CH-100: Request for Civil Harassment Restraining Orders

Fill in court name and street address under Superior Court of California, County of.

The court fills in the case number when the form is filed.

Under Person Seeking Protection, enter Your Full Name and Age.

If you have a lawyer, give your lawyer's information. If you do not have a lawyer and want to keep your home address private, you may give a different mailing address instead. You do not have to give telephone, fax, or email.

Under Person From Whom Protection Is Sought, enter the Full Name and Age, and the Address (if known).

Are you asking for protection for any other family or household members? If yes, list them: Full Name, Gender, Age, Lives with you? Yes No, How are they related to you? Yes No

Check here if there are more persons. Attach a sheet of paper and write "Attachment 3a-Additional Protected Persons" for a title.

Why do these people need protection? (Explain in the space for your answer): Check here if there is not enough space for your answer. Put your complete answer on the attached sheet of paper or form MC-025 and write "Attachment 3b-Why Others Need Protection" for a title.

How do you know the person in 2? (Explain in the space for your answer). Check here if there is not enough space for your answer. Put your complete answer on the attached sheet of paper or form MC-025 and write "Attachment 4-Relationship of Parties" for a title.

Why are you filing in this county? (Check all that apply)

The person in 2 resides in this county. I was harassed by the person in 2 in this county. I reside or am temporarily located in this county. Other (specify):

Have you or any of the persons named in 3 been involved in another court case with the person in 2?

Kind of Case, Filed in (County/State), Year Filed, Case Number (if known) (If yes, check each kind of case and indicate where and when each was filed.) Yes No

Are there now any protective or restraining orders in effect relating to you or any of the persons in 3 and the person in 2? If yes, attach a copy if you have one.

7 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.

Tell the court about the last time the person harassed you: when did it happen (provide date or estimated date), and who else was there?

(3) How did the person harass you? (Explain)

Did the person use or threaten to use a gun or any other weapon? (If yes, explain): No Yes

Were you harmed or injured because of the harassment? (If yes, explain): Yes No

(6) Did the police come? Yes No If yes, did they give you or the person in 2 an Emergency Protective Order? Yes No If yes, the order protects (check all that apply): Me, The person, The persons in 3. (Attach a copy of the order if you have one.)

Has the person in 2 harassed you at other times? Yes No (If yes, describe prior incidents and provide dates of harassment):

Check the orders you want. 8 Personal Conduct Orders: I ask the court to order the person in 2 not to do any of the following things to me or to any person to be protected listed in 3: Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy personal property of, or disturb the peace of the person.

Contact the person, either directly or indirectly, in any way, including, but not limited to, in person, by telephone, in writing, by email, by text message, by fax, or by other electronic means.

Other (specify): Check here if there is not enough space for your answer. Put your complete answer on the attached sheet of paper or form MC-025 and write "Attachment 8c-Other Personal Conduct Orders" for a title.

The person in 2 will be ordered not to take any action to get the addresses or locations of any protected person unless the court finds good cause not to make the order.

9 Stay-Away Orders: I ask the court to order the person in 2 to stay at least yards away from (check all that apply): (1) Me. (2) The other persons listed in 3. (3) My home. (4) My job or workplace. (5) My school. (6) My children's school. (7) My children's place of child care. (8) My vehicle. (9) Other (specify):

If the court orders the person in 2 to stay away from all the places listed, will they still be able to get to their home, school, or job? Yes No (If no, explain in the space for your answer): Check here if there is not enough space for your answer.

Does the person in 2 have firearms (guns), firearm parts, or ammunition? I don't know. No. Yes (If you have information, complete the section on firearms (guns), firearm parts, or ammunition.)

Describe Firearms (Guns), Firearm Parts, or Ammunition. Number or Amount. Location, if known.

If the judge grants a protective order, the person in 2 will be prohibited from owning, possessing, purchasing, receiving, or attempting to purchase or receive firearms (guns), firearm parts, and ammunition while the protective order is in effect.

I request that a Temporary Restraining Order (TRO) be issued against the person in 2 to last until the hearing. I am presenting form CH-110, Temporary Restraining Order, for the court's signature together with this Request.

Has the person in 2 been told that you were going to go to court to seek a TRO against them? Yes No (If you answered no, explain why in the space for your answer): Check here if there is not enough space for your answer. Put your complete answer on the attached sheet of paper or form MC-025 and write "Attachment 11-Temporary Restraining Order" for a title.

12 Request to Give Less Than Five Days' Notice of Hearing: You must have your papers personally served on the person in 2 at least five days before the hearing, unless the court orders a shorter time for service.

If you want there to be fewer than five days between service and the hearing, explain why in the space for your answer: Check here if there is not enough space for your answer. Put your complete answer on the attached sheet of paper or form MC-025 and write "Attachment 12-Request to Give Less Than Five Days' Notice" for a title.

13 No Fee for Filing or Service: There should be no filing fee because the person in 2 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.

The sheriff or marshal should serve (notify) the person in 2 about the orders for free because my request for orders is based on unlawful violence, a credible threat of violence, or stalking.

There should be no filing fee and the sheriff or marshal should serve the person in 2 for free because I am entitled to a fee waiver. (You must complete and file form FW-001, Application for Waiver of Court Fees and Costs.)

Number of pages attached to this form, if any:

Sign under the declaration: "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."

Lawyer's name (if any). Lawyer's signature.