Domestic Violence without Common Minor Step 1 Coversheet · PDF fileSuperior Court of California, County of Sacramento Family Law Legal Process Unit Revised January 17, 2018 Page 1

Superior Court of California, County of Sacramento Family Law Legal Process Unit

Revised January 17, 2018 Page 1 of 2 www.saccourt.ca.gov

REQUEST FOR DOMESTIC VIOLENCE

RESTRAINING ORDER (STEP 1)

FOR PARTIES WITHOUT COMMON MINOR CHILDREN

FILING FEE None REQUIRED FL/E-LP-660 - Family Law Case Participant Enrollment FORMS Form

FL/E-LP-640 - Domestic Violence Date of Birth

Verification with your name and birth date, and the restrained party’s name and birth date

DV 109 – Notice of Court Hearing DV 100 – Request for Domestic Violence Restraining Order FL/E-LP-613 – Attachment to Request for Domestic Violence Restraining Order DV 110 – Temporary Restraining Order (Please complete items 1, 2, and 3 only) CLETS 001 – Confidential CLETS Information

DV 130 – Restraining Order After Hearing (Please complete items 1, 2 and 3 and any orders you are requesting) FL 343 – Spousal, Partner, or Family Support Order Attachment (if applicable) FL 150 – Income and Expense Declaration (if applicable) DV 900 – Order Transferring Wireless Phone Account (if applicable)

COPIES Do not make copies of these forms.

Superior Court of California, County of Sacramento Family Law Legal Process Unit

Revised January 17, 2018 Page 2 of 2 www.saccourt.ca.gov

FILING All forms must be typewritten or printed in blue or black ink.

(California Rules of Court, Rule 2.100-2.119)

Bring completed forms to 3341 Power Inn Road. You must obtain a number from Reception by 4:00 p.m. in order to file your documents in person.

To get the results of your Temporary Restraining Order today, forms must be completed and filed by 2:00 p.m. The results will be given at 3:45 p.m. in room 102, please arrive early and obtain a ticket from Reception.

What is a “domestic violence restrainingorder”?

Can I get a domestic violence restraining order?

You can ask for one if:

A person has abused you or threatened to abuse you and

You have one of the following relationships with that person: married, divorced, separated, registered domestic partnership, have a child together, dating or used to date, live together or used to live together*; Or you are related within the second degree of affinity or consanguinity. This means: mother or mother-in-law, father or father-in-law, child or stepchild or legally adopted child, grandparent or grandparent-in-law, grandchild or grandchild-in-law, sister or sister-in-law, brother or brother-in-law, stepparent, daughter-in-law or son-in-law. The in-law must be through a current marriage. (See Family Code § 6211).

* You have to regularly reside in the household.

DV-500-INFO, Page 1 of 3

It is a court order that can help protect people who have been abused or threatened with abuse.

Judicial Council of California, www.courts.ca.gov Revised January 1, 2012

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Can a Domestic Violence Restraining Order Help Me?

Can a Domestic Violence Restraining Order Help Me? (Domestic Violence Prevention)

Obey child custody and visitation orders Pay child support Pay spousal support Obey orders about property

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How will the restraining order help me?The court can order the restrained person to:

Not contact or go near you, your children, otherrelatives, or others who live with youNot have any guns or ammunition Move out of your house

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The forms are available at any California courthouse or county law library or at: www.courts.ca.gov/forms.

How do I ask for a domestic violence restraining order?

You may get assistance in completing and filing your request from the court’s self-help center or a legal aid association.

After completing the forms, give them to the clerk of the court. The clerk will write a hearing date on the Notice of Court Hearing (Form DV-109). If your request for temporary orders is granted, the clerk will also give you a copy of the Temporary Restraining Order (DV-110) signed by a judicial officer.

How soon can I get the order?

The judge will decide within one business day whether or not to make any temporary orders. Sometimes the judge decides sooner. Ask the clerk if you should wait or come back later to get copies of the Notice of Court Hearing (Form DV-109) and Temporary Restraining Order (Form DV-110).

Ask the court clerk for the forms you need for these special kinds of orders, or visit www.courts.ca.gov. You may also want to talk to a lawyer.

What is abuse?

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Abuse means to intentionally or recklessly cause or attempt to cause bodily injury to you; or sexually assault you; or to place you or another person in reasonable fear of imminent serious bodily injury; or to molest, attack, hit, stalk, threaten, batter, harass, telephone, or contact you; or to disturb your peace; or destroy your personal property. Abuse can be spoken, written, or physical. (See Family Code §§ 6203, 6320).

See Form DV-505-INFO, How Do I Ask for a Temporary Restraining Order? to know which forms you need and for steps to follow after you complete the forms.

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DV-500-INFO

What if I don’t have the relationship necessary to qualify for a domestic violence restraining order?

There are other kinds of orders you can ask for:

Civil harassment order (can be used for neighbors,roommates, cousins, uncles, and aunts)Dependent adult or elder abuse restraining orderWorkplace violence order

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Having a lawyer is always a good idea, especially if you have children, but it is not required. You are not entitled to a free court-appointed lawyer. Ask the court clerk about free and low cost legal services and domestic violence help centers in your county. You can also go to the Family Law Facilitator for help with child support.

Do I need to bring a witness to the court hearing?

Do I need a lawyer?

No. But it helps to have proof of the abuse. You can bring: A written statement from a witness, made under oath Witnesses Photos Medical or police reports Damaged property Threatening letters, e-mails, or telephone messages

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Can a Domestic Violence Restraining Order Help Me?

You can get a restraining order even if you are not a U.S. citizen. If you are worried about deportation, talk to an immigration lawyer.

What if I don’t have a green card?

How will the person to be restrained know about the order?Someone who is at least 18—not you or anyoneelse to be protected by the order—must “serve” (give)the person to be restrained a copy of the order in person. The sheriff or marshal will do it for free, but you have to ask. For help with service, ask the court clerk for form DV-200-INFO, What Is “Proof of Personal Service”? or visit www.courts.ca.gov.

Call the police. The restrained person can be arrested and charged with a crime.

What if the restrained person doesn't obeythe order?

Yes. Go to court on the date the clerk gives you. If you do not, your order will end.

Do I have to go to court?

Will I see the restrained person at the court hearing?If the restrained person comes to the hearing, yes. But that person does not have the right to speak to you. If you are afraid, tell the court officer. Read Get Ready for the Court Hearing (Form DV-520-INFO).

Yes. You can bring someone to sit with you during the court hearing. But that person cannot speak for you in court. Only you or your lawyer (if you have one) can speak for you.

Can I bring someone with me to court?

When you file your papers, ask the clerk if a court interpreter is available. If the interpreter is not available for your court date, bring someone to interpret for you. Do not ask a child, or anyone to be protected by the order, to interpret for you.

What if I don’t speak English?

How much does it cost? Nothing.

DV-500-INFO

DV-500-INFO, Page 2 of 3Can a Domestic Violence Restraining Order Help Me? (Domestic Violence Prevention)

Revised January 1, 2012

The judge may or may not let a witness speak at the hearing.So if possible, you should bring their written statement under oath to the hearing. (You can use Form MC-030, Declaration, for this purpose.)

If the judge makes a temporary order, it will last until the hearing date. At that time, the judge will decide to continue or cancel the order. The restraining order can last up to 5 years. Child custody, visitation, child support, and spousal support orders can last longer than 5 years and they do not end when the restraining order ends.

How long does the order last?

Can I use the restraining order to get divorced or terminate a registered domestic partnership?No. These forms will not end your marriage or registered domestic partnership. You must file other forms to end your marriage or registered domestic partnership.

If you get a temporary restraining order that includes an order for custody, the parent with custody may not remove the child from California before notice to the other parent and a court hearing on the request to establish or modify custody. Read the order and Form DV-140, Child Custody and Visitation Order, if issued, for any other limits. There are some exceptions. Ask a lawyer.

The restraining order is valid anywhere in the United States. If you move out of California, contact the local police so they will know about your orders.

Ask the court clerk about free or low-cost legal help.For a referral to a local domestic violence or legal assistance program, call the National Domestic Violence Hotline:

1-800-799-7233 TDD: 1-800-787-3224 It’s free and private.They can help you in more than 100 languages.

Can the order stop the other parent from taking our children away?

What if I want to leave the county or state?

Need more information?

DV-500-INFO Can a Domestic Violence Restraining Order Help Me?

No. After the order is issued, only the judge can change or cancel it.

Can the restrained person and I agree tocancel the order?

DV-500-INFO, Page 3 of 3Can a Domestic Violence Restraining Order Help Me? (Domestic Violence Prevention)

Revised January 1, 2012

What if I am deaf or hard of hearing?

Assistive listening systems, computer- assisted real-time captioning, or sign language interpreter services are available if you ask at least five days before the proceeding. Contact the clerk's office or go to www.courts.ca.gov/forms for Request for Accommodations by Persons With Disabilities and Response (Form MC-410). (Civil Code, § 54.8.)

Local Form Adopted for Mandatory Use FAMILY LAW CASE PARTICIPANT ENROLLMENT FORM

CONFIDENTIAL FOR COURT USE ONLY

CASE PARTICIPANT

NAME: STATE BAR NO:

FIRM NAME:

ADDRESS:

CITY: STATE: CA ZIP CODE:

E-MAIL ADDRESS: (must be legible) TELEPHONE NO.:

ATTORNEY FOR (Name): FAX NO. (Optional):

NAME OF COURT: Superior Court of California, County of SacramentoSTREET ADDRESS: 3341 Power Inn RoadMAILING ADDRESS:

CITY AND ZIP CODE: Sacramento, CA 95826BRANCH NAME: William R. Ridgeway Family Relations Courthouse

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

CLAIMANT:

FAMILY LAW CASE PARTICIPANT ENROLLMENT FORM CASE NUMBER:

You may access some Findings and Orders After Hearing for law and motion hearings, and mediation reports prepared by Family Court Services on or after January 26, 2015 using the court's online Public Case Access System. Free access is available for 72 hours from the time the order is issued or the report is prepared, or from the time the court creates your case subscription. After 72 hours, you may still access but you will be required to pay for copies of orders and reports.

INSTRUCTIONS

To setup your account you must:

I,

declare that my private email address is (must be legible):

I understand, if I change my email address I must file a new enrollment form with the court.

, request the court create an account and/or subscription to my Family Law case. I

I would like to unsubscribe from my case and have attached a copy of my driver license, state or federal issued photo identification.

I acknowledge that confidential mediation reports contain private information that is not part of the public court file. I understand that without a court order, I must not disclose any contents of the Report to anyone (including any minor children) other than the parties to my case (petitioner/respondent/claimant) and their attorneys and court professionals. I acknowledge that the court may impose a penalty for any unauthorized disclosure of any content of the Family Court Services report.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

• File this form with the court and be prepared to show your driver license or a state or federal issued photo identification card.• A separate form must be filed for each of your Family Law cases.• Once the court has created your subscription to your Family Law case, you will receive a confirming email. You must follow the

instructions in that email to complete the process.

www.saccourt.ca.govFL/E-LP-665 (Rev 2/5/18)

(Please use Ø for zero, 1 for one and clearly differentiate i, L, S, 5, 3 and 8's).

PARTY

PARTY

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Once your subscription is completed, you will receive an email notification each time an order or report is added to your case.You must also complete and file this form, with a copy of your driver license, if you wish to unsubscribe to your Family Law case.

FL/E-LP-640

Page 1

FL\E-LP-640 (Revised 12/16/2011 ) Domestic Violence Date of Birth Verification Mandatory www.saccourt.ca.gov

SPACE RESERVED FOR FILED/ENDORSED STAMP

DOMESTIC VIOLENCE DATE OF BIRTH VERIFICATION

CASE NUMBER: ____________________________________

PLAINTIFF'S NAME: ____________________________________

PLAINTIFF'S DATE OF BIRTH: ____________________________________

DEFENDANT'S NAME: ____________________________________

DEFENDANT'S DATE OF BIRTH ____________________________________

Name of Person Asking for Order:

DV-109, Page 1 of 3Judicial Council of California, www.courts.ca.gov Revised January 1, 2012, Mandatory FormFamily Code, § 242, Approved by DOJ

Notice of Court Hearing

DV-109 Notice of Court Hearing

Name of Person to Be Restrained:

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Notice of Court Hearing A court hearing is scheduled on the request for restraining orders against the person in .

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Name and address of court if different from above:

Date: Time:

Room:Dept.:

This is a Court Order.

The court will fill out the rest of this form.

(Domestic Violence Prevention)

HearingDate

Clerk fills in case number when form is filed.

Clerk stamps date here when form is filed.

Fill in court name and street address:

Superior Court of California, County of

Case Number:

Your lawyer in this case (if you have one):

Zip:State:City:Telephone: Fax:

Address (If you have a lawyer for this case, give your lawyer’s information. If you do not have a lawyer and want to keep your home address private, give a different mailing address instead. You do not have to give your telephone, fax, or e-mail.):

Name: State Bar No.:

Firm Name:

Address:

E-Mail Address:

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All denied until the court hearing (specify reasons for denial in (b)):Partly granted and partly denied until the court hearing (specify reasons for denial in (b)):

4 Temporary Restraining Orders (any orders granted are attached on Form DV-110)

Temporary restraining orders for personal conduct, stay away, and protection of animals, as requested in Form DV-100, Request for Domestic Violence Restraining Order, are:

a.

(1) All granted until the court hearing(2)

(3)

Requested temporary restraining orders for personal conduct, stay away, and protection of animals are denied because:

b.

(1) The facts as stated in form DV-100 do not show reasonable proof of a past act or acts of abuse. (Family Code, §§ 6320 and 6320.5)

(2) The facts do not describe in sufficient detail the most recent incidents of abuse, such as what happened, the dates, who did what to whom, or any injuries or history of abuse.

(3) Further explanation of reason for denial, or reason not listed above:


DV-109, Page 2 of 3Revised January 1, 2012

Case Number:

Service of Documents and Time for Service—for Person in

At least five or ___ days before the hearing, someone age 18 or older—not you or anyone else to be protected—must personally give (serve) a court’s file-stamped copy of this form (DV-109, Notice of Court Hearing) to the person in along with a copy of all the forms indicated below:

Form DV-100, Request for Domestic Violence Restraining Order, (file-stamped) with applicable attachments a.

Form DV-120, Response to Request for Domestic Violence Restraining Order (blank form)c.

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Form DV-110, Temporary Restraining Order (file-stamped) with applicable attachments if granted by the judge

b.

Other (specify):e.

Form DV-250, Proof of Service by Mail (blank form)d.

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Notice of Court Hearing(Domestic Violence Prevention)

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Date:Judicial Officer

At the hearing, the judge will consider whether denial of any requested orders will jeopardize your safety and the safety of children for whom you are requesting custody or visitation.

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You must come to the hearing if you want the judge to make restraining orders or continue any orders already made. If you cancel the hearing or do not come to the hearing, any restraining orders made on Form DV-110 will end on the date of the hearing.

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Right to Cancel Hearing: Information for the Person in

If item (a)(2) or (a)(3) is checked, the judge has denied some or all of the temporary orders you requested until the court hearing. The judge may make the orders you want after the court hearing. You can keep the hearing date, or you can cancel your request for orders so there is no court hearing.

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If you want to cancel the hearing, use Form DV-112, Waiver of Hearing on Denied Request for Temporary Restraining Order. Fill it out and file it with the court as soon as possible.You may file a new request for orders, on the same or different facts, at a later time.

If you want to keep the hearing date, you must have all of the documents listed in item served on the other person within the time listed in item .5

If you cancel the hearing, do not serve the documents listed in item on the other person.5

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To the Person in

For information about service, read Form DV-210-INFO, What Is “Proof of Personal Service”?

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The court cannot make the restraining orders after the court hearing unless the person in has been personally given (served) a copy of your request and any temporary orders. To show that the person in has been served, the person who served the forms must fill out a proof of service form. Form DV-200, Proof of Personal Service may be used.

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If you are unable to serve the person in in time, you may ask for more time to serve the documents. Read Form DV-115-INFO, How to Ask for a New Hearing Date.

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DV-109, Page 3 of 3Revised January 1, 2012

Case Number:

Notice of Court Hearing(Domestic Violence Prevention)

—Clerk’s Certificate—

I certify that this Notice of Court Hearing is a true and correct copy of the original on file in the court.

Clerk’s Certificate

[seal]

Clerk, by , Deputy

(Clerk will fill out this part.)

Date:

Request for AccommodationsAssistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if you ask at least five days before the hearing. Contact the clerk’s office or go to www.courts.ca.gov/forms for Request for Accommodations by Persons With Disabilities and Response (Form MC-410). (Civil Code, § 54.8.)


To the Person in 2

If you want to respond in writing, mail a copy of your completed Form DV-120, Response to Request for Domestic Violence Restraining Order, to the person in and file it with the court. You cannot mail Form DV-120 yourself. Someone age 18 or older—not you—must do it.

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To show that the person in has been served by mail, the person who mailed the forms must fill out a proof of service form. Form DV-250, Proof of Service by Mail, may be used. File the completed form with the court before the hearing and bring it with you to the hearing.

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For information about responding to a restraining order and filing your answer, read Form DV-120-INFO, How Can I Respond to a Request for Domestic Violence Restraining Order?.

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Whether or not you respond in writing, go to the court hearing if you want the judge to hear from you before making orders. You may tell the judge why you agree or disagree with the orders requested. You may bring witnesses and other evidence.

At the hearing, the judge may make restraining orders against you that could last up to five years.

The judge may also make other orders about your children, child support, spousal support, money, and property and may order you to turn in or sell any firearms that you own or possess.

FL/E-LP-613

FL/E-LP-613 (Rev. May 23, 2017) Adopted for Mandatory Use Page 1 of 2

Attachment to Request for Domestic Violence Restraining Order

Page 1 of 2 www.saccourt.ca.gov

Attachment to Request for Domestic Violence Restraining Order 1. Have you participated in another case against the person who is to be restrained which involves child

custody and/or visitation? Yes No Name of court and case number: __________________________________________________________. The court's order or judgment regarding child custody and/or visitation was: ________________________ ____________________________________________________________________________________.

2. The child (ren) have been living with Mother Father Partner, since: ________________________. (approx. date) 3. Are you currently involved in a dependency case or with Child Protective Services? ____ Yes ____No 4. I have an Emergency Protective Order, Criminal Temporary Restraining Order, or Criminal

Restraining Order against the person who is to be restrained. Name of the Court and case number:_______________________________________________________

I have had no previous restraining orders against the person who is to be restrained. 5. The most recent incident of abuse by the party to be restrained was ________________________. (approx. date) Restrained party: hit me on the: arms legs face head stomach back eye kicked me on the ___________________________________________________. pushed and/or shoved me: into wall to the floor threatened me with a weapon (specify weapon and describe incident): ___________________________________________________________________. pulled my hair strangled me left bruises; describe: _________________________________________________. sexually abused me, describe: __________________________________________. City Police/Sheriff was called; Restrained party was arrested Was a report taken? Yes No Report number: _________________________ Other injuries: _______________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 6. The second most recent incident of abuse by the restrained party was: ____________________________. (approx. date) Restrained party: hit me on the: arms legs face head stomach back eye kicked me on the ___________________________________________________. pushed and/or shoved me: into wall to the floor threatened me with a weapon (specify weapon and describe incident): ___________________________________________________________________. pulled my hair strangled me left bruises; describe: _________________________________________________. sexually abused me, describe: __________________________________________. City Police/Sheriff was called; Restrained party was arrested Was a report taken? Yes No Report number: _________________________ Other injuries: _______________________________________________________ _____________________________________________________________________ _____________________________________________________________________

FL/E-LP-613

FL/E-LP-613 (Rev. May 23, 2017) Adopted for Mandatory Use Page 2 of 2

Attachment to Request for Domestic Violence Restraining Order

Page 2 of 2 www.saccourt.ca.gov

7. The third most recent incident of abuse by the restrained party was:____________________________. (approx. date) Restrained party: hit me on the: arms legs face head stomach back eye kicked me on the ___________________________________________________. pushed and/or shoved me: into wall to the floor threatened me with a weapon (specify weapon and describe incident): ___________________________________________________________________. pulled my hair strangled me left bruises; describe: _________________________________________________. sexually abused me, describe: __________________________________________. City Police/Sheriff was called; Restrained party was arrested Was a report taken? Yes No Report number: _________________________ Other injuries: _______________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 8. Since the last act of abuse, explain the delay, if any, in seeking this restraining order:

__________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________ 9. The most recent incident of threats to kill me; beat me; take child(ren) was on_________________. (approx. date) He/She said___________________________________________________________________________ _____________________________________________________________________________________. 10. Restrained party took our child(ren) on ____________________ and will not give them back. (approx. date) 11. Restrained party has physically abused sexually molested the child(ren). Children's Protective Services is is not involved. Describe the abuse: _____________________________________________________________________________________ _____________________________________________________________________________________. 12. Other past incidence of abuse:__________________________________________________________

_____________________________________________________________________________________ _____________________________________________________________________________________

_____________________________________________________________________________________ 13. Restrained party has; does not have a firearms(s) which is registered; unregistered; do not

know. The firearm(s) is a (mark all applicable): hand-gun; rifle; other (describe) ___________________ I last saw the firearm(s) on _____________________________. (approx. date) I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________________________________ (type or print name) (signature of person to be protected)

Request for Domestic Violence Restraining Order (Domestic Violence Prevention)

Request for Domestic Violence Restraining Order

What is your relationship to the person in ? (Check all that apply):

You must also complete form CLETS-001, Confidential CLETS Information,and give it to the clerk when you file this Request.

Age:

Name of Person You Want Protection From:

Full name

Sex:

Address (if known):Race: Date of Birth:

City:

Age:

Do you want an order to protect family or household members?

Description of person you want protection from:

Weight: Hair Color: Eye Color:

State: Zip:

Sex Age Lives with you? Relationship to youIf yes, list them:

If you do not have one of these relationships, the court may not be able to consider yourrequest. Read form DV-500-INFO for help.

Child’s Name: Date of Birth:Child’s Name: Date of Birth:Child’s Name: Date of Birth:

Judicial Council of California, www.courts.ca.govRevised July 1, 2016, Mandatory Form Family Code, § 6200 et seq.

DV-100, Page 1 of 6

DV-100

Name of Person Asking for Protection:

Address (If you have a lawyer for this case, give your lawyer’sinformation. If you do not have a lawyer and want to keep your home address private, give a different mailing address instead. You do not haveto give your telephone, fax, or e-mail.):

Firm Name:



Telephone:

Address:

Fax:E-Mail Address:

Zip:State:City:

M F Height:

Yes No

Yes NoYes NoYes No

Check here if you need more space. Attach a sheet of paper and write “DV-100, Protected People” for a title.

a.b.

We are now married or registered domestic partners.We used to be married or registered domestic partners.

c. We live together.d. We used to live together.e. We are related by blood, marriage, or adoption (specify relationship):f. We are dating or used to date, or we are or used to be engaged to be married.g. We are the parents together of a child or children under 18:

Check here if you need more space. Attach a sheet of paper and write “DV-100, Additional Children” for a title.

h. We have signed a Voluntary Declaration of Paternity for our child or children. (Attach a copy if you have one).

This is not a Court Order.

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Court fills in case number when form is filed.

Case Number:

SacramentoWilliam R. Ridgeway FamilyRelations Courthouse3341 Power Inn RoadSacramento, CA 95826

http://www.courts.ca.gov/documents/dv500info.pdf

Check the orders you want.

I ask the court to order the person in to stay at least yards away from (check all that apply):MeMy homeMy job or workplace

My school

My vehicleThe child(ren)’s school or child careEach person listed in

Other (specify):

a.

b.

Revised July 1, 2016

(If the person in lives with you and you want that person to stay away from your home, you must ask for this move-out order.)

I ask the court to order the person in not to do the following things to me or anyone listed in :

Other Restraining Orders and Court Cases

Have you or any other person named in been involved in another court case with the person in ?If yes, check each kind of case and indicate where and when each was filed:

Kind of Case County or Tribe Where Filed Year Filed Case Number (if known)

DV-100, Page 2 of 6

The person in 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.

If the person listed in is ordered to stay away from all the places listed above, will he or she still be able to get to his or her home, school, job, workplace, or vehicle?

Case Number:

b.No Yes

Divorce, Nullity, Legal SeparationCivil HarassmentDomestic ViolenceCriminalJuvenile, Dependency, GuardianshipChild SupportParentage, PaternityOther (specify):Check here if you need more space. Attach a sheet of paper and write “DV-100, Other Court Cases” for a title.

Move-Out Order

I ask the court to order the person in to move out from and not return to (address):

I have the right to live at the above address because (explain):



Harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy personal property, disturb the peace, keep under surveillance, impersonate (on the Internet, electronically or otherwise), or block movements

Personal Conduct Orders

a.

b. Contact, either directly or indirectly, in any way, including but not limited to, by telephone, mail or e-mail or other electronic means

Stay-Away Order

Yes No (If no, explain):

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Are there any restraining/protective orders currently in place OR that have expired in the last six months (emergency protective orders, criminal, juvenile, family)?

a.

YesNo (date of order): and (expiration date): (Attach a copy if you have one).

I believe the person in owns or possesses guns, firearms, or ammunition.

I ask for the right to record communications made to me by the person in that violate the judge’s orders.

Revised July 1, 2016 DV-100, Page 3 of 6

If you ask for orders, you must fill out and attach form DV-105, Request for Child Custody and Visitation Orders.

If you ask for child support orders, you must fill out and attach form FL-150, Income and Expense Declaration or form FL-155, Financial Statement (Simplified).

You and the other parent may tell the court that you want to be legal parents of the children (use form DV-180,Agreement and Judgment of Parentage).

If the judge approves the order, the person in will be ordered not to own, possess, purchase, or receive a firearm or ammunition. The person will be ordered to sell to, or store with, a licensed gun dealer, or turn in to law enforcement, any guns or firearms that he or she owns or possesses.

Case Number:

Guns or Other Firearms or AmmunitionYes No I don’t know

Record Unlawful Communications

Care of AnimalsI ask for the sole possession, care, and control of the animals listed below. I ask the court to order the person in to stay at least yards away from and not take, sell, transfer, encumber, conceal, molest, attack,strike, threaten, harm, or otherwise dispose of the following animals:

I ask for the animals to be with me because:

Child Custody and Visitationa.b.

I do not have a child custody or visitation order and I want one.I have a child custody or visitation order and I want it changed.

Child Support (Check all that apply):

a.b.

I do not have a child support order and I want one.I have a child support order and I want it changed.

c. I now receive or have applied for TANF, Welfare, CalWORKS, or Medi-Cal.

Property ControlI ask the court to give only me temporary use, possession, and control of the property listed here:



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Debt Payment

Check here if you need more space. Attach a sheet of paper and write “DV-100, Debt Payment” for a title.I ask the court to order the person in to make these payments while the order is in effect:

Pay to: For: Amount: $ Due date:

2

Property RestraintI am married to or have a registered domestic partnership with the person in . I ask the judge to order that the person in not borrow against, sell, hide, or get rid of or destroy any possessions or property, except in the usual course of business or for necessities of life. I also ask the judge to order the person in to notify me of any new or big expenses and to explain them to the court.

22

2

I am married to or have a registered domestic partnership with the person in and no spousal support orderexists. I ask the court to order the person in to pay spousal support. (You must complete, file, and serve formFL-150, Income and Expense Declaration, before your hearing).

Spousal Support2

2

15

16

17

http://www.courts.ca.gov/documents/dv180.pdf

http://www.courts.ca.gov/documents/fl150.pdf


What other orders are you asking for?

I ask the court to order the person in to pay the following: You can ask for lost earnings or your costs for services caused directly by the person in (damaged property,medical care, counseling, temporary housing, etc.). You must bring proof of these expenses to your hearing.

Pay to: For: Amount: $

Pay to: For: Amount: $

I ask the court to order the person listed in to go to a 52-week batterer intervention program and show proofof completion to the court.

Revised July 1, 2016 DV-100, Page 4 of 6

I ask that the person in pay some or all of my lawyer’s fees and costs.You must complete, file, and serve form FL-150, Income and Expense Declaration, before your hearing.

Case Number:

InsuranceI ask the court to order the person in NOT to cash, borrow against, cancel, transfer, dispose of, or change the beneficiaries of any insurance or coverage held for the benefit of me or the person in , or our child(ren), for whom support may be ordered, or both. Lawyer’s Fees and Costs

Payments for Costs and Services

Batterer Intervention Program

Other Orders

Check here if you need more space. Attach a sheet of paper and write “DV-100, Other Orders” for a title.



19

22

23

20

21

22

2

2

22

Rights to Mobile Device and Wireless Phone Account

(including area code):

(including area code):(including area code):

my number number of child in my care

my number number of child in my caremy number number of child in my care

Check here if you need more space. Attach a sheet of paper and write “DV-100, Rights to Mobile Device and Wireless Phone Account” for a title.

If the judge makes this order, you will be financially responsible for these accounts, including monthly service fees and costs of any mobile devices connected to these phone numbers. You may be responsible for other fees. You must contact the wireless service provider to find out what fees you will be responsible for and whether you are eligible for an account.

I ask the court to give only me temporary use, possession, and control of the following mobile devices: and the wireless phone account for the following wireless phone numbers because the account currently belongs to the person in :2

18a. Property control of mobile device and wireless phone account

b. Debt PaymentI ask the court to order the person in to make the payments for the wireless phone accounts listed in 18abecause:

2

Name of the wireless service provider is: Amount: $ Due Date:If you are requesting this order, you must complete, file, and serve form FL-150, Income and Expense Declaration, before your hearing.

c. Transfer of Wireless Phone AccountI ask the court to order the wireless service provider to transfer the billing responsibility and rights to the wireless phone numbers listed in 18a to me because the account currently belongs to the person in .2



Describe how the person in abused you or your child(ren):


Describe how the person in abused you. Abuse means to intentionally or recklessly cause or attempt to cause bodily injury to you; or to place you or another person in reasonable fear of imminent serious bodily injury; or to harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, keep you under surveillance, impersonate (on the Internet, electronically or otherwise), batter, telephone, or contact you; or to disturb your peace; or to destroy your personal property. (For a complete definition, see Fam. Code, §§ 6203, 6320.)

Date of most recent abuse:

Who was there?

Did the person in use or threaten to use a gun or any other weapon?2

Describe any injuries:

Did the police come?If yes, did they give you or the person in an Emergency Protective Order?Attach a copy if you have one.The order protects

DV-100, Page 5 of 6

Case Number:

Describe Abuse

a.

1.

2.

Check here if you need more space. Attach a sheet of paper and write “DV-100, Recent Abuse” for a title.

3.

4.

5.

No Yes (If yes, describe):

No Yes

you or the person in


I don’t knowYes No

No Fee to Serve (Notify) Restrained PersonIf you want the sheriff or marshal to serve (notify) the restrained person about the orders for free, ask the court clerk what you need to do.

The court will schedule a hearing on your request. If the judge does not make the orders effective right away (“temporary restraining orders”), the judge may still make the orders after the hearing. If the judge does not make the orders effective right away, you can ask the court to cancel the hearing. Read form DV-112, Waiver of Hearing on Denied Request for Temporary Restraining Order, for more information.

Court Hearing

The papers must be personally served on the person in 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 below. For help, read form DV-200-INFO, “What Is Proof of Personal Service”?

2

2

2

2

2

27

25

26

24 Time for Service (Notice)


http://www.courts.ca.gov/documents/dv200info.pdf


I don’t knowYes No


The persons listed in item need an order for protection because (describe):

I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.

DV-100, Page 6 of 6

Case Number:

Other Persons to Be Protected

Number of pages attached to this form, if any:

Date:

Type or print your name Sign your name

Lawyer’s name, if you have one Lawyer’s signature

Date:



Has the person in abused you (or your child(ren)) other times?

Describe Abuse (continued)

Date of abuse:

Who was there?

Did the person in use or threaten to use a gun or any other weapon?


Did the police come?

If yes, did they give you or the person in an Emergency Protective Order?

Attach a copy if you have one.The order protects

b.1.

2. Describe how the person in abused you or your child(ren):

Check here if you need more space. Attach a sheet of paper and write “DV-100, Recent Abuse” for a title.

3.

4.

5.

No Yes (If yes, describe):

No Yes

you or the person in If the person in abused you other times, check here and use Form DV-101, Description of Abuse or describe any previous abuse on an attached sheet of paper and write “DV-100, Previous Abuse” for a title.

28

29

272

3

2

2

2

2

2


DV-101, Page 1 of 2Judicial Council of California, www.courts.ca.govRev. January 1, 2017, Optional Form Family Code, § 6200 et seq.

3

1

2

Describe abuse to you or your children.

Name of person asking for protection:

Name of person you want protection from:

Case Number:DV-101 Description of Abuse

a. Date of abuse:

d.

This form is attached to DV-100, Request for Domestic Violence Restraining Order .

b. Who was there?

2Describe how the person in abused you or your children:

Description of Abuse (Domestic Violence Prevention)

Describe any use or threatened use of guns or other weapons:

e.

Did the police or other law enforcement come?If yes, did they give you or the person in an Emergency Protective Order?

2The Emergency Protective Order protectsAttach a copy of the Emergency Protective Order if you have one.

f. YesNoYes No I don’t know2

You The person in


Case Number:

4

5


a. Date of abuse:

d.

b.

c.

e.

Did the police or other law enforcement come?If yes, did they give you or the person in an Emergency Protective Order?

2The Emergency Protective Order protects

Attach a copy of the Emergency Protective Order if you have one.

f. YesNoYes No I don’t know2

You The person in

Has the person in abused you (or your children) other times?2


Check here if you need more space. Attach a sheet of paper and write “DV-101—Description of Abuse” for atitle.

DV-101, Page 2 of 2Rev. January 1, 2017 Description of Abuse (Domestic Violence Prevention)

Who was there?

2Describe how the person in abused you or your children:

Describe any use or threatened use of guns or other weapons:


Full name

This order expires at the end of the hearing stated below:

DV-110, Page 1 of 6

Person in must complete items , , and only.

Description of restrained person:

Sex AgeRelationship to person in

In addition to the person named in , the following persons are protected by temporary orders as indicated in items and (family or household members):

1 31 2

16

1

The court will complete the rest of this form.

Hearing Date: Time:

Relationship to protected person:

Judicial Council of California, www.courts.ca.govRevised July 1, 2016, Mandatory Form Family Code, § 6200 et seq.Approved by DOJ

Temporary Restraining Order (CLETS—TRO)


Temporary Restraining Order

1 Name of Protected Person:


Firm Name:



Telephone:

Address:

Fax:

E-mail Address:

Zip:State:City:

2 Name of Restrained Person:




Court fills in case number when form is filed.

Case Number:

Sex:

Address (if known):Race: Date of Birth:

City:

Age:Weight: Hair Color: Eye Color:

State: Zip:

M F Height:

3 Additional Protected Persons

Check here if there are additional protected persons. List them on an attached sheet of paper and write, “DV-110, Additional Protected Persons” as a title.

a.m. p.m.

4


DV-110

7

Court Hearing


Case Number: County: Expiration Date: No information has been provided to the judge about a criminal protective order.

A criminal protective order on form CR-160, Criminal Protective Order—Domestic Violence, is in effect. a.

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

You must take only personal clothing and belongings needed until the hearing and move out immediately from

b.

To the person in

DV-110, Page 2 of 6

You must not do the following things to the person in and persons in :

Contact, either directly or indirectly, in any way, including but not limited to, by telephone, mail, e-mail or other electronic meansTake any action, directly or through others, to obtain the addresses or locations of the persons in and . (If this item is not checked, the court has found good cause not to make this order.)

Peaceful written contact through a lawyer or process server or another person for service of Form DV-120(Response to Request for Domestic Violence Restraining Order) or other legal papers related to a court case isallowed and does not violate this order.

Exceptions: Brief and peaceful contact with the person in , and peaceful contact with children in , as required for court-ordered visitation of children, is allowed unless a criminal protective order says otherwise.

Harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy personal property, disturb the peace, keep under surveillance, impersonate (on the Internet, electronically or otherwise), or block movements

1 3

3

1

1

3

a.

You must stay at least (specify): yards away from (check all that apply):

Exceptions: Brief and peaceful contact with the person in , and peaceful contact with children in , as required for court-ordered visitation of children, is allowed unless a criminal protective order saysotherwise.

1 3

a.

c.

b.


Case Number:

Criminal Protective Order

Not requested Denied until the hearing Granted as follows:

b.

(address):

Granted as follows:Denied until the hearingNot requested


5

7

6

8

2



Stay-Away Order

Move-Out Order



The person in The persons in Home of person in

The job or workplace of person in

School of person in 13

Vehicle of person in 1

11

1

The child(ren)’s school or child careOther (specify):


Child custody and visitation are ordered on the attached form DV-140, Child Custody and Visitation Order or . The parent with temporary custody of the child must not remove the child from California unless the court allows it after a noticed hearing (Fam. Code, § 3063).

You cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, otherfirearms, or ammunition.You must:

Sell to, or store with, a licensed gun dealer, or turn in to a law enforcement agency, any guns or other firearms within your immediate possession or control. Do so within 24 hours of being served with this order.

•

Within 48 hours of receiving this order, file with the court a receipt that proves guns have been turned in, stored, or sold. (You may use Form DV-800, Proof of Firearms Turned In, Sold, or Stored, for the receipt.) Bring a court filed copy to the hearing.

•

DV-110, Page 3 of 6Revised July 1, 2016

No Guns or Other Firearms or Ammunitiona.

c.

Property Control

Not ordered now but may be ordered after a noticed hearing.

Case Number:

b.

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


The person in is given the sole possession, care, and control of the animals listed below. The person in must stay at least yards away from and not take, sell, transfer, encumber, conceal, molest, attack, strike,threaten, harm, or otherwise dispose of the following animals:

Child Support

Until the hearing, only the person in can use, control, and possess the following property:


Care of Animals

Child Custody and Visitation

Debt PaymentThe person in must make these payments until this order ends:Pay to: For: Amount: $ Due date:Pay to: For: Amount: $ Due date:


(specify other form):





The person in can record communications made by you that violate the judge’s orders.

12

9

10

11

13

14

21

1

1

2



If the people in and are married to each other or are registered domestic partners, must not transfer, borrow against, sell, hide, or get rid of or destroy any property, including animals, except in the usual course of business or for necessities of life. In addition, each person must notify the other of any new or big expenses and explain them to the court. (The person in cannot contact the person in if the court has made a “no contact” order.)

21 1the person in2the person in

21

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.

Property Restraint Not requested Denied until the hearing Granted as follows:

15

16


No Fee to Serve (Notify) Restrained PersonIf the sheriff serves this order, he or she will do so for free.

Judge (or Judicial Officer)


Case Number:

Spousal SupportNot ordered now but may be ordered after a noticed hearing.

Insurance is ordered NOT to cash, borrow against, cancel, transfer, dispose of, or change the beneficiaries of any insurance or coverage held for the benefit of the parties, or their child(ren), if any, for whom support may be ordered, or both.

The person in the person in

Lawyer's Fees and CostsNot ordered now but may be ordered after a noticed hearing.

Payments for Costs and ServicesNot ordered now but may be ordered after a noticed hearing.

Batterer Intervention ProgramNot ordered now but may be ordered after a noticed hearing.

Other Orders

Check here if there are additional orders. List them on an attached sheet of paper and write “DV-110, OtherOrders” as a title.

Date:


Temporary Restraining Order(CLETS—TRO)


23

20

19

21

22

24

1 2


17

18 Rights to Mobile Device and Wireless Phone Accounta. Property control of mobile device and wireless phone account

Not requested Denied until the hearing Granted as follows:Until the hearing, only the person in can use, control, and possess the following property:1Mobile device (describe) and account (phone number):Mobile device (describe)

and account (phone number):Mobile device (describe)and account (phone number):

Check here if you need more space. Attach a sheet of paper and write "DV-110 Rights to Mobile Device and Wireless Phone Account" as a title.

b. Debt Payment Not requested Denied until the hearing Granted as follows:The person in must make these payments until this order ends:2Pay to (wireless service provider): Amount: $ Due date:

c. Transfer of Wireless Phone AccountNot ordered now but may be ordered after a noticed hearing.

Instructions for Law Enforcement

This order is effective when made. It is enforceable by any law enforcement agency that has received the order, is showna copy of the order, or has verified its existence on the California Law Enforcement Telecommunications System(CLETS). If the law enforcement agency has not received proof of service on the restrained person, and the restrainedperson was not present at the court hearing, the agency shall advise the restrained person of the terms of the order andthen shall enforce it. Violations of this order are subject to criminal penalties.


Case Number:

Child custody and visitation: If you do not go to the hearing, the judge can make custody and visitation orders foryour children without hearing from you.

•

Child Custody, Visitation, and Support

Child support: The judge can order child support based on the income of both parents. The judge can also have thatsupport taken directly from a parent's paycheck. Child support can be a lot of money, and usually you have to pay until the child is age 18. File and serve a Financial Statement (Simplified) (form FL-155) or an Income and Expense Declaration (form FL-150) if you want the judge to have information about your finances. Otherwise, the court may make support orders without hearing from you.

•

Spousal support: File and serve an Income and Expense Declaration (form FL-150) so the judge will have information about your finances. Otherwise, the court may make support orders without hearing from you.

•


Service of Order by Mail

You Cannot Have Guns, Firearms, And/Or Ammunition.

You cannot own, have, possess, buy or try to buy, receive or try to receive, or otherwise getguns, other firearms, and/or ammunition while the 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. The judge will ask you for proof that you did so. If you do not obey this order, you can be charged with a crime. Federal law says you cannot have guns or ammunition while the order is in effect.

If the judge makes a restraining order at the hearing, which has the same orders as in this form, you will get a copy of thatorder by mail at your last known address, which is written in . If this address is incorrect, or to find out if the orderswere made permanent, contact the court.

2

It is a felony to take or hide a child in violation of this order.

If You Do Not Obey This Order, You Can Be Arrested And Charged With a Crime.

•• If you travel to another state or to tribal lands or make the protected person do so, with the intention of disobeying this

order, you can be charged with a federal crime.

If you do not obey this order, you can go to jail or prison and/or pay a fine.•

Warnings and Notices to the Restrained Person in 2



Arrest Required if Order Is ViolatedIf an officer has probable cause to believe that the restrained person had notice of the order and has disobeyed the order,the officer must arrest the restrained person. (Pen. Code, §§ 836(c)(1), 13701(b).) A violation of the order may be aviolation of Penal Code section 166 or 273.6.


Case Number:


—Clerk's Certificate—

I certify that this Temporary Restraining Order is a true and correct copy of theoriginal on file in the court.

Clerk’s Certificate [seal]

Clerk, by , Deputy


Date:

Certificate of Compliance With VAWA

This temporary protective order meets all “full faith and credit” requirements of the Violence Against Women Act,18 U.S.C. § 2265 (1994) (VAWA), upon notice of the restrained person. This court has jurisdiction over the parties and the subject matter; the restrained person has been or will be afforded notice and a timely opportunity to be heard as provided by the laws of this jurisdiction. This order is valid and entitled to enforcement in each jurisdiction throughout the 50 states of the United States, the District of Columbia, all tribal lands, and all U.S. territories, commonwealths, and possessions and shall be enforced as if it were an order of that jurisdiction.

3.

4.

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.

Child Custody and Visitation•

•

The custody and visitation orders are on form DV-140, items and . They are sometimes also written on additional pages or referenced in DV-140 or other orders that are not part of the restraining order. Forms DV-100 and DV-105 are not orders. Do not enforce them.

3 4

Conflicting Orders–Priorities for EnforcementIf more than one restraining order has been issued protecting the protected person from the restrained person, the orders must be enforced according to the following priorities (see Pen. Code, § 136.2, and Fam. Code, §§ 6383(h), 6405(b)):1.

2.

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

If the Protected Person Contacts the Restrained PersonEven if the protected person invites or consents to contact with the restrained person, the orders remain in effect and mustbe enforced. The protected person cannot be arrested for inviting or consenting to contact with the restrained person. Theorders can be changed only by another court order. (Pen. Code, §13710(b).)



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

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.

This is not a Court Order—Do not place in court file.

CLETS Information

Person to Be Protected (Name):

Eye Color: Date of Birth: Hair Color: Age:

Confidential CLETS InformationJudicial Council of California, www.courts.ca.govNew January 1, 2012, Mandatory FormCal. Rules of Court, rule 1.51

FSex: Height: Weight: Race: M

Person to Be Restrained (Name):

Describe any marks, scars, or tattoos:

Other names used by the restrained person:

Describe any guns or firearms that you believe the person in owns or has access to (Number, types, and locations):

1

CLETS-001, Page 1 of 1

Eye Color: Date of Birth: Hair Color: Age:

FSex: Height: Weight: Race: M

4 Other People to Be ProtectedSexName Date of Birth

CONFIDENTIAL

CLETS-001

Additional persons to be protected are listed on Attachment 4.

Guns or Firearms3

2

California Law Enforcement Telecommunications System (CLETS)Information Form

Important: This form MUST NOT become part of the public court file. It is confidential and private.

Case Number (if you know it):

This form is submitted with the initial filing (date):

This is an amended form (date):

Fill out as much of this form as you can and give it to the court clerk. If the court issues a restraining order, this form will provide law enforcement with information that will help them enforce it. If any of this information changes, fill out a new (amended) form.

1Race

Driver’s License Number and State: Social Security Number: Vehicle (Type, Model, Year): (License Number and State):

Vehicle (Type, Model, Year): (License Number and State):

Mailing Address (listed on restraining order):

Zip:State:City: Telephone (optional):

Employer:

Occupation/Title: Work Hours:

Residence Address:

Zip:State:City: Telephone:

Business Address:

Zip:State:City: Telephone:

Relation to Person in

2

Judicial Council of California, www.courts.ca.govRevised July 1, 2016, Mandatory FormFamily Code, § 6200 et seq. Approved by DOJ


Restraining Order After Hearing (CLETS—OAH)(Order of Protection)


Full name

The orders, except as noted below, end on

Sex AgeRelationship to person in

In addition to the person named in , the following persons are protected by orders as indicated in itemsand (family or household members):

Expiration Date

If no date is written, the restraining order ends three years after the date of the hearing in item (a).

(date):

•• If no time is written, the restraining order ends at midnight on the expiration date.

Note: Custody, visitation, child support, and spousal support orders remain in effect after the restraining orderends. Custody, visitation, and child support orders usually end when the child is 18.

•

• The court orders are on pages 2, 3, 4, and 5 and attachment pages (if any).

This order complies with VAWA and shall be enforced throughout the United States. See page 5.

DV-130, Page 1 of 7

at (time):

DV-130

Name of Restrained Person:

Description of restrained person:




Clerk fills in case number when form is filed.

Case Number:

Telephone:

Address:


Fax:

Firm Name:

E-Mail Address:

Name of Protected Person:

Zip:State:City:

Your lawyer in this case (if you have one):Name: State Bar No.:

Sex:

Mailing Address (if known):Race: Date of Birth:

City:

Age:Weight: Hair Color: Eye Color:

State: Zip:

M F Height:

Additional Protected Persons1 6

71

Check here if there are additional protected persons. List them on an attached sheet of paper and write,“DV-130, Additional Protected Persons,” as a title.

a.m. p.m. or midnight

5

1

2

3

4

Relationship to protected person:

Restraining Order After Hearing (Order of Protection)

Amended OrderOriginal Order


The person in must move out immediately from (address):


HearingsThe hearing was on (date): with (name of judicial officer): a.

The court has granted the orders checked below. Item is also an order. If you do not obeythese orders, you can be arrested and charged with a crime. You may be sent to jail for up to oneyear, pay a fine of up to $1,000, or both.

The people in and must return to Dept. (date):at (time):

b.

To the person in :

These people were at the hearing (check all that apply):(name):(name):

c.

The person in must not do the following things to the protected people in and :a.

Peaceful written contact through a lawyer or process server or another person for service of legal papers related to a court case is allowed and does not violate this order.

b.

c.

The person in must stay at least (specify): yards away from (check all that apply):a.

b.

Case Number:

The person in The person in

12

The lawyer for the person in The lawyer for the person in

12

1 2a.m. p.m.

2

9

of the court on

6

7

8

5

2 1 3

Contact, either directly or indirectly, by any means, including, but not limited to, by telephone, mail,e-mail, or other electronic means.Take any action, directly or through others, to obtain the addresses or locations of any protected persons.(If this item is not checked, the court has found good cause not to make this order.)

Exceptions: Brief and peaceful contact with the person in , and peaceful contact with children in , as required for court-ordered visitation of children, is allowed unless a criminal protective order saysotherwise.

1 3

Stay-Away Order2

The person in The persons in Home of person in

The job or workplace of person in

School of person in 13

Vehicle of person in 1

11

1

The child(ren)’s school or child care

Exceptions: Brief and peaceful contact with the person in , and peaceful contact with children in ,as required for court-ordered visitation of children, is allowed unless a criminal protective order saysotherwise.

1 3

Move-Out Order2



DV-130, Page 2 of 7

No Guns or Other Firearms or AmmunitionThe person in cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other wayget guns, other firearms, or ammunition.

a.

9

2

Harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy personalproperty, disturb the peace, keep under surveillance, impersonate (on the Internet, electronically or otherwise), or block movements.


to review (specify issues):


Other (specify):

The court has made the necessary findings and applies the firearm relinquishment exemption under Family Code section 6389(h). Under California law, the person in is not required to relinquish this firearm (specify make, model, and serial number of firearm):

yards away from and not take, sell, transfer, encumber, conceal, molest, attack, strike,

The person in has the right to record communications made by the person in that violate the judge’s orders.21

The person in is given the sole possession, care, and control of the animals listed below. The person in

threaten, harm, or otherwise dispose of the following animals:

Only the person in can use, control, and possess the following property:

b. The person in must: Sell to, or store with, a licensed gun dealer, or turn in to a law enforcement agency, any guns or other firearms within his or her immediate possession or control. Do so within 24 hours of being served with this order.

•

Within 48 hours of receiving this order, file with the court a receipt that proves guns have been turned in, sold, or stored. (Form DV-800, Proof of Firearms Turned In, Sold, or Stored, may be used for the receipt.) Bring a court filed copy to the hearing.

•

c.

The person in must make these payments until this order ends:Pay to: For: Amount: $ Due date:

Pay to: For: Amount: $ Due date: Pay to: For: Amount: $ Due date:

Check here if more payments are ordered. List them on an attached sheet of paper and write “DV-130,Debt Payments” as a title.

Child support is ordered on the attached Form FL-342, Child Support Information and Order Attachment

Child custody and visitation are ordered on the attached Form DV-140, Child Custody and Visitation Order or (specify other form):

Case Number:

9

10

11

12

13

14

2

The court has received information that the person in owns or possesses a firearm. 2


Care of Animals

Child Custody and Visitation

Child Support

Property Control

Debt Payment

must stay at least1 2

or (specify other form):

1

2



DV-130, Page 3 of 7

d.2

The firearm must be in his or her physical possession only during scheduled work hours and during travel to and from his or her place of employment. Even if exempt under California law, the person inmay be subject to federal prosecution for possessing or controlling a firearm.

2

This is a Court Order.Revised July 1, 2016

The must not transfer, borrow against, sell, hide, or get rid of or destroy any property, including animals, except in the usual course of business or for necessities of life. In addition, theperson must notify the other of any new or big expenses and explain them to the court. (The person in cannot contact the person in if the court has made a“No-Contact”order.)Peaceful written contact through a lawyer or a process server or other person for service of legal papers relatedto a court case is allowed and does not violate this order.

Property Restraintperson in person in 1 2

21

15

16

Other orders (specify):

The person in must go to and pay for a 52-week batterer intervention program and show written proof ofcompletion to the court. This program must be approved by the probation department under Penal Code§ 1203.097. The person in must enroll by (date): or if no date is listed, must enroll within 30 days after the order is made. The person in must complete, file and serve Form 805, Proof of Enrollment for Batterer Intervention Program.

If the sheriff or marshal serves this order, he or she will do it for free.

Attachment or (specify other form):Spousal support is ordered on the attached Form FL-343, Spousal, Partner, or Family Support Order

The person in must pay the following lawyer’s fees and costs:

The person in must pay the following:

No Fee to Serve (Notify) Restrained Person

Case Number:

20

21

22

23

Spousal Support

Lawyer's Fees and Costs

Payments for Costs and Services

Batterer Intervention Program

Other Orders


2

2

Pay to: For: Amount: $ Due date:


Check here if more payments are ordered. List them on an attached sheet of paper and write “DV-130, Payments for Costs and Services” as a title.

2

24



DV-130, Page 4 of 7

19 is ordered NOT to cash, borrow against, cancel, transfer, disposeof, or change the beneficiaries of any insurance or coverage held for the benefit of the parties, or their child(ren), if any, for whom support may be ordered, or both.

1 2The person in the person inInsurance


18 Rights to Mobile Device and Wireless Phone AccountProperty Control of Mobile Device and Wireless Phone Account

Only the person in can use, control, and possess the following property:1Mobile device (describe) and account (phone number):Mobile device (describe) and account (phone number):

Check here if you need more space. Attach a sheet of paper and write "DV-130 Rights to Mobile Device and Wireless Phone Account" as a title.

b.The person in must make these payments until this order ends:2Pay to (wireless service provider): Amount: $ Due date:

Debt Payment

a.

The court has made an order transferring one or more wireless service accounts from the person in to the person in . These orders are contained in a separate order (Form DV-900).

c. Transfer of Wireless Phone Account2

1

17

22

••

All of the attached pages are part of this order.Attachments include (check all that apply):

Certificate of Compliance With VAWA

This restraining (protective) order meets all “full faith and credit” requirements of the Violence Against Women Act,18 U.S.C. § 2265 (1994) (VAWA) upon notice of the restrained person. This court has jurisdiction over the partiesand the subject matter; the restrained person has been or will be afforded notice and a timely opportunity to be heardas provided by the laws of this jurisdiction. This order is valid and entitled to enforcement in each jurisdiction throughout the 50 states of the United States, the District of Columbia, all tribal lands, and all U.S. territories, commonwealths, and possessions and shall be enforced as if it were an order of that jurisdiction.

• Number of pages attached to this seven-page form:

Case Number:

Attached pages are orders.27

DV-140Other (specify):

DV-145 DV-150 FL-342 FL-343

Date:Judge (or Judicial Officer)



DV-130, Page 5 of 7


c. No information has been provided to the judge about a criminal protective order.

(List other orders on an attached sheet of paper. Write “DV-130, Other Criminal Protective Orders” as a title.)

a.Case Number: County: Expiration Date:

26 Criminal Protective OrderForm CR-160, Criminal Protective Order—Domestic Violence, is in effect.

b.Case Number: County: Expiration Date:

Other Criminal Protective Order in effect (specify):

Proof of service of Form DV-109 and Form DV-110 (if issued) was presented to the court. The judge’s orders in this form are the same as in Form DV-110 except for the end date. The person in must be served. This order can be served by mail.Proof of service of Form DV-109 and Form DV-110 (if issued) was presented to the court. The judge’s orders in this form are different from the orders in Form DV-110, or Form DV-110 was not issued. The person in must be personally “served” (given) a copy of this order.

2

2

Servicea.

b.

(1)

(2)

The people in and were at the hearing or agreed in writing to this order. No other proof of service isneeded.The person in was at the hearing on the request for original orders. The person in was not present.1 2

1 225

Proof of service of Form FL-300 to modify the orders in Form DV-130 was presented to the court. c.The people in and were at the hearing or agreed in writing to this order. No other proof of1 2(1)

(2) was not at the hearing and must be personally “served” (given) a copy1 2The person in of this amended order.

service is needed.

DV-900

Arrest Required if Order Is ViolatedIf an officer has probable cause to believe that the restrained person had notice of the order and has disobeyed the order,the officer must arrest the restrained person. (Pen. Code, §§ 836(c)(1), 13701(b).) A violation of the order may be aviolation of Penal Code section 166 or 273.6.

Case Number:



DV-130, Page 6 of 7



Instructions for Law Enforcement

Start Date and End Date of OrdersThe orders start on the earlier of the following dates:••

The hearing date in item (a) on page 2, orThe date next to the judge’s signature on this page.

The orders end on the expiration date in item on page 1. If no date is listed, they end three years from the hearing date.4

5

You cannot have guns, firearms, and/or ammunition.You cannot own, have, possess, buy or try to buy, receive or try to receive, or otherwise getguns, other firearms, and/or ammunition while the order is in effect. If you do, you can go tojail and pay a $1,000 fine. Unless the court grants an exemption, 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. The judge will ask you for proof that you did so. If you do not obey this order, you can be charged with a crime. Federal law says you cannot have guns or ammunition while the order is in effect. Even if exempt under California law, you may be subject to federal prosecution for possessing or controlling a firearm.

Warnings and Notices to the Restrained Person in 2

It is a felony to take or hide a child in violation of this order.

If you do not obey this order, you can be arrested and charged with a crime.

•• If you travel to another state or to tribal lands or make the protected person do so, with the intention of disobeying this

order, you can be charged with a federal crime.

If you do not obey this order, you can go to jail or prison and/or pay a fine.•

Notice/Proof of ServiceLaw enforcement must first determine if the restrained person had notice of the orders. If notice cannot be verified, therestrained person must be advised of the terms of the orders. If the restrained person then fails to obey the orders, theofficer must enforce them. (Fam. Code, § 6383.)Consider the restrained person “served” (notified) if:

The officer sees a copy of the Proof of Service or confirms that the Proof of Service is on file; orThe restrained person was at the restraining order hearing or was informed of the order by an officer. (Fam. Code, § 6383; Pen. Code, § 836(c)(2).) An officer can obtain information about the contents of the order in the DomesticViolence Restraining Order System (DVROS). (Fam. Code, § 6381(b)-(c).)

••

If the Protected Person Contacts the Restrained PersonEven if the protected person invites or consents to contact with the restrained person, the orders remain in effect and mustbe enforced. The protected person cannot be arrested for inviting or consenting to contact with the restrained person. Theorders can be changed only by another court order. (Pen. Code, § 13710(b).)

—Clerk's Certificate—I certify that this Restraining Order After Hearing (Order of Protection) is a true andcorrect copy of the original on file in the court.


Conflicting Orders—Priorities for Enforcement

Clerk’s Certificate

[seal]

Case Number:



DV-130, Page 7 of 7

Date: Clerk, by , Deputy

If more than one restraining order has been issued protecting the protected person from the restrained person, the orders must be enforced in the following priority (see Pen. Code, § 136.2 and Fam. Code, §§ 6383(h)(2), 6405(b)):1.

2.

3.

4.

EPO: If one of the orders is an Emergency Protective Order (Form EPO-001) and it is more restrictive than other restraining or protective orders, it has precedence in enforcement over all other orders.No-Contact Order: If there is no EPO, a no-contact order that is included in a restraining or protective order has precedence in enforcement over any other restraining or protective order.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.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.



Child Custody and VisitationThe custody and visitation orders are on Form DV-140, items and . They are sometimes also written onadditional pages or referenced in DV-140 or other orders that are not part of the restraining order.

Enforcing the Restraining Order in CaliforniaAny law enforcement officer in California who receives, sees, or verifies the orders on a paper copy, in the California Law Enforcement Telecommunications System (CLETS), or in an NCIC Protection Order File must enforce the orders.

3 4

FL-343

SPOUSAL, PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT

TO Findings and Order After Hearing (form FL-340) Judgment (form FL-180)

above (for temporary support only).

1. Net income. The parties’ monthly income and deductions are as follows (complete a, b, or both ):

Total Total Total Net monthlygross monthly monthly hardship disposable

income incomedeductions deductions

receiving TANF/CaIWORKS a. Petitioner:b. Respondent:

3. Judgment for spousal or partner support

months.The parties were married for (specify numbers): yearsb.

See Attachment 3d.

THE COURT ORDERS

petitioner petitioner 6. respondent must pay to the respondentspousal support family supportas

$ per month, beginning (date): , payable through (specify end date):

day of each month.payable on the (specify):

Support must be paid by check, money order, or cash. The support payor’s obligation to pay support will terminate on the death of either party, remarriage, or registration of a new domestic partnership of the support payee.

An earnings assignment for the foregoing support will issue. (Note: The payor of spousal, family, or partner support is responsible for the payment of support directly to the recipient until support payments are deducted from the payor’s earnings, and for any support not paid by the assignment.)

Service of the earnings assignment is stayed provided the payor is not more than (specify number): days late in the payment of spousal, family, or partner support.

d.

Page 1 of 2

Form Approved for Optional Use Judicial Council of California FL-343 [Rev. July 1, 2012]

Family Code, §§ 150, 299, 3651,SPOUSAL, PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT

(Family Law) 3653, 3654, 4320, 4330, 4337

www.courts.ca.gov

The marital standard of living was (describe):

receiving TANF/CaIWORKS

Other (specify):

The parties were registered as domestic partners or the equivalent for (specify numbers): c.

partner support

c.

b.

The



OTHER PARENT:

CASE NUMBER:

temporary

THE COURT FINDS

2. A printout of a computer calculation of the parties’ financial circumstances is attached for all required items not filled out

Modifies a judgment or order entered on (date):

The parties are both self-supporting, as shown on the Declaration for Default or Uncontested Dissolution or Legal d.

Separation (form FL-170). e.

The issue of spousal or partner support for the petitioner respondent is reserved for a later determination. 4.

The court terminates jurisdiction over the issue of spousal or partner support for the petitioner respondent. 5.

Restraining Order After Hearing (CLETS-OAH) (form DV-130) Other (specify):

a.

a.

$

$

$

$

$

$

$

$

THIS IS A COURT ORDER.

Stipulation of Parties

months.years

PETITIONER/PLAINTIFF: CASE NUMBER:


OTHER PARENT:

The parties must promptly inform each other of any change of employment, including the employer’s name, address, and telephone number.

8.

This order is for family support. Both parties must complete and file with the court a Child Support Case Registry Form (form FL-191) within 10 days of the date of this order. The parents must notify the court of any change of information submitted within 10 days of the change by filing an updated form. A Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on Changing a Child Support Order (form FL-192) is attached.

9.

NOTICE: Any party required to pay support must pay interest on overdue amounts at the “legal” rate, which is currently 10 percent.

THIS IS A COURT ORDER.

Page 2 of 2SPOUSAL, PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT (Family Law)

FL-343 [Rev. July 1, 2012]

Other orders (specify):11.

Notice: If this form is attached to Restraining Order After Hearing (CLETS-OAH) (Order of Protection) (form DV-130), the orders issued on this form (FL-343) do not expire upon termination of the restraining orders issued on form DV-130.

10.

The petitioner7. respondent should make reasonable efforts to assist in providing for his or her support needs.

Wireless service provider (name):




Fills in case number:

Case Number:

1

2


All rights and responsibilities for the accounts listed in , including all financial responsibility for the telephone numbers, monthly service costs, and costs for any mobile device associated with the telephone numbers, must be immediately transferred to the new account holder (person in ).

TO THE WIRELESS SERVICE PROVIDER: This order is made under California Family Code section 6347.

Order Transferring Wireless Phone AccountDV-900

The person in will be financially responsible for the accounts listed in starting:

4

Order Transferring Wireless Phone Account (Domestic Violence Prevention)

DV-900, Page 1 of 2Judicial Council of California, www.courts.ca.govNew July 1, 2016, Mandatory FormFamily Code, § 6347

THE ORDER APPLIES TO:

TRANSFER OF RIGHTS AND RESPONSIBILITIES

Date:

Judicial Officer

Transfer of the following wireless phone number(s):Telephone number (include area code):

Telephone number (include area code):Telephone number (include area code):Telephone number (include area code):Telephone number (include area code):

Check box to include attachment with additional telephone number(s).

5

the date the account is transferred by the wireless service provider(specify date)

6 The person in must send this order and a completed copy of form DV-901 to the wireless service provider listed in . For information on where to send this form and Form DV-901, go to the following website:http://www.sos.ca.gov/registries/safe-home/domestic-violence-wireless-plans. Form DV-901 is a confidential form and must NOT be filed with the court.

1

ATTENTION WIRELESS SERVICE PROVIDERThe new account holder’s (person in ) contact information, including information on form DV-901, must NOT be disclosed to the current account holder (person in ).

3

Current account holder (name):

New account holder (name):

Billing telephone number:

4

3

3 4

3

32

This order is made under California’s Domestic Violence Prevention Act.



http://www.sos.ca.gov/registries/safe-home/domestic-violence-wireless-plans

When the current account holder has already terminated the account

When differences in network technology prevent the functionality of a device on the network

When there are geographic or other limitations on network or service availability

If the provider determines that transfer CANNOT occur, then the provider MUST notify the person in within 72 hours of receipt of this order (California Family Code section 6347).


DV-900, Page 2 of 2 New July 1, 2016

Case Number:

•

•

•

3

Order Transferring Wireless Phone Account (Domestic Violence Prevention)

INSTRUCTIONS FOR WIRELESS SERVICE PROVIDERThe orders contained on page 1 of this form must be followed unless the wireless service provider cannot operationally or technically effectuate the order due to certain circumstances, including, but not limited to, any of the following:

—Clerk's Certificate—

I certify that this order is a true and correct copy of the original on file in the court.

Clerk’s Certificate [seal]

Clerk, by , Deputy


Date:

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:



CASE NUMBER:INCOME AND EXPENSE DECLARATION

Date:

(SIGNATURE OF DECLARANT)

Page 1 of 4

INCOME AND EXPENSE DECLARATIONForm Adopted for Mandatory UseJudicial Council of California

FL-150 [Rev. January 1, 2007]

FL-150

Family Code, §§ 2030–2032, 2100–2113, 3552, 3620–3634,

4050–4076, 4300–4339www.courtinfo.ca.gov

Employment 1.

Employer:

Employer's address:

Occupation:

Employer's phone number:

Number of years of college completed (specify):

I have completed high school or the equivalent:

Date job started:

If unemployed, date job ended:

I get paid $ gross (before taxes)

I work about hours per week.

(If you have more than one job, attach an 8½-by-11-inch sheet of paper and list the same information as above for your other jobs. Write "Question 1—Other Jobs" at the top.)

Number of years of graduate school completed (specify):

Degree(s) obtained (specify):

3. Tax information

I last filed taxes for tax year (specify year):

single head of household married, filing separatelymarried, filing jointly with (specify name):

I file state tax returns in

I claim the following number of exemptions (including myself) on my taxes (specify):

This estimate is based on (explain):

I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and any attachments is true and correct.

OTHER PARENT/CLAIMANT:

per month per week

California

4. Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $

(Give information on your current job or, if you're unemployed, your most recent job.)

Age and education2.

I have:

a.

c.

d.

My tax filing status is

other (specify state):

(If you need more space to answer any questions on this form, attach an 8½-by-11-inch sheet of paper and write the question number before your answer.)

b.

Yes Nob.c.

d.

e.

Degree(s) obtained (specify):

My age is (specify): a.

professional/occupational license(s) (specify):

vocational training (specify):

If no, highest grade completed (specify):

a.

b.

c.

d.

e.

f.

g.

h.

Attach copies of your pay stubs for last two months (black out social security numbers).

per hour.

Number of pages attached:

(TYPE OR PRINT NAME)

TELEPHONE NO.:

ATTORNEY FOR (Name):

E-MAIL ADDRESS (Optional):

Disability: Social security (not SSI) State disability (SDI) Private insurance .

All other property,

CASE NUMBER:PETITIONER/PLAINTIFF:



Income (For average monthly, add up all the income you received in each category in the last 12 months and divide the total by 12.)

Page 2 of 4INCOME AND EXPENSE DECLARATIONFL-150 [Rev. January 1, 2007]

Salary or wages (gross, before taxes). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal tax return to the court hearing. (Black out your social security number on the pay stub and tax return.)

5.

a.

c.

Last month

$

$Commissions or bonuses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

My financial situation has changed significantly over the last 12 months because (specify):9.

Assets11.

a.

b.

Total$

$

$

Cash and checking accounts, savings, credit union, money market, and other deposit accounts . . . . . . . . . . . . . . . .

c.

Stocks, bonds, and other assets I could easily sell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Average monthly

Change in income.

Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.)

I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and

6.

7.

Rental property income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dividends/interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$$

8.

$

Trust income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Additional income.

Pension/retirement fund payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Social security retirement (not SSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unemployment compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Workers' compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other (military BAQ, royalty payments, etc.) (specify): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g.

h.

i.

j.

k.

l.

d.

e.

$

$

Public assistance (for example: TANF, SSI, GA/GR) currently receiving . . . . . . . . . . . . . . . . .

Spousal support from this marriage from a different marriage . . . . . . . . . . . . . . . . . .

$

$

$

$

$

$

$b. Overtime (gross, before taxes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a.

c.

d.

b.

I am the owner/sole proprietor business partner other (specify):Number of years in this business (specify):

Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your social security number. If you have more than one business, provide the information above for each of your businesses.

Name of business (specify):

Type of business (specify):

Income from self-employment, after business expenses for all businesses. . . . . . . . . . . . . . . . . . . . . $

Deductions10.

a.

Last month

$

$

$$

$

Required union dues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. Required retirement payments (not social security, FICA, 401(k), or IRA). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical, hospital, dental, and other health insurance premiums (total monthly amount). . . . . . . . . . . . . . . . . . . . . . . .

d. Child support that I pay for children from other relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e. Spousal support that I pay by court order from a different marriage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g. $Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g") . . . . .

Partner support from this domestic partnership from a different domestic partnershipf. $

$f. Partner support that I pay by court order from a different domestic partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

amount):

c.

real and personal (estimate fair market value minus the debts you owe) . . . .

FL-150

CASE NUMBER:

Name AgeHow the person is related to me? (ex: son)

That person's gross monthly income

Pays some of the household expenses?

The following people live with me:

Average monthly expenses

Groceries and household supplies. . . . . . .

Rent or mortgage. . . $(1)

Eating out. . . . . . . . . . . . . . . . . . . . . . . . . .

If mortgage:

average principal:

Utilities (gas, electric, water, trash) . . . . . .

$

Telephone, cell phone, and e-mail . . . . . . .

average interest:

$

$

Laundry and cleaning . . . . . . . . . . . . . . . . . $

Clothes . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

Education . . . . . . . . . . . . . . . . . . . . . . . . . .

Real property taxes . . . . . . . . . . . . . . $

Entertainment, gifts, and vacation. . . . . . . . $

Homeowner's or renter's insurance(if not included above) . . . . . . . . . . . .

Auto expenses and transportation

$

$

Monthly payments listed in item 14(itemize below in 14 and insert total here). .

Maintenance and repair . . . . . . . . . . .

$

$Savings and investments. . . . . . . . . . . . . . . $

$

Other (specify): . . . . . . . . . . . . . . . . . . . . . . $

Child care . . . . . . . .. . . . . . . . . . . . . . . . . . $

TOTAL EXPENSES (a–q) (do not add in $the amounts in a(1)(a) and (b))


$

$

$

$

Yes No

Yes No

Yes No

Yes No

a.

b.

c.

d.

Estimated expenses Actual expenses Proposed needs

Installment payments and debts not listed above

(insurance, gas, repairs, bus, etc.) . . . . . . .

Charitable contributions. . . . . . . . . . . . . . . . $

Date of last paymentAmountForPaid to

$

$

$

$

Home:

Balance

The source of this money was (specify):I still owe the following fees and costs to my attorney (specify total owed): $

I confirm this fee arrangement.

(SIGNATURE OF ATTORNEY)(TYPE OR PRINT NAME OF ATTORNEY)

Attorney fees (This is required if either party is requesting attorney fees.):

To date, I have paid my attorney this amount for fees and costs (specify): $

Insurance (life, accident, etc.; do notinclude auto, home, or health insurance). . . $

My attorney's hourly rate is (specify): $

12.

13.

14.

15.

a.

b.

c.

(2)

(3)

(4)

d.

e.

f.

g.

h.

i.

j.

k.

l.

m.

n.

o.

p.

q.

r.

e. Yes No

$

$

$

$

Amount of expenses paid by others $ s.

a.

b.c.d.

Date:

Health-care costs not paid by insurance. . .

(a)

(b)




FL-150

$ $

$ $

CASE NUMBER:PETITIONER/PLAINTIFF:



CHILD SUPPORT INFORMATION

I do not have health insurance available to me for the children through my job.Children's health-care expenses

I doa.

The monthly cost for the children's health insurance is or would be (specify): $

Additional expenses for the children in this case

Children's health care not covered by insurance . . . . . . . . . . . . . . . . . . . .

Travel expenses for visitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Children's educational or other special needs (specify below): . . . . . . . .


Child care so I can work or get job training. . . . . . . . . . . . . . . . . . . . . . . . .

Name of insurance company:

Address of insurance company:

I have (specify number): children under the age of 18 with the other parent in this case.

The children spend percent of their time with me and percent of their time with the other parent.

(Do not include the amount your employer pays.)

Amount per month

$

Special hardships. I ask the court to consider the following special financial circumstances

Major losses not covered by insurance (examples: fire, theft, other insured loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Expenses for my minor children who are from other relationships and are living with me . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Extraordinary health expenses not included in 18b. . . . . . . . . . . . . . . . . .

(attach documentation of any item listed here, including court orders):

$

$

$

$

$

$

Amount per month For how many months?

(NOTE: Fill out this page only if your case involves child support.)

(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)

b.

a.

c.

d.

16.

17.

18.

19.

a.

b.

b.

c.

d.

a.

b.

c.

Names and ages of those children (specify):

The expenses listed in a, b, and c create an extreme financial hardship because (explain):

Other information I want the court to know concerning support in my case (specify):20.

Number of children

Child support I receive for those children. . . . . . . . . . . . . . . . . . . . . . . $

(1)

(3)

(2)

FL-150

Superior Court of California County of Sacramento

William R. Ridgeway Family Relations Courthouse 3341 Power Inn Road

Sacramento, CA 95826 Domestic Violence Resources In Sacramento County

1/30/2018

Emergency Police / Medical 911 Crisis Hotlines/Shelters A Community for Peace (Citrus Heights) 916-728-7210 My Sister’s House (Asian/Pan Pacific Services) 916-428-3271 PEACE for Families (Roseville) 800-575-5352 WEAVE 916-920-2952 – main crisis line St. John’s Program for Real Change 916-453-1482 24/7 Sexual Assault hotline 800-656-HOPE 24/7 Domestic Violence hotline 800-799-SAFE Reporting Abuse Adult Protective Services (Elderly / Adult Victims) 916-847-9377 Children’s Protective Services (CPS) 916-875-5437

Children’s Emergency Services Parent Support Hotline 916-394-2005 Volunteers with training in child development, discipline techniques, health, cultural issues, community resources, and emergency services are available to help and listen without passing judgment. Children’s Crisis Nursery 916-394-2000 Emergency Childcare and shelter services. Victim Assistance Victim/Witness Center 916-874-5701 Trained and experienced victim advocates provide crisis counseling, direct assistance, and information about the criminal justice system and community referrals.

Victim Notification of Abuser’s Release from Jail. 800-491-3064 Victims can register to be notified upon their abuser’s release from jail. Safe at Home 877-322-5227 A Confidential mailing address program for victims of domestic violence offered by the California Secretary of State.

Superior Court of California County of Sacramento

William R. Ridgeway Family Relations Courthouse 3341 Power Inn Road

Sacramento, CA 95826 Domestic Violence Resources In Sacramento County

1/30/2018

Help Getting a Temporary Restraining Order Temporary Restraining Order Workshop Family Relations Courthouse Self Help Computer Room, Room 113A Mondays, Wednesdays and Fridays at 8:45 am (Spanish interpreter available) This workshop will help victims (both female and male) who do not have an attorney to complete the forms to apply for a Domestic Violence Restraining Order. Other Legal Services 1-800-VICTIMS Legal assistance in family law matters for victims of domestic violence The Family Law Facilitators Office Self Help Center 3341 Power Inn Road, Room 113 (Monday through Thursday, 8:30 a.m. to 4:00 p.m.) The Family Law Facilitators Office provides assistance with child custody, visitation, establishing paternity, child and spousal support, completion of court forms, orders and judgments, preparation of support calculations, instructions on follow up steps, referrals to other resources. Sacramento Regional Family Justice Center 3701 Power Inn Road, 3rd floor (Monday through Friday, 9:00 a.m. to 5:00 p.m.) The Sacramento Regional Family Justice Center provides resources to victims of domestic violence and elder abuse, including safety plans, legal assistance for the preparation of restraining orders, and court accompaniment. Attorneys are available to answer questions after pickup of temporary restraining orders.

Batterer’s Treatment Programs Batter’s Treatment Programs are for the abuser, male or female, and are focused on stopping the cycle of violence through anger management and personal techniques to reduce conflict and common triggers of abuse. Batterer’s Treatment Programs are certified by the Sacramento County Department of Probation. Victim Counseling A Community For Peace 6060 Sunrise Vista Drive, Suite 2340, Citrus Heights, 916-728-5613 My Sister’s House 3053 Freeport Blvd. #120, Sacramento, 916-428-3271 PEACE for Families, Roseville Service Office 124 Main Street, Roseville, 916-773-7273, Ext 104 Sacramento Counseling Associates 7844 Madison Avenue, Suite 105, Sacramento, 916-962-7101 Southeast Asian Assistance Center 5625 24th Street, Sacramento, 916-421-1036 Services are available to Vietnamese, Lao, Mien, Hmong, Chinese, Cambodian, Russian, Ukrainian, Bosnian, Croatian, Herzegovinian, and Serbian WEAVE Counseling Center 1900 K Street, Sacramento, 916-920-2952