Request Restraining OrderCal. Super. - 6th Dist.February 23, 2021‘ C 100 Request for Civ" Harassment Clerk stamps date here when formis filed. Restraining Orders Read Can a Civil Humssmcm Reslraim'ng Order Help Me? (form CH-100- INFO) before completing this form. Also fill out Confidential CLETS I L E Infonnation (fomz CLETS-OOI) with as much information as you know. waxFEB 2 3 2021 Person Seeking Protection k® r f e Court a. Your Full Name: Superior u CA ounty o1 Santa Clara K; cm (L Mrmn i [La Age: 9 3 DEPUTY Your Lawyer (ifyou have onefor Ids ca. e) Name: State Bar No.2 Fill in court name and street address: Finn Name, ‘ - Superior Court of California, County of ' fl Santa Clara b. Your Address (Ifyou have a lauycr, giveyour lanyer’s Civil Division information. [fyou d0 n0! have a lanyer and want t0 keep your 191 North First Street home address private, you may give a different mailing address 5811 JOSE, CA 951 13 instead. You do not have t0 give telephone, fax, 0r e-mail.) Address: '7g7 B)Mil HU0 #3 Court fills in case number when form is filed. City:SQ bl K‘s; Slate:( a Zip: Q5123 case Numiei: c H 00 98 8 0 Telephone: Fax: E-Mail Address: ® Person From Whom Protection ls Sought FullNamc: Mg}; Qa§rQAfiQAo Age: g: Address (ifknogn): QYQ ANJ\ “ff City: um“ \Wh I State: fllip: 95”.; ® Additional Protected Persons a. Are you asking for protection for any other family or household members? D Yes E NO Ifyes, listthem: I‘ullName $3.; Ag; Liveg with mg? ng azgtng relatgdlg mg? D Yes D N0 D Yes D No D Yes D No D Yes D No D Check here {/‘there are more persons. Attach a sheet ofpaper and write “Attachment 3a-Additi0na1 Protected Persons "for a tille. You may uscform MC-025, Attachment. b. Why do these people need protection? (Explain below).- D Check here ifthere is not enough spaceforyour answer. Put your complete answer 0n the attached Sheet of paper orform MC-025 and write "AIIac/mzent 3b-Why Others Need Protection "for a title. This is not a Court Order. JWfiggjfiyfifgg'jgfgng'wmgf 9°" Request for Civil Harassment Restraining Orders CH'1°°- P399 1 °f6 Codedc‘wlprocedurefi 5276M 527-9 (Civil Harassment Prevention) 9 CaseNumflrl CHOU 98 8 UL _ _ ® Relationship of Parties G) How do you know the person in ® ? (Explain below): 6X Y‘OOWVWAJLL 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 4-Relati0nship ofParties "for a title. Venue Why are you filing in this county? (Check all that apply): a. B The person in® lives in this county. b. m l 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 @1’ D Yes E No (lfyes, check each kind ofcase and indicate where and when each wasfiled.) Ki f s Eilgd in (figumz/SLQM Yggr FilgdWW (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) E] Eviction (7) D Guardianship (8) B Workplace Violence (9) D Small Claims (10) D Criminal (l l) D Other (specifiz): b. Are there now any protective or restraining orders in effect relating to you or any ofthe persons in® and the person in®? E No D Yes (Ifyes. 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 alamed, 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 dale 0r estimated dale): E2 bf! e0Q a £2 :1 0;) 3 (2) Who else was there? #1381 21-037mm SM. Iva»; amah 302,3 This is not a Court Order. Revised January 1. 201a Request for Civil Harassment Restraining Orders CH-100- P898 2 °f6 (Civil Harassment Prevention) 9 Case Number:Mamma- ® a. (3) How did the person in ® harass you? (Explain below):D Check here ifthere is no! enough spaceforyour answer. Put your complete answer on the attached sheet ofpaper orform MC-025 and write "Al(achmem 7a(3)--Describe Harassment "for a title. axes ,rmd {Mlg (4) Did the person in® use or threaten to use a gun or any other weapon? D Yes E No (lfyes, explain below): D Check here iflhere is no! enough spacefor your answer. Pu! your complete answer on the attached sheet ofpaper orform MC-025 and write “Allachmen! 7a(4)-Use of Weapons "for a lille. (5) Were you harmed or injured because of the harassment? m Yes D No (Ifyes. explain below): D Check here ifthere is no! enough spacefor your answer. Pu! your complete answer on (he attached sheet ofpaper 0r orm MC-025 and write “Attachment 7a(5)-Harm 0r Injury " or a title. “\Efifi-Ah’) -/ A348 a/ nuré gnjdm/r/o'f om!“ (6) Did the police come? mYes D No If yes, did they give you or the person in® an Emergency Protective Order? D Yes E 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? fl Yes D No (lfyes, describe prior incidents andprovide dares ofharassment below): D Check here ifthere is no! enough spacefor your answer. Put your complete answer 0n the attached sheet of paper orform MC-025 and write "Attachment 7b-Previous Harassment ”for a title. $\1\\ FlltrflmJ" \l \wfarfl.$%‘u\o\ Aflbr £44113 A1,)” #6 [7de COVfl-c‘cA’ Mk Anxll nan This is not a Court Order. Request for Civil Harassment Restraining Orders CH-100. Pace 3of6 (Civil Harassment Prevention) 9 RwuodJm 1, 2018 Case Number: 21QH009880 Check the orders you want. =,-> m 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, Q 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 (specifi): D Check here iflhere is not enough spacefor your answer. Pu! your complete answer on the attached sheet ofpaper orform MC-025 and write “Allachmem 8c-01her Personal Conduct Orders, "for a title. ‘ The person in ® will be ordered no! to lake any action Io gel the addresses 0r locations ofany protectedperson unless (he courlfinds good cause no! (0 make the order. ® 8 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) E Me. (8) E My vehicle. (2) D The other persons listed in @. (9) D Other (specifir): (3) E My home. (4) E My job or workplace. (5) D My school. (6) D My children’s school. (7) D My children’s place ofchild care. b. lflhe 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? g YCS D N0 (lfno. explain below): D Check here iflhere is n0! enough spacefor your answer. Pu! your complete answer 0n the attached sheet of paper orform MC-025 and write ”Allachmem 9b-Slay-Away Orders, "for a (ille. Guns or Other Firearms and Ammunition Does the person in® own or possess any guns or other firearms? D Yes D No m l don’t know lfthejudge grams a protective order. the person in® will be prohibitedfrom owning. possessing, purchasing. receiving. or attempting lo purchase 0r receive a gun. otherfirearm. and ammunition while (he protective order is in effect. The person in ® will also be ordered Io mrn in Io law enforcement, 0r sell Io or store with a licensed gun dealer. any guns orfireurmx within his ur lwr innnudiale possession 0r control. This is not a Court Order. “m’m ‘-2°‘° Request for Civil Harassment Restraining Orders CH-100» P8994 0'5 (Civil Harassment Prevention) 9 CaseNuzTrCHOO 9880 ® 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 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? D Yes D No (lfyou answered n0. explain why below): D Check here ifthere is not enough spacefor your answer. Put your complete answer 0n (he attached sheet 0f paper orform MC-025 and write “Attachment II-Temporary Restraining Order ”for a title. D Request to Give Less Than Five Days' Notice of Hearing You mus! have your papers personally served (m the person in® al leaslfive days before the hearing. unless the court orders a shorter Iimefor service. (Form CH-200-INFO explains What ls “Proof of Personal Service”? Form CH-200. Proof of Personal Service. may be used t0 show the court (ha! 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 no! enough spacefor your answer. Put your complete answer on the attached sheet 0f paper orform MC-025 and write “Attachment 12-Requesl Io Give Less Than Five Days ' Notice "for a title. E 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. E 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. E 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 l ask the court to order payment of my D lawyer’s fees D Court costs. The amounts requested are: . l_t¢in_ Amo t [33m AmountFNM cu, s 55's s 3 s s $ $ D Check here ifthere are more items. Pu! (he items and amounts on the attached sheet ofpaper orform MC-025 and wrile “Atlachmenl 14-Luuwer 's Fem um! Costs "for a title. This is not a Court Order. R”"°"'”"’"2°“ Request for Civil Harassment Restraining Orders CH-1°°: Page 5 0'6 (Civil Harassment Prevention) 9 CaseNu“:CH00 98 8 0 D Possession and Protection of Animals I 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 l own, possess, lease, keep, or hold, or which reside in my household. (ldennfi animals by, e.g., type, breed. name, color, sex.) l request sole possession of the animals because (specrfl good causefor granting order): D Check here iflhere is no! enough spacefor your answer. Pu! your complete answer on the attached sheet ofpaper orform MC-025 and write “Attachment 15a-Possession ofAm'maIs "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 othenavise dispose of, the animals listed above. D Additional Orders Requested I ask the court to make the following additional orders (specifiz): D Check here iflhere is not enough spacefor your answer. Pu! your complete answer on the attached sheet of paper orform MC-025 and write “Atlachment 16-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: wag (I g0&\ ( Type or r I your name This is not a Court Order. Request for Civil Harassment Restraining Orders CH-100. Paoe6 of6 (Civil Harassment Prevention) Rcwud Januuy 14 2018 1O 11 12 21cuoo9880 CASE NAME: 3"“ CASE #z Last Name Last heme CH-100, Item 7a(3) - DESCRIBE HARASSMENT: a) How do you know the person you want to restrain? f)! ’Roamfig b) Are you living with the persoh? D YES h No c) Has the person D physically abuse yougfi'physically or verballythreatened you and/or Wharassed you many times? (Please check all that apply.) d) ln 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) gm/M 42/4/2021 was 7% /i//mz Me 8en/dA flx/ [444/ CM/ 4 au/flmz Mé/ Z / / 20 MIISL/M <3 Maze 0741/; ' hM \o ¢m4 ma. kam‘ \oM {ks a$5knn‘asit‘%L/‘gé hp CH-‘IOO, Item 7a(3) - DESCRIBE HARASSMENT MC-OZO SHORT TITLE: M1\M C555 NUMBER Camclo 21cH009830 10 11 12 13 14 15 16 17 18 19 2O 21 22 23 24 25 Last Mama QMIM Ska 4/:0/42/ 8Q MM rm" iw/AJIZ/c'ww V116 Iggw/Jré. J numbers): age stated cn mfcrmat‘cn and belief are {specifyifem numbers, not/.'ne §Th:s page may be used wnh any Judmal Ccunsil form :r any other paper med thn the court. Page Jusiaa! Coundl o.’ Cl y. MC-Z‘ZO {New January 1. Fc-m warmed Dy Opuonu Form Mann Sean's Essen”! =ar~ss 7M ADDITIONAL PAGE caczmjm Attach to Judicial Council Form or Other Court Paper 17 18 19 20 21 22 23 24 CASE NAME: CASE #: Mgmgand géxwgb 21CH009880 Last Nam Last Name e) Were any guns or otherweapons used or threatened to be used during any abuse in the past three months? D YES M NO If "YES", describe: f) Were there any injuries during abuse in the past three months?RYES D NO 1f “YES", describe: M M 3w \mka RM, o Mk g) Did the police come to any of these recent events? EYES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months? D YES MO If “YES". please attach a copy. i) ls the person you want to restrain in jail right now for violence against you? EYES DNO |f“YES”,where: ' Hasthe erson ou wantrestrained ever beenin'ailforviolencea ainst ou or our J Y Y Children? D YES fl NO If “YES", when: Describe what the person did to you or your children that caused them to go to jail: CH-‘IOO, Item 7a(3) - DESCRIBE HARASSMENT 12 13 14 18 19 20 21 22 23 24 CASE NAME: 210H009880 D YES KNO If "YES", please attach a copy. l) Describe the worst abuse and when it happened: D The most recent abuse i_s the worst abuse OR restraining order against (descrzse w+.-::.~.eyc.: ca ysu): J £54.,- l.-Lg “Am gm (42m: ‘ig ibé Ca k) Do you have a criminal protective order (restraining order from criminal court)? D The worst abuse was (appramaze dag) and the person | want a Arm 0L m mkgwk mugmovk. bananas: ShL 39; un-Nz‘julc menA/L V\ m) Describe any other previous (past) Violante or threats of vio!ence that you h already written about here (include dates or estimates as to when it happened): V (D 3.. H-{D CH-100, Item 72(3) - DESCRIBE HARASSMENT