Fake Restraining Order Form – Fill Out and Use This PDF

3 Respondent (Restrained Person)

Case Number:

Full Name:

Description:

Sex:

M

F Height:

Weight:

Date of Birth:

Hair Color:

Eye Color:

Age:

Race:

Home Address (if known):

City:

State:

Zip:

Relationship to Employee:

4 Additional Protected Persons

In addition to the employee, the following family or household members or other employees are protected by the temporary orders indicated below:

Full Name

Sex Age Household Member?

Relation to Employee

Yes No

Yes No

Yes No

Additional protected persons are listed at the end of this Order on Attachment 4.

5Expiration Date

This Order expires at the end of the hearing scheduled for the date and time below:

Date:		Time:				a.m.		p.m.

This is a Court Order.

Case Number:

To the Respondent:

The court has issued the temporary orders checked as granted below. If you do not obey these orders, you can be arrested and charged with a crime. You may have to go to jail for up to one year, pay a fine of up to $1,000, or both.

a. You are ordered not do the following things to the employee and to the other protected persons listed in 4 :

(1)	Harass, molest, strike, assault (sexually or otherwise), batter, abuse, destroy personal property of, or
	disturb the peace of the person.
(2)	Commit acts of violence or make threats of violence against the person.
(3)	Follow or stalk the person during work hours or to or from the place of work.
(4)	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 e-mail, by fax, or by other electronic means.

(5) Enter the workplace of the person.

(6) Take any action to obtain the person’s address or locations. If this item is not checked, the court has found good cause not to make this order.

(7) Other (specify):

Other personal conduct orders are attached at the end of this Order on Attachment 6a(7).

b.Peaceful written contact through a lawyer or a process server or other person for service of legal papers related to a court case is allowed and does not violate this order. However, you may have your papers served by mail on the petitioner.

a. You must stay at least			yards away from	(check all that apply):
(1)			(7)
	The employee			The employee’s children’s place of child care
(2)	Each other protected person listed in 4 (8)			The employee’s vehicle
(3)	The employee’s workplace		(9)	Other (specify):

(4) The employee’s home

(5) The employee’s school

(6) The employee’s children’s school

b. This stay-away order does not prevent you from going to or from your home or place of employment.

This is a Court Order.

(Workplace Violence Prevention)

Case Number:

8No Guns or Other Firearms and Ammunition

a.You cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, other firearms, or ammunition.

b.You must:

(1)Sell to or store with a licensed gun dealer or turn in to a law enforcement agency any guns or other firearms in your immediate possession or control. This must be done within 24 hours of being served with this Order.

(2)File a receipt with the court within 48 hours of receiving this Order that proves that your guns or firearms have been turned in, sold, or stored. (You may use form WV-800, Proof of Firearms Turned In, Sold, or Stored for the receipt.)

c. The court has received information that you own or possess a firearm.

9 Other Orders
Not Requested	Denied Until the Hearing	Granted as Follows (specify):

Additional orders are attached at the end of this Order on Attachment 9.

To the Petitioner:

10Mandatory Entry of Order Into CARPOS Through CLETS

This Order must be entered into the California Restraining and Protective Order System (CARPOS) through the California Law Enforcement Telecommunications System (CLETS). (Check one):

Additional law enforcement agencies are listed at the end of this Order on Attachment 10.

11 No Fee to Serve (Notify) Restrained Person

Ordered

Not Ordered

The sheriff or marshal will serve this Order without charge because:

a. The Order is based on a credible threat of violence or stalking.

b. The petitioner is entitled to a fee waiver.

This is a Court Order.

(Workplace Violence Prevention)

Case Number:

12Number of pages attached to this Order, if any: Date:

Judicial Officer

Warnings and Notices to the Restrained Person in 2

You Cannot Have Guns or Firearms

You cannot own, have, possess, buy or try to buy, receive or try to receive, or otherwise get guns, other firearms, or ammunition while this Order is in effect. If you do, you can go to jail and pay a $1,000 fine. You must sell to or store with a licensed gun dealer or turn in to a law enforcement agency any guns or other firearms that you have or control as stated in item 8 above. The court will require you to prove that you did so.

Notice Regarding Nonappearance at Hearing and Service of Order

If you have been personally served with this Temporary Restraining Order and form WV-109, Notice of Court Hearing, but you do not appear at the hearing either in person or by a lawyer, and a restraining order that is the same as this Temporary Restraining Order except for the expiration date is issued at the hearing, a copy of the order will be served on you by mail at the address in item 3 .

If this address is not correct or you wish to verify that the Temporary Restraining Order was converted into a restraining order at the hearing without substantive change, or to find out the duration of the order, contact the clerk of the court.

After You Have Been Served With a Restraining Order

•Obey all the orders. Any intentional violation of this Order is a misdemeanor punishable by a fine or by imprisonment in a county jail, or by both fine and imprisonment. (Pen. Code, § 273.6.)

•Read form WV-120-INFO, How Can I Respond to a Petition for Orders to Stop Workplace Violence?, to learn how to respond to this Order.

•If you want to respond, fill out form WV-120, Response to Petition for Workplace Violence Restraining Orders, and file it with the court clerk. You do not have to pay any fee to file your response if the petition claims that you threatened violence against or stalked the employee, or placed the employee in reasonable fear of violence.

•You must have form WV-120 served on the petitioner or the petitioner’s attorney by mail. You cannot do this yourself. The person who does the service should complete and sign form WV-250, Proof of Service of Response by Mail. File the completed proof of service with the court clerk before the hearing date or bring it with you to the hearing.

•In addition to the response, you may file and have declarations served, signed by you and other persons who have personal knowledge of the facts. You may use form MC-030, Declaration, for this purpose. It is available from the clerk’s office at the court shown on page 1 of this form or at www.courts.ca.gov/forms. If you do not know how to prepare a declaration, you should see a lawyer.

•Whether or not you file a response, you should attend the hearing. If you have any witnesses, they must also go to the hearing.

•At the hearing, the judge can make restraining orders against you that last for up to three years. Tell the judge why you disagree with the orders requested.

This is a Court Order.

(Workplace Violence Prevention)

Case Number:

Instructions for Law Enforcement

Enforcing the Restraining Order

This order is enforceable by any law enforcement agency that has received the order, is shown a copy of the order, or has verified its existence on the California Restraining and Protective Orders System (CARPOS). Agencies are encouraged to enter violation messages into CARPOS. If the law enforcement agency has not received proof of service on the restrained person, the agency must advise the restrained person of the terms of the order and then must enforce it. Violations of this order are subject to criminal penalties.

Start Date and End Date of Orders

This order starts on the date next to the judge’s signature on page 4. The order ends on the expiration date in item 5 on page 1.

If the Protected Person Contacts the Restrained Person

Even if the protected person invites or consents to contact with the restrained person, this order remains in effect and must be enforced. The protected person cannot be arrested for inviting or consenting to contact with the restrained person. The order can be changed only by another court order. (Pen. Code, § 13710(b).)

Conflicting Orders—Priorities for Enforcement

If more than one restraining order has been issued, the orders must be enforced according to the following priorities: (See Pen. Code, § 136.2, Fam. Code, §§ 6383(h)(2), 6405(b).)

1.EPO: If one of the orders is an Emergency Protective Order (form EPO-001) and is more restrictive than other restraining or protective orders, it has precedence in enforcement over all other orders.

2.No Contact Order: If there is no EPO, a no-contact order that is included in a restraining or protective order has precedence over any other restraining or protective order.

3.Criminal Order: If none of the orders includes a no contact order, a domestic violence protective order issued in a criminal case takes precedence in enforcement over any conflicting civil court order. Any nonconflicting terms of the civil restraining order remain in effect and enforceable.

4.Family, Juvenile, or Civil Order: If more than one family, juvenile, or other civil restraining or protective order has been issued, the one that was issued last must be enforced.

Date:

Clerk, by

, Deputy

This is a Court Order.

(Workplace Violence Prevention)