mb {I a an nbd' 41) 'l/mx lg/A CH hm SCUM MM Ia {Ime - ‘om‘w Math'm. (4) Did the person in® use or threaten t0 use a gun or any other weapon? D Yes E No (Ifyes, explain below): D Check here ifthere is not enough spaceforyour answer. Pu! your complete answer on the attached sheet ofpaper orform MC-025 and wriIe “Attachment 7a(4)-Use 0f Weapons "for a title. (5) Were you banned or injured because of the harassment? D Yes E N0 (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 “Altachment 7a(5)-Harm or Injury "for a title. (6) Did the police come? D ch g No lf yes, did they give you or the person in® an Emergency Protective Order? D Yes D No If yes, the order protects (check all that apply): D Me 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? $ Yes D No (Ifyes, describe prior incidents and provide dates ofharassment below): D Check here ifthere is not enough spaceforyour answer. Put your complete answer on (he attached sheet of paper orform MC-025 and write‘‘Attachment 7b-Previous Harassment ”for a title. 0n +10 Summzv 0F 9mm Wormu Salazar Human m mi me 013 er Wm fxo‘nflnmna MV d(l/AMMI - V121 [ad a1 .ijD pmkmdg 1M I This is not a Court Order. ”WWW“ "2°” Request for Civil Harassment Restraining Orders CH-100. Page 3 of6 (Civil Harassment Prevention) 9 CaseNuEfGHoo 98 7 5 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 to me or to any person to be protected listed in@z a. m 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. E 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 interofficc mail, by e-mail, by text message, by fax, or by other electronic means. C.E Other (specifil): D Check here ifthere is not enough spaceforyour answer. Put your complete answer 0n the attached sheet ofpaper orform MC-025 and write “Attachment 8c-0ther Personal Conduct Orders, "for a title 1 Tm: 3'11 mv Mp AM. my AAMVWI 5 Me W 4w cw’fi 44 awning Mamas mmml Maw mm he Amer magma; mm+ pmd Awa 4m hzr regUWn’L J The person in will be ordered not to take]anv action to get the addresses or locations ofany protectedperson unless the courtfinds good cause not t0 make the order. E Stay-Away Orders a. l ask the court to order the person in® to stay at leastm yards away from (check all that apply): (1) SMC. (8) E My vehicle. (2) w The other persons listed in @. (9) D Other (speci v ): (3) m My home. W‘ [t M N \IdeY (4) m Myjob or workplace. fine UM“! Q ,Af ‘ (5) m My school. (6) m My children’s school. (7)fl My children’s place ofchild care. L b. 1f the court orders the person in ® to stay way 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 N0 (If'wv explain belowl‘ D Check here ifthere is not enough spaceforyour answer. Put your complete answer on the attached sheet 0f paper orform MC-025 and write “A (lachment 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? X Yes D No D I don’t know lfthejudge grants a protective order, the person in® will be prohibitedfrom owning, possessing, purchasing, receiving. 0r attempting to purchase or receive a gun, otherfirearm, and ammunition while the protective order is in eflect. The person in ® will also be ordered Io turn in lo law enforcement, or sell t0 0r store with a licensed gun dealer, any guns orA/irearms within his 0r Iwr immedialo paxsession or control. This is not a Court Order. W“““""°'V‘-2°‘° Request for Civil Harassment Restraining Orders CH-Wo- P399 4 0'6 (Civil Harassment Prevention) 9 Case Number: 218H009875 ® E Temporary Restraining Order I 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 wcre going to go to court to seek a TRO against him/her? D Yes W No (lfyou answered no, explain why below): D Check here ifthere is n0! enough spaceforyour answer. Put your complete answer on the attached sheet 0f [gaper arform MC-025 and write “Attachment 1 l-Temporary Restraining Order "for a title. l {1Q ndr have PW Contad mm am [m afwud 13w mtiye, ® D Request to Give Less Than Five Days' Notice of Hearing You must have your papers personally served 0n the person in® at leastjive days before the hearing, unless the court orders a shorter timejbr service. (Form CH-200-INFO explains What ls “Proof 0f 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 bc fewer than five days between service and the hearing, explain why below: D Check here iflhere 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. ® D No Fee for Filing or Service a. E 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.B The sheriff 0r 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 flee because I am entitled to a fee waiver. (You must complete andfileform FW-001, Application for Waiver 0f Court Fees and Costs .V) D Lawyer's Fees and Costs l ask the court to order payment ofmy D lawyer’s fees D Coun costs. The amounts requested are: Lem mm Ltcm mom; $ $ $ $ $ S D Check here ifthere are more items. Put (he ilems and amounts 0n the attached sheet ofpaper orform MC-025 and write ”Attachment 14~~~Lcm1ver 's Fees and Costs "for a title. This is not a Court Order. meym‘“ Request for Civil Harassment Restraining Orders CH-100- P899 5°f6 (Civil Harassment Prevention) -> Case Number 21cH009875 ® D Possession and Protection of Animals l ask the court to order thc following: a. D That I be given the sole possession, care. and control of the animals listed below, which I own, possess. lease, keep. 0r hold, or which reside in my household. (Identify animals by, e.g., type, breed, name, color, sex.) I request sole possession of the animals because (specify good causefor granting order): D Check here ifthere is not enough spaceforyour answer. Put your complete answer 0n (he attached sheet ofpaper orfonn MC-025 and write “Attachment lSa-Possession ofAnima/s "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. D Additional Orders Requested I ask the court to make the following additional orders (specifil): D Check here ifthere is not enough spaceforyour answer. Putyour complete answer on the attached sheet of paper orform MC-025 and write “Attachment lé-Additional Orders Requested, "for a title. ® Number of pages attached to this form, if any: Date: b 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 is true and correct. Date a lad lm :wafwwu //Av Xgi/ Type or prim vour n me Sign vour name 42' This is not a Court Order. Request for Civil Harassment Restraining Orders CH-Wo- P896 60'6 (Civil Harassment Prevention) wmtzma ZICH009875 -~ KEEP MY KIDS. MY AND THE TOOL. IN ARMS REACHu
