Request Restraining OrderCal. Super. - 6th Dist.March 8, 2021Request for Civil Harassment Restraining Orders Read Can a Civil Harassment Restraining Order Help 1W8? (form CH-I 00- INFO) before completing this form. Also fill out Confidential CLETS [affirmation abrm CLETS-OOI) with as much information as you know. Person Seeking Protection I a. Your Full Name: pom).WQ1-. {- . .- ' Co r .WON‘CLS \ WQ‘ P‘ Age: 3 e [)ch COU'W organ K9 kuua CI Your Lawyer (Ifyou have onefor this case) Fill In court nameW rjnhfimflO¢ . U, r Name: State Bar N0.: Superior Court of California, County of / Santa Clara Finn Name:M b. Your Address ([fyozr have a lawyer, give your lawyer ’S information. [fyou do not have a lawyer and want to keep your home address private, you may give a different mailing address instead You d0 not have 2‘0 give telephone, fax, 0r e- mail) Address: \0 go \AD \\xJ dim) Clerk stamps date here when form is filed. FMAE W ‘8 2021 191 N. First Street 191 N. First Street San Jose, CA 95113 Civil Courthouse- DTS Court fills in case number when form is filed Case Number: 2% CH8fifiggg 8City; StateQfi_Zipzm ‘4 ’ Fax:Telephone: \,r 1' E-Mail Address: ® Person From Whom Protection ls Sought Full Name: “\fir-AM C/R§"fl€/V\CCL’\ Age: g g Address (if own): J \Ad) MLKLSS City: Dr“ 3 S'C State: CIA; Zip: 0757 /}_’ ® Additional Protected Persons a. Are you asking for protection for any other family or household members? dYes DNO Hyes, list them: . FullName K Sex A e C7\\Ucip< ’W'Wu P3 5 C) How are they related to you?6x v ax (KLives with you?D Yes a NoD Yes D N0 D Yes D No D Yes D No D Check here ifthere are more persons. Attach a sheet ofpaper and write "Anaclzment 3a-Add2‘ti0nal Protected Persons "for a title. You may useform MC-025, Attaclmzem. b. Why d0 these people need protection? (Explain below): D Check here ifrhere is nor enough spacefor your answer. Pm your complere answer 0n the attached sheet of paper orform 1WC-025 and wrile “Ariachmem 3b--Why Others Need Protection "for a rifle. Mv‘x &6~00\\“h7 IWLS \Qpbw) Mm “WA Mir C {U5 ”69inmmmé (‘Agrduxk {home hm“ m mvgw ghakmxx; #997MM"MdjréwflUK/lD\C¢JsM\C/‘I ' U") +0 héf“ fir.” )7imLu (x- wkm V} UJ This Is not a Court Order. \\J‘-L. Rag Judicial Councn of Calmomla www. couris.ca gov Revise January 1. 2018 Mandatory Form Code of Ciwl Procedure. §§ 527 6 and 527 9 Cm“lEsngntlal whom Request for Civil Harassment Restraining Orders CH-100, Page 1 of6 (Civil Harassment Prevention) ROHC, I pVERN9 Case Number: ® Relationship of Parties How do you know the person in ®? (Explain below): D Check here iflhcre is not enough spacefor your answer Pu! your complete answer 0n {he attached sheet 0f paper orfianC-025 andwrire “AI/achm n! 4-R\elan'onslzi Parties ‘for a\Um WM WW“M R37): WV»; 9k LSMFM \Jmmgs)~( \(Mé. 36> \NwflévQ/VLQO\‘\C2. 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MA; gm wfimzim \NL; n rs page stated oninf(Required for venfiedpieading) The items o ation and belief'koare (specify item numbers notline numbers): NO) MV This page may be used with any Judicial Council form or any other paper filed with the court Page W \sflz \6 CA WomfxWW WV; \th XWW Q “Am: Co-r mefi‘fidl ATOPP dim JutfFtdaJCOUnciIOITCaIfomia Mmogw-Ianuam 19871 Attach to Judicial Council Form or Other Court Paper pbonaleFotm Mamnaoe sssE arFormTM ADDITIONAL PAGE CR0201. 501 1O .11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 CASE NAME: ”(WW and W’EMA‘Y CASE #: Last Name Last Name e) Were any guns or other weapons used orthreatened to be used during any abuse in the past three months? D YES ago If “YES", describe: f) Were there any injuries during abuse in the past three months? CI YES KNO If ”YES", describe: g) Did the police come to any ofthese recent events? MYES D NO h) Did they give you an Emergency Protective Order for abuse in the past three months? El 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? i DYES fiNO If"YES”.where: j) Has the person you want restrained ever been in jail for violence against you or your children? DYES fiNO |f“YES”,when: Describe what the person did to you or your children that caused them to go to jail: CH-1oo, Item 7a(3) - DESCRIBE HARASSMENT Page 13 1O 11 12\ 14 15 16 17 18 19 20 21 A 22 23 24 25\ mf‘ «:Kb 4 t :Mklu OD\ C‘a ’7¢\ m 0mg / \ CASE NAME: \ “‘3‘” and Cmg‘m‘flé“ CASE #: Last Name Last Name k) Do you have a criminal protective order (restraining order from criminal coufl)? D YES W0 If “YES", please attach a copy. I) Describe the worst abuse and when it happened: D The most recent abuse Ls the worst abuse OR I 0 9»! restraining order against (describewnameydidtom):WA,“ (XML, nub SCMANWMJ AKAI’AMM ‘NA “mm, &H l V‘V\ \\ °\’ L3H» UV) “((13%) Stung \mm Maggi WM“ Q“):A&Em U (A Qr (\MA ‘mAnQ \Kb \(k Ccum QOLQXM wwun @AH Wn<¢ fin Mu ADM \1Mlma fvwg‘hiA ux n 09m nmrx Q5 l? \AW/ @0035 W)“Aw \N{0°9:3h\’\k°(\gt\5? \OVWW‘é \WMXG CW‘A \‘ m) Describe any_other previous (past) violence or threats of violence that you haven’t Mhe worst abuse was (approximate date) and the person | want a already written about here (include dates or estimates as to when it happened): fl‘ffl “(‘1’ AP” MW- >/ \‘AQC/ Nmée So (\MMA OAWL ch9h36 Wham “\o‘m/Svpa 5n NQNDLXQQ 4mm. VUMQ w; oAfi, QVGAVV, \MQ¢§§DHQ¥LA.N 1 3m AMA Queugwm AXAZAA“ n \A Qéoj A‘Sa‘ugir‘gwmgg \QV vdvfikknkm /\\§b QQWWW %MWJ\X®W “AA \M'Qt’ffi MIN ?kgxg‘g) M®w\:\é\:)(fikm\ ?\\ (AA 0 0/1 Uhl-H CLxle gruAr/l 09+? f4” W4; {v I’LL! CH-100, Item 73(3)- DESCRIBE HARASSMENT I E t M? 3M . >0 AXJAK/ "r NW \é DLJA Ca” Mum rumDHmu Page f l