Clerkstampsdafishers when formisfiled.
`
`__
`
`‘
`I
`
`i
`
`'
`
`t
`
`I
`
`n
`
`7'
`
`'h
`
`Request fo'r- Civil Harassment
`' Restraining Orders
`Read Can 'a CivilHm assmenr Remaining Order Help Me? 0’07 m CH—J 00-
`INFO) before completing this form. Also fill out Confidential CLETS ,r
`y” OW
`In ormatz'on 07m CLETS—OO] wi h as much mformafiqn as
`f
`0r
`Ln
`L
`j
`(D Person Seeking Protection
`
`.
`
`'
`
`I
`
`.
`
`'
`
`,
`
`State Bar NO]:
`
`_
`
`_
`
`-
`
`A
`
`-
`
`s
`
`.-
`
`_ $3 Ed E fl
`
`‘
`
`'
`
`-
`
`:
`
`SAN MATEO QQUNW:
`APR 2 5 2013 ‘
`
`i 1-
`
`7
`. .‘Fill_'in court na lndsfreet a_ddr=ss.
`s'AN MATEO
`- 400 COUNTY CENTER'3 '
`REDWOOD CITY, CA 94063-1655
`
`-
`
`-“'
`
`‘
`
`ty 0
`
`f
`
`— Superior _Co_urt of Cahforma Coun
`KfiUWWMaHm fim‘Afvfe 3Q
`Your Lawyer ('fyou have onefm this case)
`m am
`Name
`N e.
`F
`b. Your Address (L’you have a lawyer, give your lawyer’s -
`izy’ormarz'on. nyou d0 7102‘ have a lawyer and want to keep yozrr
`home addressprz'vaz‘e, you may give a dz’fi‘erent 771az‘Zing address
`State:L Zip.4HCZ72 ,Case'N
`instead. You do 1202‘ have 2‘0 give telephone, far. 0r e-mail.)
`Addfebé' 2‘ 2 7 SK‘F \aj )Kd
`_City: @‘m0m*— -
`Telephone.Q50 6(2'2 ?JQIFQQC P/A .
`E-Mail Address: \J’qS‘Cfl Qaé/L ‘ Q/ \‘akaco Cofl—i
`Person From Whom Protection ls Sought
`Fulleame H6\ ‘ gSC‘ §UZQ/L WK, H0\AQmAge: g__Z
`I {I f, R06 hm Rf!
`Address (zf/mown).
`City: D&a-fl\c&l
`,State: CAZip: @909 LI
`Additiorial Protected Persons
`E Age
`a. Are you asking for protection for any other family or household members? D Yes ' B N0
`Ifyes, Zz'szfithem:
`M <35) W5 D No Rae; May Le/
`WNW, LTvaoé¥Q
`Livejs With vou? How are thev related to vou?
`D Yes D No. ‘
`D Yes D No
`D Yes E No
`D Check he] e z'fthez e crre ma] epezsons. Attach a sheet ofpapel and write ”Attachment 3a—Addn‘zonal P; ofecred
`Persons ’for a title. fay may usefoz m MC—025, Attachment.
`b. Why do these people need p1otection? Explain below).
`D Check heI e z'fz‘hei e is 7202‘ enough Spacefm your answer. Pui‘yow complete answeI on the attached sheer of
`paper 07 f0rmMC—025 and w; ire ”Attachment 3b—Why Others N ed Protection’’for a title.
`
`i
`
`3
`
`'
`
`:
`
`e
`
`v:-
`
`Courtfillsm casenumberwhsr; fc-lansz'fiéd.
`"7T
`
`5 4
`fight! v0 2 3 V Jr
`
`.
`
`1
`
`N__a__rneFu11
`
`-
`
`.
`
`'l fCaHom'a, www.coufiscagov
`J d' ‘ IC
`Ruev'acs':d£:::n,°1,2ol1s,Luandamwm
`Code o(CivnProcsdura, §§ 527.6 and 527.9
`
`Request for Civil Harassment Restraining Orders
`(Civil Harassmént Prevention)
`
`CH-1oo, Page 1 ofe
`A
`
`K 19— CIV- 02354
`PETRO
`Petitiosn for Civil Harassment Restraining Order
`
`|H||||_|||H|I_|l|lli
`
`||||||||l|____
`
`—
`:
`9
`
`

`

`Case Number:
`
`.
`
`__
`
`v
`
`'
`
`'
`
`‘
`
`V
`
`(1)
`
`(6)
`
`[j Eviction
`
`How d0 you know“ the person in ® ? Explain below):
`Relationship ofParfleS
`J. aw (Jo sxueas, ?awxvxarg' cad»: w Ham amA bag; am; Dmkke/N
`D Check here ifthere is not enough spacefor your answer. Putyolzn' conplgtg answer 012 Ike arrached sheet 0f
`Japer crform MC—025 and write ‘24tz‘aclmzerzz‘ 4~Relazi0nship ofParries ”for a title.
`.Venue
`b. M was harassed by the person in® injhis county.
`Why a you filing in this county? (Check all that appbz):
`a. {The person in® lives in this county.
`c. D Other (spectfil):
`Other Court Cases
`ffhe persons named in®been involved in another court case with the person in ®?
`a. Have you 01‘ an
`D Yes
`(Ifyes, check each kind ofcase and indicate where am!when each wasfiled.)
`Np
`‘Yegrfilgfi Case‘Nggmber fiflmmwzl
`Hf (3&3; g
`Filed €51. /anzzz:_‘t{-{?Igrgg
`1:;
`' m CivnHarassmem
`(2) D Domestic Violence
`(3) D Divorce,Nullity, Legal Separation
`(4) D Paternity, Parentage, Child Custody
`(5) D Elder or Dependent Adult Abuse
`(7) D Guardianship
`(8) D Workplace Violence
`(9) D SmaIICIaims'
`(1 O) D Criminal
`(1 1) D Other(specijjI):
`Are there nowawake or restraining orders in effect relating to you or any ofthe persons in@ and the
`
`([fyes, attach a copy z‘fyou have one.)
`
`person in @‘2
`[j Yes
`o
`Description ofHarassment
`Harassment means violence 0r threats 0f violence against you, or a course of conduct that seriously alarmed,
`annoyed, 0r harassed you and caused you substantial emotional distress. A course of conduct 1's more than one act.
`a. Tell the court about the last time the person in® harassed you. .
`When did it happen? (provide date 0r estimated date): 9/2 i / Iq
`(1)
`Debmnk IH-oor‘ ©— an’ baa “3, Angus’ko
`(2) Who else was there?
`
`~
`
`.
`
`. ,
`
`,
`
`REVI'SEC‘JW‘Y 1-20”
`
`Request for Civil Harassment Restraining Orders
`(Civil Harassment Prevention)
`
`_
`
`CH-100: Page 2 0f5
`*9
`
`

`

`® a. (3)
`
`(4)
`
`(5)
`
`.4. .,.~---_..A;-_.-_-,_ -.
`
`,-.—_1..- _-._7.- -— -_-
`
`,
`
`g-.— ~:;-. .-
`
`.,-.. a ~;- —.--.‘,- .
`
`Case Number:
`
`'
`
`”-
`
`E
`
`.-.A.,=E:;..-.--
`"
`
`‘»
`
`-
`
`"3g" L" ' "
`
`Howdid the person in @harass You? (Explain below):
`D Check here z'fz‘here z's not enough space foryour answer. Putyour conzplelfa, answer on'z‘heia‘zfta'clwd
`sheaf: ofpapgr afform MC-025 andzwrz'z‘e ‘Détzfaphngefiz‘ 74(3)eDeSCI‘ibg ngdssmqnffqr a_zfiz‘la.
`Hehsfiq gazanvyo ReWAen F’m‘yeé ct’fi'"hoséé\%;
`c>¥~zM $.4A/A @‘POCQechQL. rho
`§MLn\—« og—Q.
`namefak-{fir‘ A44@# A. gammcaat
`(jam me,
`eds Me, RJndneé. Me 1n
`Jug, aflm [ESos-(Aa. Ma $a3 Qnekl a, ..,5t<:¢sf- .‘gbdlg
`$\ae‘, -- CJncw<9$
`Aom“ «ere/x PMCeeéod- *0 «£‘Qp ~Mwewm
`6M0) “CarC-P 'C/u; \rxer Mo¥~er a5 Q-Qk-l
`Did the pers‘ori‘in® u'se‘ 0r threat'en to use a gun or any other weapon?
`D :Y-e‘s“ I
`u N6 (Ifye'i-e-x'pfiléin Below):
`D Check here ifthere i5 710t‘e710ugh space for'youi‘ dfiSfié—r."Pzzt you): bdhzjfleie bfisfiiei‘b—fi‘fliE—dz‘i‘aéfiéd
`sheet ofpaper 07‘f0rm _MC—025 and wrz'z‘e ‘Hfiachmem‘ 7a(4)—Use ofWeapons ”for a z‘z'z‘le.
`
`"'-
`
`_
`
`,
`
`Were you banned or injured because of the harassment?
`Yes D No ([fyes, explain below): .
`D Check here 'z'frhere 2'5 hot enough space foryour answer. Put your complete answer 0n the attached
`Yleé mod CHILCA‘ Mus QC! davalj
`sheer ofpaper 07‘f0rm MC—025 and write ”Alfachmenz 7a(5)—Harm 0r IIZquj/"for a title.—
`+'eab é‘op 4mg heed
`
`(6)
`
`Didihé poliqé come? @465 D No
`Ifyes, did they give you 6r the person in® an Emergency Protective Order? D Yes D No
`Eyes; the order pr’otectsfcheck all that apply).-
`D Thepersonin® - D The persons in@.
`4D' Me
`(Attach a copy offhe order z'fyou have one.)
`b. Has the person in C2) harassed you at other times?
`l7 Ina; $0 came, 4o W rescue nu De.lv CW
`D Yes D No -{Ifyes, describeprz'or incidents mzdprovzicg’ggz’ate; oflzqg‘gzssmengbelgwj.‘
`D Check here z'fz‘here 2's not enough Spaceforypur answer. Puryour complete amwér 0n the attached sizeer of
`paper orform MQ—025 and write ‘idrz‘achmem‘ 7b—Previ0m Hafasézi7efil‘”f0r a title.
`QM“; Pag,‘\p‘c(‘,‘ 01nd FSGJ‘Q ‘V‘CO'VW ‘kufl rth/‘IVLM [01" dgtdécax)
`c4 )CQ—q, WWW“,
`+195w+QA am awe, ”3:
`o'yOJf aw Cajé- §‘A-e,
`\M’J (o wt'Hlk “81" Cubt-éé ma, P¢\Qik‘\E—V’DS (MB
`’bcgé Soy
`
`:v.‘ '-
`
`'
`
`sx
`
`'
`
`Revised January 1, 201 B
`
`Request for Ci'Vil'HAéia'éfs'fifer Rézét'r‘aifi-ing Orders
`(Civil Harassrfiefif PréVéniion)
`
`n
`
`CH-100. Page 3 ofs
`
`9
`
`

`

`Ca
`
`mm
`
`Number:
`
`I
`
`progfizfiisad in
`Harass, intimidate, molest, attack, strike, stalk, threaten, asSault (sexually or othenvise), hit, abuse, destroy
`
`:
`
`_
`
`Che ' the orders you want. m
`E/P:(rsonal Conduct Orders
`Iask the court to order the person in @ not to do any of the following things to me 0r to any person to be
`a. Wal property 0f, or disturb the pe‘ace of the person.
`Contactthe 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 (speczfi/j:
`D Check here Ijrr/aEJ‘e 1's nor enough spaceforyo uranswer. Puz‘yozzr complete answer 0n the attached
`she?! ofpaper Oi‘form MC—025 and write "Attachment 86—0tl7erPersonaZ Conduct Orders, “for a
`
`b,
`
`,
`
`4
`
`title.
`
`e.
`
`(1)
`
`(3)
`(4)
`
`'
`
`(8)
`
`I
`
`‘
`
`r5071 in ® will be ordered not to [aka any action [0 get [/72 addresses 0r locations '0] a1uzpz-ofeciedperson
`The
`zm 55 the courtfinds g00d cause not 2‘0 make the order.
`a. Iaskw order the person in ® to stay at least
`Stay-Away Orders
`Oyards away from (check all that apply:
`(2) 5% other persons listed in®
`y vehicle.
`(9) D Other (speczfi):
`y home.
`Myjob orworkplace. l
`'(5) D My school.
`(6) D My children’s school.
`(7) D My children’s place of Child care.
`b. Ifthe court orders the person in (i3 to stay away from all the places listed above, will he or she still be able
`L_j Yes [:1 No (1] m7, expiain below:
`t0 get to his or her home, school, Brj ob?
`D Check herei there 2's not enozmh 5 ace 07‘ our answer. Put our com late answer 0n the attached sheet 0
`P
`P
`y
`y
`a
`paper orform MC—025 and write ‘HttaC/zment 9b—-Stay-Away Orders, ”for a title.
`
`Guns orOther Firearms and Ammunition
`Does the person in® own or possess any guns or other firearms?
`D Yes E/No [:1
`jj’thejizdge grants api‘ote ctz've order, theperson 1'72® will be prohibitedfi‘om owning, possessing, purchasing,
`is 2'72 eflect. leeperson in ® will also be ordered t0 turn 1'72 t0 law ely’arcement, orsell t0 0r store wit}: a
`receiving, 0r attempting tapurchase 0r receive a gun, otherfirearm, and ammunition while the protective order
`
`licensedgun dealer, any guns orfiz‘earms within his 0r her immediate possession 0r control.
`
`I don’t know
`
`Revised January 1, 201B
`
`Request for Civil Harassment Restraining Orders
`(Civil Harassment Prevention)
`
`'
`
`CH~100, Page4 of6
`~>
`
`

`

`Case Number:
`
`® Temporary Restraining Order
`I request that a Temporary ReSUaining Order (TRO) be issued against the person in® t0 1E: until the hgaring; I
`am presegitingtfonn CH—l 10, fezngqrazyfigsnpinmg QI'CZEIj, fgr thqqourt’s signage together With this Request.
`Has the person in
`been told that ybu were going to go to court to‘ seek a TROfagainst-Ehfi/héf? '
`D Yes
`No (Ifyou answered n0, explain why below):
`D Check here z'fthei'e is 1101‘ enough spaceforyour answer. Putyour complete answer 0n the attached sheet 0f
`j? wish \‘Trg-W D6) Cam am“ 0.}ny mew
`er orfo‘rm MC—025 find write ‘Z/iz‘rachmem‘ JJ—Tempormy Restraizfing Order ”for a title. -
`
`'
`
`-
`
`.
`
`:---:»:.:'
`
`-
`
`-
`
`—
`
`_
`
`.
`
`A
`
`5
`
`._
`
`h‘
`
`D Requesf to Give Less-Than Five Days‘ thice'of Hearin‘g'
`You must have yourpaperspersonalbi served 0n the person z'fi <2) at Zekzsrfzve days before the hearing, unless the
`court orders a shorter fimefor service. (Form CH—200-JNFO explains What Is “Proof 0f Personal Service”? Form
`CH—ZOO, Proof of Persona] Service, may be used 2‘0 show the court that the papers have been served.)
`Ifyou want there to be fewer than five days betWeen service and the hethIg, explain why below:
`D Check here ifthere 1's not enough Spaceforyour a_nm/er. Putyour complete answer 012 the attached sheer 0f
`paper 0rf0rm MC—025 and write ‘Ldl‘z‘achmem‘ JZ—Requesz‘ t0 Give Less Than Five Days ’ Notice “for a firle.
`
`_
`
`.
`
`..
`
`.
`
`H
`
`‘
`
`,
`
`'
`
`-
`
`-
`
`fl
`a. me should be no filing fee because the person in ® has used or threatened to use violence against me,
`® Efl/(o Fee erg Filing‘or S'e'rvice
`has stalked me, or has acted or spoken in some other way that makes me reasonably fear violence.
`b1 D The sheriff or marshafshould serve (notify) the person in® about the Orders fdr free beéause my request
`for orders is based on unlawful violence, a credible thxeat ofviolence, or stalking.
`c. D There should be no filing fee ind the sherifi or marshal should serve the person in ®f0r free becausel
`am'entifled to a fee waiver. (You must complete mzdfileform FW-OOJ, Application for Waiver of Court
`Fees and Costs .)
`D Lawyer‘s Fees and Costé‘“
`Iask the court to ordgr payment ofmy D 1awyerfs fees
`The amounts requested are:
`11m;
`
`l m
`
`D Court costs.
`m
`
`‘
`
`I
`
`Amount
`
`$
`$
`$.
`
`$
`$
`$
`[:J Check here ifthere are'more items. Put the items and amounts 0n the attached sheet ofpaper oilform
`MC—025 and write ‘Z/Iz‘z‘achment J4—Lmyyer ’S Fees and Costs: Tifor a title.
`
`RevisedlanUEW-m‘s '
`
`Request for CW“ Hé‘i‘sa‘é‘éih‘é'rjtt'Restrain'ing Orders
`(Civil HaraSsPnent 'PreVe‘r'xtidh)
`
`"
`
`CH-100, Page50f6
`
`+
`
`

`

`Case Num ber:
`
`@ D Posseséion and Protection ofAnimaIs
`a. D That I be given the sole possession, care, and Control of the animals listed below, whichI own, possess,
`lease, keep? or hold, or which reside in. my household.
`(Identify animals by, e.g., type, breed, name, color, sex.)
`
`I ask the court to order the following:
`
`Irequest sole pdssession of the animals because (specifi/ good causefor grinning order):
`D Check here {fthere z's 1102‘ enough spaceforyour answer. Putyour complete answer 0n t/ze attached
`she er ofpaper oz‘form MC—025 and write ‘Httachmem‘ 15a—Possessi0n ofAm'maZs ”for a title.
`
`b. D That the person in @must stay at least
`yalds away 1r,om and not Lake seii u ansier, cncurr CM
`conceal, molest, attack, strike, threaten, harm, or otherwise dispose of, the anim als listed above.
`
`E] Additional Orders Requested
`I ask the court to make the following additional orders (specify):
`D Check here ifrhere is not enough spaceforyour answer. Putyour complete answer 0n the attachedsheet 0f
`paper orfozm MC—025 and write ‘Mrlachment 16 Additional Orders Requested, ”for a title.
`
`® Number ofpages attached to this form, if any:
`
`DaLe:
`
`EL
`
`awyer s szg77ature
`
`Lawyer ’S name (ifany)
`
`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.
`
`v/i/z(M
`£02m? MMWQJ $\amdfl x
`
`Type orprz'ntyourname
`
`H
`
`Sign your name
`
`l
`
`RavisedJamW-Zm
`
`Request for Civil Harassment Restraining Orders
`(Civil Harassment Prevention)
`
`CH-100, Page 6 offi
`
`