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HomeMy WebLinkAboutMINUTES - 01132009 - C.09 (8) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: JANUARY 13, 2009 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to California Government Codes. RI (�gII�� � you is your notice of the action taken on your claim by the Board of DEC 1 0 2008 Supervisors. (Paragraph IV below), given Pursuant to Government Code COUNTY COUNSEL Section 913 and 915.4. Please note all AMOUNT: $2,500.00 MARTINEZ CALIF. "Warnings". CLAIMANT: JENNER DULANGE MATBESON ATTORNEY: UNKNOWN DATE RECEIVED:. DEMMER 10, 2008 ADDRESS: 2441 ENCINAL DRIVE, BY DELIVERY TO CLERK ON; DECKER 10, 2008 WALNUT CREEK, .CA 94597 BY MAIL POSTMARKED: HAND DELIVERED FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DECEMBER 10, 2008 DAVID TWA, C k Dated: By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Silpervisbrs ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 9.10 and 910.2, and we are so notifying claimant. The Board,cannot act for 15 days (Section 910.8). O Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). Other: S­)25r I©e-- .CI(i��f(�—� D'CCat (-Eoe—/) IC` &5 CL, 1 _n5 e_Dlz rA-C ,D u b l iL a!Lx T l TT c9 M`fie_ CD On+-WV (or)�I yz:�_ Dated: 5-09 By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) O Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: .. ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dat A� AVID TWA, CLERK, By eputy Clerk WANING(05v. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to We a court action on this claim.See Government Code Section 945.6.You may seek the advice of an attorney of your choice in.connection with this matter.If you want to consult an attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated. �a^07AVID TWA, CLERK, By Deputy Clerk e This warningwdoes,not apply to claims which are not subject to the California Tort-Claims Act such as actions lin;mverse'condemnation, actions for specifics relief such a's."mandamus or injunction, or Federal.Civil Rights claims. The ,a t1;t ig� , . V„ic.` above list is not exhaustive4ndjlegal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra. Costa does not waive any of its rights under California Tort Claims Act -to.ti Y,nox;does it waive rights under the statutes of limitations'applicable to actions not subject to the California Tort Claims Act i i wyF+ ' ... 'i�,�1,.a .i • � 'R. .``.."vti'A �%y •y�.s uifi.h?2i.a .;� w �-- ^4 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. A claim relating to a cause of action for death or for injury to person or to personal property or growing crops shall be presented not later than six months after the accrual of the cause of action. A claim relating to any other cause of action shall be presented not later than one year after the accrual of the cause of action. (Gov. Code § 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ■rr■rrrrrerre■•••r■■rr■•rrrre werre•reerrr•■rrrer rr rrr■rrersr ee■rrer ■■we ■■•vast RE: Claim By: Reserved for Clerk's filing stamp �EN13���tANG� MA'SC\E�Oa1 ) �Its D Against the County of Contra Costa or ) D61 120 Og CLERK District) CpN t? O,FsUp (Fill in the name) ) RaCosU V/ 7S The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$2����`2° and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 1 1l t$/og 1 Whe e did the damage or injury occur? (Include city and county) ��tT3�l�ZJ Q 3. ,Hqw did the damage or injury occur? (Give full details; use extra paper if required) Nc�� T�jr_L�rJ of 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage?T'�P-LCXEW- TV\A9- Oj� s-cZvTr� Ov- 5 What are the names of county or district officers, servants, or employees causing the damage or injury? SSE 'D, (�uelcEt2 `����� �LEZj ICS — 6. What damage or injuries do your claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) '� - '�j NRS i=?cTPA t JOR1; 7. How was the amount claimed above computed? (Include the estimated amoujntt of m y prospective injury or damage.) ru $ 6 V c�3 //14 1K 1 N IS Nva CWR'K 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this accident or injury: TIME AMOUNT I2�9 �C�$ Io- QPM ��26 SEEN@ ..miss 0 RaMMURNMENEW Room IQ�ssSSSNow 33........ amnoam......., Gov. Code Sec. 910.2 provides "The claim shall be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney) 1 Name and address of Attorney ) (Claimant's Signature) (Address) 7 Telephone No. ) Telephone No. 2 S ) -l7 D — 9 0 S PUBLIC RECORDS NOTICE: Please be advised that this claim form, or any claim filed with the County under the Tort Claims Act, is subject to public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) Furthermore, any attachments, addendums, or supplements attached to the claim form, including medical records, are also subject to public disclosure. .......rs..............................•r............■.,..,......r.was a 6 W a&a man.r...l NOTICE: Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city, or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000.00), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000), or by both such imprisonment and fine. 100 , ] RI-1 ® , t `temporary Restraining Clerk stanysdakel tfla4-tvheDohiUffled. Order and Notice of hearing Zppg NOV 19 i A S. 0 OName of personasmg for protection,( rotected person): , SEAN NC-"2 c3 LA tJG�G (VB,,-c"e�>K) t Protected person's address (slap this ifyou have a lawyer): (Ifyou want t K Tt +r f i + '. -q, your address to be private, gi mailing address instead): City: A State:CA Zip: u5'3 Telephone number: 975 I-i — ©S Protected person's lawyer(if any): (Name, address, telephone number, Fill in court name and street address: and State Bar number): Superior Court of California,County of SUPERIOR COURT-MARTINEZ FAMILY LAUD BUILDING 751 PINE ST.PA.BOX 911 MkPNEZ,CA 94553 ORes-trained person's name: n t�La2:XR M.Nw I \171�-OSot,� Fill in case number: /� r r Case ter: c 0 C 2 4 `� Descript,on oft t person: Si M ❑ F HE: t: �� v a➢ �i Weight:and 1-1 acC&J- IMHair Color: Eye Color: Age:� Date of Birth: 2S S List the full names of all family or household members protected by this order: �e� _•A1 No#' O Court Hearing Date (Fecha de la Audiencia) Clerk will fill out section below. Name and address of court if different fr m bove: Hearing "� Date 1 ( Time: , i Superior Court-Walnut C lreei 640 Ygnaeio Valley Rd. I Date I Dept.: Rm.: Walnut Creek,CA 94596 To the person in ®: At the hearing,the judge can make restraining orders that last for up to 5 years.The judge can also make other orders about your children,child support,spousal support, money, and property. File an answer on Form DV-120 before the hearing.At the hearing, you can tell the judge that you do not want the orders against You. Even if you do not attend the hearing, you must obey the orders. Para la persona nolnbrada en (2): En esta audiencia el juez puede hater que la orden de restriccidn sea vdlida hasta un rndximo de 5 arios. El juez puede tambien hater otras ordenes acerca de ninos, manutencion, dinero y propiedad. Presente una respuesta en el formulario DV-120.antes de la audiencia. Si Usted se opone a estas ordenes, vaya a la audiencia y digaselo al juez.Aunque no vaya a la audiencia, bene que obedecer estas ordenes. To the person in1�: At the hearing, the judge will consider whether denial of any orders will jeopardize your safety and the safety of children for whom you are requesting custody,visitation, and child support. Safety concerns related to the financial needs of you and your children will also be considered. OTemporary Orders (ordenes Temporales) Any orders made in this form end at the time of the court hearing in ®, unless ajudge extends them. Read this form carefully. All checked boxes 2 and items 10 and 11 are court orders. Todas las ordenes hechas en esta formulario terrninarcin en la fecha y hora de la audiencia en ®, al rnenos que un juez las extienda. Lea este formulario con cuidado. Todas las cosillas marcadas Z y los articulos 10 y 11 son ordenes de la corle. Judicial Council of Caldoinia,ivmv.courmlo.ca.gov Temporary Restraining Order DVA 10,Page 1 of Revised July 1.2007.Mandatory Fonn �� �g /� Family Code,§6200 e1 seq.Approved by DOJ and Notice of Hearing (CLEFTS--TRO) (Domestic Violence Prevention) Case Number: Your name: tA pDC IV BATF 1 o tJ `� 544 O6 51 Persona induct Orders Nb in 2 must not do the followin things to t protected people listed i 1�and s, att\hea ke,threaten, assa t(sexually or herwise), hit,follow, alk,molest, estroy perso al p rty,de peace,keep un er surveillance, block movements act(eiectly or indirect) ,or telephone,or nd messages or it or e-mail xcept and peaceful c coact as required for ourt-ordered A cation of childr unless a riminti order says therwise any airect or throu others,to get the addre ses or locati ns of any protecte persons r eir fambers, retak s, or guardians. (If item c i not chec d, the court has fo d goodse not this order. ritten contact through a lawyer or through a process server or an her person in order to erve I gal allowed and does not violate this order.inal protective order on Form CR-160 is in effect. Case Number: County (if known): Expiration Date: (If more orders, list them in item 96) O `ffl Npeo r, t� (� ust st at leas yards aw from: isted ' d. ❑ The ch' dren's s ool or child ca iste ine. ❑ Other (s cify) ❑ Vehicle of p son i 1 O8 ❑ Move-Out Order The person in®must take only personal clothing and belongings needed until the hearing and move out immediately from (address): 09 ❑ Child Custody and Visitation Order a. ❑ You and the other parent must make an appointment for court mediation (address and phone,nVmber): b. ❑ Follow the orders listed in Form DV-140, which is attached. 10 No Guns or Other Pirearmp or Ammunition The person in ( cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, firearms, or ammunition. 11 `turn in or sell guns or firearms. The person in®: Must sell to a licensed gun dealer or turn in to police any guns or firearms that he or she has or controls. This must be done within 24 hours of being served with this order. Must bring a receipt to the court within 48 hours of being served with this order,to prove that guns and firearms have been turned in or sold. 12 ❑ Property Control Until the hearing, only the person in can use,control, and possess the following property and things: Revised Jury 1.2007 Temporary Restraining Order DVAiD, Page 2 of 5 and Notice of Hearing (CLETS—'TRO) (Domestic Violence Prevention) �- Case Number: Your name: / WT41�Scgt�� 13 ❑ Property Restraint If the people in(�)and®are married to each other or are registered domestic partners,they must not transfer, borrow against,sell,hide, or get rid of or destroy any property,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 O if the court has made a "no contact"order) 14 Unlawful communications may be recorded. The person in 0 can record communications made by the person in ®that violate the judge's orders. 15 No Fee to Notify (Serve) Restrained Person If the sheriff serves this order, he or she will do it for free. 16 ❑ Other Orders (specify): 17 If the judge makes a restraining order at the hearing,which has the same orders as in this form,the person in 0 will get a copy of that orde�m�aiI at or he t known addr me�`irainned p 's address here). Zags �t3P4�1 �,1Fr A,0 l LVs I f this address is not correct, or to know if the orders were made permanent, contact the court. 18 ❑ Time for Service a s To: Pei-son Served With Order Someone 18 or over—not you or the other If you want to respond in writing, someone 18 or protected people—must personally"serve" a copy over—not you—must"serve" Form DV-1.20 on the ,,,of this order to the restrained person at least . person in(1),then file it with the court ai least /� �days before the hearing. �days before the hearing. For help with Service or answering, read Form DV-210-INFO or DV-540-INFO. Date: —LC - ` f Judge J ial cer) 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 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. Revised tiny 1.2007 Temporary Restraining Order DV-110, Page 3 of 5 and Notice of Hearing (GLETS—TRO) (Domestic Violence Prevention) Case Number: Your name: ® � " • • • • • • Z 19 If you do not obey this order, you can be arrested and charged with a crime. It is a felony to take or hide a child in violation of this order. You can go to prison and/or pay a fine. 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 prison and/or pay a fine. 20 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 get guns,firearms,andlor 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 a gun dealer or turn in to police any guns or 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 if you are subject to a restraining order made after a noticed hearing. 21 After You Have Been Served With a Restraining Order • Obey all the orders. • If you want to respond, fill out Form DV-120. Take it to the court clerk with the forms listed in item z2. • File DV-120 and have all papers served on the protected person by the date listed in item to of this form. • At the hearing,tell the judge if you agree or disagree with the orders requested. • Even if you do not attend the hearing, thejudge can make the restraining orders last for 5 years. 22 Child Custody, Visitation, and Support Child Custody and Visitation: If.you do not go to the hearing, the judge can snake custody and visitation orders for your children without hearing your side. Child Support: Thejudge can order child support based on the income of both parents. The judge can also have that support taken directly from your paycheck. Child support can be a lot of money, and usually you have to pay until the child is I S. File and serve a Financial;Statement(Form FL-155) or 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 your side. Spousal Support: File and serve a Financial'Statement(Form FL-155) or 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 your side. 23 Requests for Accommodations 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.courtinfo.ca.gov/forms for Request for Accommodations by Persons With Disabilities and Order(Form MC-410). (Civil Code, § 54.8.) Revised Jafy 1,2007 Temporary Restraining Order DV-110, page 4 of 5 and Notice of Hearing (CLETS—TRO) "° (Domestic Violence Prevention) Case r: Your name: instructions for Law Enforcement 24 Start Date and End Date of Orders The start date is the date next to the judge's signature on page 3. The orders end on the hearing date on page 1 or the hearing date on Form DV-125, if attached. 25 Arrest Required If Order Is Violated If 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.(Penal Code, §§ 836(c)(1), 13701(b).)A violation of the order may be a violation of Penal Code section 166 or 273.6. 26 Notice/Proof of Service Law enforcement must first determine if the restrained person had notice of the orders. if notice cannot be verified,the restrained person must be advised of the terms of the orders. If the restrained,person then fails to obey the orders,the officer must enforce them. (Family Code, § 6383.) Consider the restrained person"served"(noticed)if: • The officer sees a copy of the Proof of Service or confirms that the Proof of Service is on file; or • The 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'Domestic Violence Restraining Orders System (DVROS). (Fam. Code, § 6381(b)(c).) 27 if the Protected Person Contacts the Restrained Person Even if the protected person invites or consents to contact with the restrained person,the orders remain in effect and must be enforced. The protected person cannot be arrested for inviting or consenting to contact with the restrained person. The orders can be changed only by another court order. (Pen. Code, § 13710(b).) 28 Child Custody and Visitation • Custody and visitation orders are on Form DV-140, items 43 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. 29 Enforcing the Restraining Order in California Any'law enforcement officer in California who receives, sees, or verifies the orders on a paper copy,or on the California Law Enforcement Telecommunications System (CL'ETS),or,in an NCIC Protection Order File must enforce the orders. 30 Conflicting Orders A protective order issued in a criminal case on Form CR-160 takes precedence in enforcement over any conflicting civil court order. (Pen. Code, § 136.2(e)(2).) Any nonconflicting terms of the civil restraining order remain in full force. An emergency protective order(Form EPO-001)that is in effect between the same parties and is more restrictive than other restraining orders takes precedence over all other restraining orders. ��oQcCl:Rr \%I1 - 1 tIllcate# I certify that this Temporary Restraining Or r iLrt, correct copy of00 4- W the i [seal 'oP original on file in the court. �e v% NOV 19 Z008 Date: Clerk,b i Deputy Y Y Revised July� 'to�`_� Temporary Restraining Order DV-910, Page 5 of 5 and Notice of Hearing (CLETS—TRO) (Domestic Violence Prevention) Jif Clerk sta n s d$t2; barn /fled. t t Request for Order OYour name{person king for protect�1�rr�� 2000 NOV 19 A 8iQ 1 T��lt� c�nl 1y , t�ES00 Your address (skip this ifyou have a lawyer): (If you want your address to be rivate, give a mailing address instead): ZJc Y I t~t'`i r � 1z sy ( ab. — City: WA UT_—__611[ State: Zip: Your telephone number(optional): `��S1 �i1M Your lawyer(if you have one): (Name, address, telephone number, Fill in court name and street address: and State Bar number): Superior Court of California,County of SUPERIOR COURT-MARTINEZ FAMILY LAW BUILDING 751 PINE ST.P.O.BOX 911 MARTKEZ, CA 94553 ON e of person you want protection` n1 from: \ �S.h-C'� Clerk fills in case number when form is filed. Description of the�a�rson• Sex: $T M ❑ F Height- ���l ` Case N rft� Q 0 5 2A 4 Weight:tlLiQ'Racea�k)HairColor: j 1Y CY Eye Color:,_�Az � Age:_S�5 Date of Birth: 2 — UBesides you,who needs protection? (Family or household members): FLIU.Name Age Lives with you? How are they related to you? ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑Check here if you need more space. Attach Form MC-020 and write "DV-100, Item 3—Protected People"by your statement. NOTE:In any item that asks for Form MC-020,you can use an 81/2 X 114nch sheet ofpaper instead. OWhat is your relationship to the person in®? (Check all that apply): a. ❑ We are now married or registered domestic partners. b. ❑ We used to be married or registered domestic partners. c. ❑ We live together, d. ❑ We used to live together. e- 9 We are relatives, in-laws, or related by adoption(specify relationship): ` f. ❑ We are dating or used to date. g ❑ We are engaged to be married or were engaged to be married. h. ❑ We are the parents together of a child or children under 18: Child's Name: Date of Birth: Child's Name: Date of Birth: Child's Name: Date of Birth: ❑ Check here if you need more space.Attach Farm MC-020 and write "DV-100, Item 4h" by your statement. L ❑ We have signed a Voluntary Declaration of Paternity for our child or children. (Attach a copy if you have one.) o • ® o ' Judicial Council ofCalifomia,wmv.coumn,o.ca.gov Request for Order Ott-100,Page 1 of A Revised July 1.2007,Mandatory Form (Domestic Violence Prevention) Family ly Cotle,§6200 et seq. Case N e 8 052441 Your name: 'J t IQ 0i�mtj t 3f✓ \V �A�1 "�c�le, OOther Court Cases a. Have you and the person in(�) been involved in another court case? M No ❑ Yes If yes, where? County: State: What are the case numbers? (Ifyou know): What kind of case? (Check all that apply): ❑ Registered Domestic Partnership ❑ Divorce/Dissolution ❑ Parentage/Paternity ❑ Legal Separation ❑ Domestic Violence ❑ Criminal ❑ Juvenile ❑ Child Support ❑ Nullity ❑ Civil Harassment ❑ Other(specify): b. Are there any domestic violence restraining/protective orders now(criminal,juvenile,family)? X No ❑ Yes If yes, attach a copy if you have one. V4/ at orders do you want? Check the boxes that apply to your, case. [✓( 0 Personal Conduct Orders I ask the court to order the person in ®not to do the following things to me or any of the people listed in (4): a. Harass, attack, strike, threaten, assault(sexually or otherwise),hit,follow, stalk, molest, destroy personal property, disturb the peace, keep under surveillance,or block movements b. Contact(either directly or indirectly),or telephone,or send messages or mail or e-mail The person in®will be ordered not to take any action to get the addresses or locations of any protected person, their family members, caretakers, or guardians unless the court finds good cause not to make the order. O I Stay-Away Order 'r^� I ask the court to order the person in®to stay at least ^'V yards away from (check all that apply): a. A Me e. ❑ The children's school or child care b. ❑ The people listed in f. ❑ My vehicle C. My home g. ❑ Other (specify): d. ❑ My job or workplace 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, or place of worship? K Yes ❑ No (Ifno, explain): O ❑ 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): 0 ❑ Child Custody, Visitation, and Child Support I ask the court to order child custody, visitation,and/or child support. You must fill out and attach Form DV-105. 10 ❑ Spousal Support You can make this request only if you are married to, or are a registered domestic partner of, the person in and no spousal support order exists, To askfor spousal support,you must f ll out,file, and serve Form FL-150 before your hearing. Revised July 1.2007 Request for Order DVA 00, Page 2 of 4 (Domestic Violence Prevention) __> v - Case Num a J Your name: What orders do you want? Check the boxes that apply to your case. Q 11 Record Unlawful Communications I ask for the right to record communications made to me by the person in(2) that violate the judge's orders. 12 ❑ Property Control I ask the court to give only me temporary use,possession, and control of the property listed here: 13 ❑ Debt Payment I ask the court to order the person in®to make these payments while the order is in effect: ❑ Check here if you need more space. Attach Form MC-020 and write "DV-100, Ite!m,13—Debt Payment" by your statement. Pay to: For: Amount: $ Due date: Pay to: For: Amount: $ Due date: Pay to: For: Amount: $ Due date: 14 ❑ Property Restraint I 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. 15 attorney Fees and Costs I ask that the person in ® pay some or all of my attorney fees and costs. You must complete and file Form FL-150, Income and Expense Declaration. 16 Payments for Costs and Services I ask that the person in ® 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. \ NrED Pay to:T_. i�3 WMOL-kl�C3-�-!V Y� �4?(uFor: &KKCR-.*LaMN►_ Pay to: Foi'r Amount: $ Pay to: For: ' Amount: $ 17 ❑ Datterer Intervention Program I ask the court to order the person listed in® to go to a 52-week barterer intervention program and show proof of completion to the court. 18 No Fee to Serve (Notify) Restrained Person If you want the sheriff or marshal to serve (notify) the restrained person about the orders for free, ask the court clerk whatyou need to do. e e O • - Revised July 1.2007 Request for Order DV-100, Page 3 of 4 (Domestic Violence Prevention) Case Nu O Your name: What orders do you want? Check the boxes that apply to your case. Cif 19 ❑ More Time for Notice I need extra time to notify the person in (2) about these papers.Because of the facts explained on this form,I want the papers served up to days before the date of the hearing.For help, read Form DV-210-INFO. If necessary, add additional facts: 20 ❑ Other Orders What other orders are you asking for? ❑ Check here if you need more space. Attach Form MC-020 and write "DV-100, Item 20—Other Orders"by your statement. 21 Guns or Other Firearms [.believe the person in(J)owns or possesses guns or firearms. ❑ Yes ❑ No ❑ I don't know If the judge approves the order, the person in 0 will be required to sell to a gun dealer or turn into police any guns or firearms that he or she owns or possesses. ►� Av\�-�rJ .�L 22 Describe the most recent abuse. l per �Flaf� UT�S©tV� ✓ �� a. Date of most re c t abuse: ' `t`r tS t� �/aCV� S �e W4tj r ilk b. Who was thereN��!t�nl c. W did the person in 4)do or say that made you afraid? �F_��m SATt6�1 :Ja 9t 3QLX-_-DcE;i AeNT � N Al1EA BScl�S AS (, Wa Ate)-r -Tz!s l�CLG �c�3C 1ZS� �lC Tnn�ce� ,4N� e &iT- d. Describe any use or threatened use of guns or other weapons: e. Describe any injuries: f. Did the police come? ® No ❑ Yes If yes,did they give you an Emergency Protective Order? ❑ Yes ❑ No ❑ I don't know Attach a copy if you have one. ❑ Check here if you need more space. Use Form MC-020 and write "DV-100, Item 22—Recent Abuse" by your statement. ❑ Check here if the person in®has abused you(or your children) other times. Use Form DV-101 or Form MC-020 to describe any previous abuse. I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: ill 1-7 �C b Type or print your name Sign jk ur name Revised Juty A.2007 - Request for Order D AO%Page 4 of 4 (Domestic Violence Prevention) 0 Description of Abuse Case N e w (� This form is attached to DSV-100,Item 21. 1pYour name: !�"''' l Name of person you want protection from(restrained person): C_�tC= (�y i�A ) �(y�gn o Describe the 2nd most recent abuse. a. Date of 2nd most recent abuse: K- L J-c,� CoeE* c, - J- ,- b. Who was there? Caw RTS dnl of r 7x�c�) C. What did the person in do or say to you that made you afraid? d. Describe any use or threatened use of guns or other weapons. e. Describe any injuries. f. Did the police come? No ® Yes If yes, did they give you an Emergency Protective Order? ® Yes ® No ® 1 don't know Attach a copy if you have one. Judicial COep611 of Ca I Atom uv-n'.amrriiJfamgos- DV-1'01, Page I oft New January 1,2001,Optional form Description of Abuse Family Code,§6200 c'mq. Alnrrin Demi't fM (Domestic Violence Prevention) Case N Vet ® � 0 5 2 -4 4 Your name: Describe other recent abuse. a. Date of other recent abuse: GC14 b. Who was there? �s c�2Si✓4tJ laV�l Sp N C. What did the person in ® do or say to you that made you afraid? d. Describe any use or threatened use of guns or other weapons. C. Describe any injuries. f. Did the police come? MNo ® Yes If yes,did they give you an Emergency Protective Order? ® Yes F_61 No ® I don't know Attach a copy ifyou have one. ® Describe other abuse against you or your children. ® Ifyou need more space, check the box and attach form MC-020. Or attach a sheet ofpaper and write "Dig-101 - Description of Abuse"at the top. New January I,2007 DV-101, Page 2 of 2 ,,,,,, Description of Abuse (Domestic Violence Prevention) IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF CONTRA COSTA DECLARATION RE:NOTICE UPON EX PARTE APPLICATION FOR DOMESTIC V(01-01 RI T�A61832RQE% 41 In the matter of: CASE NO.: VV �{JJ //�J jj�� PERSON TO BE PROTECTED: ��NNt� VL�ivCrE (��N�S�gJ PERSON TO BE RESTRAINED: G-LO-j�,A I declare that I am the person to be protected in the within action. N I did not tell the restrained person that I am applying for a restraining order for the following reason(s): (a) I am afraid for my life, I have already been threatened or I have already been harmed. ® (b) I do not want to have any contact with this person. ® (c) I do not know where this person is to contact. ® (d) I'm afraid that this person will take off with the child(ren). (e) Other reason: � 6C [ZA� pAZN ON C0 Qr-NQ-T- I did tell the restrained person that I was filing a restraining order and that person's response was: I declare under penalty of perjury that the foregoing is true and correct and that this declaration is executed at Martinez, California SIGN YOUR NAME HEE `* 111i� o� T ODAY'S DATE Marlin Deans Essential Forms TM DECLARATION RE: NOTICE UPON EX PARTE APPLICATION FOR DOMESTIC VIOLENCE RESTRAINING ORDER 4 ` NOV 17 2009 Temporary Restraining Clerk stamp ate "n rrrr' .I _.. . Order and Notice of Hearing 2099 NOV ) 9 A OName of person mg for protectio (protected person): 8 Protected person's address (skip this ifyou have a lawyer): (ifyou want your address to be private, give a mailing address instead): t City: '\ State:CLA5 Zip: l��J Telephone number: 925 ) y-rci Protected person's lawyer (ifany): (Name, address, telephone number, Fill incourt name and street address: and State Bar number): Superior Court of California,County of SUPERIOR COURT-MARTINEZ FAMILY LAW BUILDING 751 PINE ST.P.O.BOX 911 0MART4NEZ,CA 94553 2 Res rained person's name: _ N)r /:�D`�.O A J Fill in case num — Description of thatSperson: Sex: �M ❑ F HE,: ,t: Se to' , Case Numbe � y a_ J Weight:�LEkace:C�LSTq�air Color:5 " 0 4�� Eye Color: Age: Date of Birth: t 19 List the full names of all family or household members protected by this order: �t1/NE� OCourt Hearing pate (Fecha de la Audiencla) Clerk will fill out section below. Name and address of court if diffgent from above: Hearing "� Date: G�O _ Time: � or Court" Cree V. DatRin.: 640YgnacioValley 96 Wu ' To the person in 0: At the hearing,the judge can make restraining orders that last for up to 5 years.The judge can also make other orders about your children,child suppe-t, spousal support, money,and property. File an answer on Form DV-120 before the hearing. At the hearing,you can tell thejudge that you do not want the orders against you. Even if you do not attend the hearing, you must obey the orders. Para la persona nombrada en 42 : En esta audiencia el juez puede hacer que la orden de restriction sea vdlida hasta ror m6ximo de 5 ahos. El juez puede tambien hacer otras ordenes acerca de ninos, manutencion, dinero y propiedad. Presente una respuesta en el formulario DV-120,antes de la audiencia. Si Usted se opone a estas ordenes, vayo a la audiencia y digaselo al juez. Aunque no vaya a la audiencia, bene que obedecer estas ordenes. To the person inl1: At the hearing,the judge will consider whether denial of any orders will jeopardize your safety and the safety of children for whom you are requesting custody, visitation, and child support. Safety concerns related to the financial needs of you and your children will also be considered. Temporary Orders (ordenes Ternporales) Any orders made in this form end at the time of the court hearing in ®, unless ajudge extends them. Read this form carefully. All checked boxes Q✓ and items 10 and 11 are court orders. , ' Todas las ordenes hechas en esta forrnulario terminartin en la fecha y hora de la audiencia en ®, al menos que un juez las extienda. Lea este formulario con cuidado. Todas las casillas marcadas Q y los articulos 10 y 11 sora ordenes de to torte. Judicial Council or Calms.mvd,coutlmro.Ca.gov Temporary Restraining Order DV-110, Page 1 of Revised July 1.200),mandatory Form ,,p p� y u /�( y-�r Family code.§6200 at seq.Approved by DOJ and Notice of Hearing (CLE 1 J—TRO) (Domestic Violence Prevention) — T Cas u elm 05243 Your name: O6 Personal Conduct Ord rs T e rson in 72 must not the fol wing things to the protected eople li d in1�and rass, attack, strike,threaten, as ult(sexually or otherwis ), hit,follow, talk,molest,destroy rsonal pr erty,disturb the eace, keep un r surveillance,or blo k movements Con act(either direc ly or indirectly), r telephone, or sen messages or mail e-mail ❑ cept for brief d peaceful cont✓ as required for ourt-ordered visitatio of children unl s a c mina)protec ve order says otherw e c. (S Take a y action, di ectly or through others, to get the a dresses or locations of an protected p rsons or of their amily me bers,caretakers,or guar 'ans. (If it m c is not checked, the co t has foun good cause n to make this order.) Peaceful writte contact hrough a lawyer or through ro ss server or another person in rder to erve legal papers is allowe nd es not violate this order. ❑ A criminal prote ' e order on Form CR-160 is in effect. Case Number: County own): Expiration Date: (If more orders, lis em in item 16) 7 Stay- way Or r The p son in � mu t Stay at least yards a from: The person liste in® d. ❑ The ildren's school or chi care b. The people listed 1 ® e. er (specify): c. N Home ❑ Job ❑ e icle of person in 88 ❑ Move-Out Order The person in®must take only personal clothing and belongings needed until the hearing and move out immediately from (address). 0 ❑ Child Custody and Visitation Order a. ❑ You and the other parent must make an appointment for court mediation(address and phon'4 number): b. ❑ Follow the orders listed in Form DV-140, which is attached. 1.0 No Guns or Other Firearms or Ammunition The person in (�)cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, firearms, or ammunition. 11 `turn in or sell guns or firearms. The person in®: Must sell to a licensed gun dealer or turn in to police any guns or firearms that he or she has or controls. This must be done within 24 hours of being served with this order. Must bring a receipt to the court within 48 hours of being served with this order,to prove that guns and firearms have been turned in or sold. 12 ❑ Property Control Until the hearing, only the person in Ci)can use, control, and possess the following property and things: Revised July 1,2007 Temporary Restraining Order DV-'110, Page 2 of 5 and Notice of Hearing (CLETS—TRO) (L)omestic Violence Prevention) Case Ib¢�: Your name: o � 2 1 N '�lI A / V V\�b� ON UU 13 43 ❑ Property Restraint If the people in T and 02 are married to each other or are registered domestic partners,they must not transfer, borrow against,sell,hide, or get rid of or destroy any property,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 (Z)cannot contact the person in O if the court has made a "no contact"order) 14 Unlawful communications may be recorded. The person in1Q can record communications made by the person in 0 that violate the judge's orders. 15 No Fee to Notify (Serve) Restrained Person If the sheriff serves this order, he or she will do it for free. 16 ❑ Other Orders (specify): 17 If the judge makes a restraining order at the hearing,which has the same orders as in this form, the person in will get a copy pf that ordev mail a his or herkt known addrite estrained person's address here): If this address is not correct, or to know if the orders were made permanent, contact the court. 18 ❑ Time for Service A i i • B Order Someone 18 or over—not you or the other If you want to respond in writing, someone 18 or protected people—must personally"serve" a copy over—not you—must"serve" Form DV-1.20 on the ofhis order to the restrained person at least . person i T,then file it with the court aheast days before the hearing. days before the hearing. For heipp with Service or answering, read Form DV-210-INF0 or DV-540-INFO. Date:�1-- l0 � 000 tJF,%udzcz macer) 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 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. Revised July,,2007 Temporary Restraining Order DV-110, Page 3of5 and Notice of Hearing (CLETS—TRO) (Domestic Violence Prevention) f - 1. . 0 2-4,3 ._i~u Your name: V j, & LM6 nl 1f TNE6�st� • • • • • • 19 if you do not obey this order, you can be arrested and charged with a crime. • It is a felony to take or hide a child in violation of this order. You can go to prison and/or pay a fine. • 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 prison and/or pay a fine. 20 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 get guns,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 a gun dealer or turn in to police any guns or 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 if you are subject to a restraining order made after a noticed hearing. 21 After You Have Been Served With a Restraining Order • Obey all the orders. ° If you want to respond, fill out Form DV-120. Take it to the court clerk with the forms listed in item zz. • File DV-120 and have all papers served on the protected person by the date listed in item � of this form. • At the hearing, tell the judge if you agree or disagree with the orders requested. • Even if you do not attend the hearing,the judge can make the restraining orders last for 5 years. 22 Child Custody, Visitation, and Support • Child Custody and Visitation: If you do not go to the hearing, thejudge can make custody and visitation orders for your children without hearing your side. • Child Support: The judge can order child support based on the income of both parents. The judge can also have that support taken directly from your paycheck.Child support can be a lot of money, and usually you have to pay until the child is 18. File and serve a Financial Statement(Form FL-155) or 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 your side. Spousal Support: File and serve a Financial Statement(Foran FL-155) or an Income and Expense Declaration (Foran FL-150) so the judge will have information about your finances. Otherwise,the court may.make support orders without hearing your side. 23 Requests for .Accommodations 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.courtinfo.ca.gow/forms for Request for Accommodations by Persons With Disabilities and Order(Form MC-410). (Civil Code, § 54.8.) Revised July 1.2007 Temporary Restraining Order DV-110, Page of 5 and Notice of Hearing (CLETS—TRO) (Domestic Violence Prevention) Your name: . Instrudb ions fo r Law Eno 24 Start Date and End Date of Orders The start date is the date next to the judge's signature on page 3.The orders end on the hearing date on page 1 or the hearing date on Form DV-125,if attached. 25 Arrest Required If Order Is Violated If 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.(Penal Code, §§ 836(c)(1), 13701(b).)A violation of the order may be a violation of Penal Code section 166 or 273.6. 26 Notice/Proof of Service Law enforcement must first determine if the restrained person had notice of the orders. If notice cannot be verified,the restrained person must be advised of the terms of the orders. If the restrained,person then fails to obey the orders,the officer must enforce them.(Family Code, § 6383.) Consider the restrained person"served"(noticed) if: • The officer sees a copy of the Proof of Service or confirms that the Proof of Service is on file; or • The 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 Domestic Violence Restraining Orders System(DVROS).(Fam. Code, § 6381(b)(c).) 27 If the Protected Person Contacts the Restrained Person Even if the protected person invites or consents to contact with the restrained person,the orders remain in effect and must be enforced. The protected person cannot be arrested for inviting or consenting to contact with the restrained person.The orders can be changed only by another court order. (Pen. Codd, § 13710(b).) 28 Child Custody and Visitation • Custody and visitation orders are on Form DV-140, items(�)and a 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 IAV-105 are not orders. Do not enforce them. 29 Enforcing the Restraining Order in California Any law enforcement officer in California who receives, sees, or verifies the orders on a paper copy, or on the California Law Enforcement Telecommunications System(CLETS), or in an NCIC Protection Order File must enforce the orders, 30 Conflicting Orders A protective order issued in a criminal case on Form CR-160 takes precedence in enforcement over any conflicting civil court order. (Pen. Code, § 136.2(e)(2).) Any nonconflicLg terms of the civil restraining order remain in full force. An emergency protective order(Form EPO-001)that is in effect between the same parties and is more restrictive than other restraining orders takes precedence over all other restraining orders. .. ��C�}1CS,ce4f cte I certify that this Temporary Restraining der ' a tru an correct copy of the • • •., bQ original on file in the court. sa Ql t0 �.: NOV 9 2008 Date: Clerk, Deputy • @W i,soo „ Temporary Restraining Order DV-110, Page 5 of 5 1�tPgq r,;;ZnCand Notice of Hearing (CLETS—TRO) (Domestic Violence Prevention) � Q Request for Order Clerkstampsdate ere"when form is Two. tIIOB' 01 19 ) A 8 08 OYour name(person asking for protection): �Ea�yAt�&��ru110C1E N1A'j�E�nA\ fi 1(kv f <- tis •^,- Your address (skip this if you have a lawyer): (If you want your address _ihAr % to bepprivate, give a mailing-address instead): /I City: 4 srt Ct�sY State: -s_.L_ Zip: Your telephone number(optional): 07- �CA7M-965< Your lawyer (if you have one): (Name, address, telephone number, Fill in court name and street address: an State Bar number). Superior Court of California,County of o n1 G SUPERIOR COURT-MARTINEZ FAMILY LAW BUILDING 751 PINE ST.P.O. BOX 911 MARTWEZ,CA 94553 O2Na f e of person yo want protection LL1.SAM ` t�1 r Clerk fi capp f bar .r o is ile Descri tion of that U D '74 arson: Sex: Case r: Height: - Description SSp� K M ❑ F Height: _ Weight:A=14ace:CW Hair Color: t '� Eye Color:'.RL4>G Age: j5q Date of Birth: UBesides you,who needs protection? (Family or household members). FuIL NnmP Age Lives with you? How are they related to you? ❑ Yes ❑ No ❑ Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No ❑ Check here if you need more space. Attach Form MC-020 and write "DV-100, Item 3—Protected Peopfe" by your statement. NOTE: In any item that asks for Form MC-020,you can use an 81/2 X 11-inch sheet ofpaper instead. OWhat is your relationship to the person in®? (Check all that apply). a. ❑ We,are now married or registered domestic partners. b. ❑ We used to be married or registered domestic partners. c. ❑ We live together. d. ❑ We used to live together. e CK We are relatives, in-laws,or related by adoption (specify relationship): ' — -T-N LAO f. ❑ We are dating or used to date. g ❑ We are engaged to be married or were engaged to be married. h• ❑ We are the parents together of a child or children under 18: Child's Name: Date of Birth: Child's Name: Date of Birth: Child's Name: Date of Birth: ❑ Check here ifyou need more space. Attach Form MC-020 and write "DV-100, Item 4h" by your statement. i. ❑ We have signed a Voluntary Declaration of Paternity for our child or children. (Attach a copy if you have one.) e - Judicial Council of Califomia,wmv.couninlosa.gov Request for Order - Dv-100,Page 1 of 4 Revised July 1,2007,Mandatory Fonn (Domestic Violence Prevention) FarrnVy Code.g 820D el seq. VV�IJ� ,M �� Case b�. 052431 Your name: ��/SfJ�' OOther Court Cases a. Have you and the person in® been involved in another court case? No ❑ Yes If yes, where? County: State: What are the case numbers? (Ifyou know): What kind of case? (Check all that apply): ❑ Registered Domestic Partnership ❑ Divorce/Dissolution ❑ Parentage/Patemity ❑ Legal Separation ❑ Domestic Violence ❑ Criminal ❑ Juvenile ❑ Child Support ❑ Nullity ❑ Civil Harassment ❑ Other(specify): b. Are there any domestic violence restraining/protective orders now(criminal,juvenile,family)? X No ❑ Yes Ifyes, attach a copy Ifyou have one. W t orders do you want? Check the boxes that apply to yopr case. [✓� O6 Personal Conduct Orders . I ask the court to order the person in ®not to do the following things to me or any of the people listed in O9 : a. D4 Harass, attack, strike,threaten,assault(sexually or otherwise), hit,follow, stalk,molest, destroy personal property, disturb the peace,keep under surveillance, or block movements b. M Contact(either directly or indirectly),or telephone,or send messages or mail or e-mail The person in®will be ordered not to take any action to get the addresses or locations of any protected — person, their family members, caretakers, or guardians unless the court finds good cause not to make the order. O Sepetay-Away Order I ask the court to order the_person in®to stay at least _ yards away from (check all that apply): a. ;R Me e. ❑ The children's school or child care b. ❑ The people listed in O3 f. ❑ My vehicle c. ❑ My home g. ❑ Other (specify): d. ❑ Myjob or workplace 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, or place of worship? K Yes ❑ No (If no, explain): O ❑ 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): O9 ❑ Child Custody, Visitation, and Child Support I ask the court to order child custody, visitation, and/or child support. You must fill out and attach Foran DV-105. 10 ❑ Spousal Support You can make this request only if you are married to, or are a registered domestic partner of, the person in and no spousal support order exists. To ask for spousal support,you must fill out,file, and serve Foran FL-150 before your hearing. • • ® e Revised July 1,2007 Request for Order DV-100, Page 2 of 4 (Domestic Violence Prevention) 1 n^ Case tber: Your name: �L�it`I {���LAAk3f 11f\ILT►lO►.1 IIVVD� m 5 2 -43J What orders do you want? Check the boxes that apply to your case. Q 11 C9 Record Unlawful Communications I ask for the right to record communications made to me by the person in(2)that violate the judge's orders. 12 ❑ Property Control I ask the court to give only me temporary use,possession, and control of the property listed here: 13 ❑ Debt Payment I ask the court to order the person in�Y to make these payments while the order is in effect: ❑ Check here if you need more space.Attach Form MC-020 and write "DV-100, Itetyr,13—Debt Payment" by your statement. Pay to: For: Amount: $ Due date: Pay to: For: Amount: $ Due date: Pay to: For: Amount: $ Due date: 14 ❑ Property Restraint I 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 42 to notify me of any new or big expenses and to explain them to the court. 15 Attorney Fees and Costs 1 ask that the person in ® pay some or all of my attorney fees and costs. You must complete and file Form FL-150, Income and Expense Declaration, 16 Payments for Costs and Services I ask that the person in 0 pay the following: You can ask for lost earnings or your costs for services caused directly by the person in 0 (damaged property, medical care, counseling, temporary housing, etc.). You must bringpo of of these expenses to your hearing. (/ �� Pay to: 5 � ��i l to ATlE�For:SAL K7-!I eSAmount: $ 000 °= Pay to: For:- Amount: $ Pay to: For: Amount: $ 17 ❑ Batterer Intervention Program [ ask the court to order the person listed in® to go to a 52-week barterer intervention program and show proof of completion to the court. 18 No Fee to Serve (Notify) Restrained Person If 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. • o o • - Revised July 1,2007 Request for Order DV-100,Page 3 of 4 (Domestic Violence Prevention) Cas w e a 5 fL .0 Your name: V �ANG� ( V 1/4Tr( so(V �/ What orders do you want? Check the boxes that apply to your case. 19 ❑ More Time for Notice I need extra time to notify the person in (2) about these papers.Because of the facts explained on this form, I want the papers served up to days before the date of the hearing. For help, read Form DV-210-INFO. If necessary, add additional facts: 20 ❑ Other Orders What other orders are you asking for? ❑ Check here if you need more space.Attach Form MC-020 and write "DV-100, Item 20—Other Orders" by your statement. 21 Guns or Other Firearms 1 believe the person in( owns or possesses guns or firearms. ❑ Yes ❑ No ❑ I don't know If the judge approves the order, the person in T will be required to sell to a gun dealer or turn in to pgqliice any guns or firearms that he or she owns or possesses. W1ZLL&M1,AWw 22 Describe the most recent abuse. a. Date of most recent abuse:�<�� -TU N b. Who was there? -ILA)AI2LAA\C1�E �a s\l e1. mA R= QAkZAA c. W*t did the person in� do or say that made you afraid? 1rt; .Ft Sfy�i rCS�flt�) ©F r r ar-KC���f eta M �rem y �Tel t�sc� S AS SocA L-�2Y --P�-t. t&M-r. Es-?u'� -T� s d. Describe any use or threatened use of guns or other weapons: e. Describe any injuries: f. Did the police come? CR No ❑ Yes If yes,did they give you an Emergency Protective Order? ❑ Yes ❑ No ❑ I don't know Attach a copy if you have one. ❑ Check here if yoze need more space. Use Form MC-02d and write "DV 100, Item 22—Recent Abuse"by your statement. ❑ Check here if the person in(�) has abused you (or your children) other times. Use Form DV-101 or Form MC-020 to describe any previous abuse. ' I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: ��,NSC'�t3►1a1�� /V 1Aj�i�'�t>J � i�s�����°�-, Type or print your name Sign yeur name Revised July 1,2007 Request for Order DVA 00,Page 4 of 4 (Domestic Violence Prevention) Description of Abuse case Nu ` Q This form is attached to DV-100,Item 21. Your name: N Name of person you want protection from(restrained person): Describe the 2nd most recent abuse. a. Date of 2nd most recent abuse: b. Who was there? (;Fin}� �Aty A�1L oFV C. What did the person in do or say to you that made you afraid? ACA44n eJ 4-eTAet*= Wk r A i, F�GA,�T'rl '1<,SJ t-<, AS d. Describe any use or threatened use of guns or other weapons. e. Describe any injuries. f. Did the police come? ].No ® Yes If yes,did they give you an Emergency Protective Order? ® Yes ® No ® I don't know Attach a copy ifyou have one. Judicial Council of California, .wrir.co nrlinfo.ca.gov p y�, DV-101, Page t oft Ncw January 1,2003,Optimal Form Descriptioin of Abuse Fnmily Code,§8200 Optimal q. Demi Fneenlia,l;,muTM1' (Domestic Violence Prevention) CaseAwm 2 4 -^^--�� Your name: , Jin)tAEfj� 0SAN Onrz ���1itUSOK Describe other recent abuse. a. Date of other recent abuse: b. Who was there? WTD LT/�Iv� Q �(AC��E � c O til c. What did the person in do or say to you that made you afraid? ` ' A—C QC�r o�y NtAp d. Describe any use or threatened use of guns or other weapons. C. Describe any injuries. f. Did the police come? 10 No E3 Yes If yes,did they give you an Emergency Protective Order? ® Yes ® No ® 1 don't know Attach a copy ifyou have one. Describe other abuse against you or your children. 4 ® if you need more space, check the box and attach form MC-020. Or attach a sheet ofpaper and write "DV-101 - Description of Abuse"at the top. Nell lanu;,q �,lom Description of Abuse DV-tot, Paget ort �feloNell Uean 1 F2003 U env„,'I'hl (Domestic Violence Prevention) IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF CONTRA COSTA OECLARATION RE: NOTICE UPON EX PARTE APPLICATION FOR DOMESTIC VIOLENCE RESTRAINING ORDER p In the matter of: CASE NO.: 4-3 PERSON TO BE PROTECTED: N, PERSON TO BE RESTRAINED: i , L '�``�C��vvvccc»>�X� ,�V�V�t.J�� •� I declare that I am the person to be protected in the within action. I did not tell the restrained person that I am applying for a restraining order for the following reason(s): (a) I am afraid for my life, I have already been threatened or I have already been harmed. ® (b) I do not want to have any contact with this person. ® (c) I do not know where this person is to contact. ® (d) I'm afraid that this person will take off with the child(ren). (e) Other reason: M E+j-N_ ���1101J�� 4N CSN I did tell the restrained person that I was filing a restraining order and that person's response was: I declare under penalty of perjury that the foregoing is true and correct and that this declaration is executed at Martinez, California SIGN YOUR NAME HEPE IOOAYSDATE Marlin Dean's Essential Forms TM DECLARATION RE: NOTICE UPON EX PARTE APPLICATION FOR DOMESTIC VIOLENCE RESTRAINING ORDER