street address: 1100 i street modesto, ca 95353 mailing ... · that person does not have the right...

Revised 7/2014

SUPERIOR COURT OF STANISLAUS COUNTY www.stanct.org (209) 530-3100

Street Address: 1100 I Street Modesto, CA 95353 Mailing Address: P.O. Box 1098 Modesto, CA 95353

Self Help Center: 800 11th Street Room #220 Modesto, CA 95353

(PROVIDING ASSISTANCE TO PARTIES REPRESENTING THEMSELVES)

DOMESTIC VIOLENCE PROTECTED PERSON’S PACKET

All documents must be typed or printed legibly per Rules of Court 2.104, in blue or black ink.

This packet includes the necessary forms to obtain a temporary restraining order.

Judicial Council forms, local forms, and information are available in the Clerk’s Office, the Stanislaus County Law Library located at 1101 13th Street, Modesto, CA and on the following websites:

Stanislaus County Superior Court: www.stanct.org Stanislaus County – Local Forms: www.stanct.org/Forms.aspx?id=3 Judicial Council’s Self Help: www.courts.ca.gov/selfhelp.htm Judicial Council Forms: www.courts.ca.gov/formsrules.htm Stanislaus County Law Library: www.stanislauslawlibrary.org Free Interactive Electronic Forms Program: www.icandocs.org/ca/california.html California’s Free Website for Legal Help: www.lawhelpcalifornia.org Law Libraries, Websites, or Self-Help Legal Books: www.courts.ca.gov/1091.htm

REQUIRED FORMS:

• CLETS-001 Confidential CLETS Information • FL004 - Declaration RE: Notice Upon Ex Parte Application for Orders • DV-100 - Request for Order • DV-110 - Temporary Restraining Order • DV-109 - Notice of Court Hearing • DV-200 - Proof of Service (In Person)

ATTACHMENT FORMS: The following forms are provided in this packet and may be used if they apply to your circumstances:

• MC-020 - Attachment to Domestic Violence • DV-101 - Description of Abuse • DV-105 - Child Custody, Visitation and Support Request (attachment to DV-100) • DV-140 - Child Custody and Visitation Order (attachment to DV-110) • DV-150 - Supervised Visitation Order (attachment to DV-110) • FL-150 - Income and Expense Declaration(Only required if addressing support issues)

http://www.stanct.org/


http://www.stanct.org/Forms.aspx?id

http://www.courts.ca.gov/selfhelp.htm

http://www.courts.ca.gov/formsrules.htm

http://www.stanislauslawlibrary.org/

http://www.icandocs.org/ca/california.html

http://www.lawhelpcalifornia.org/

http://www.courts.ca.gov/1091.htm

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Typewritten Text

SHC

Revised 7/2014

If you are requesting Child Abduction Prevention Orders, then you MUST attach the following forms to DV-105 and DV-140. These forms are available at the clerk’s office, Self Help Center or at the Judicial Council’s Website: www.courts.ca.gov/formsrules.htm.

• DV-108 – Request for Order; No Travel with Children (attachment to DV-105) • DV-145 – Order: No Travel with Children (attachment to DV-140)

NOTES: If you are seeking orders regarding economic issues (example: child support or spousal support), you MUST file either an Income and Expense Declaration (FL–150) or a Financial Statement (FL-155). The Income and Expense Declaration is included in this packet. If your only source of income is TANF, SSI, or GA/GR or if you have applied for TANF, SSI, or GA/GR, the Financial Statement is available upon request. Both forms are accessible on the Judicial Council website listed above. The Income and Expense Declaration can be typed directly from the website and the calculations will be computed for you.

Parties are encouraged to review and comply with Local Rules regarding Family Law proceedings. Local Rules can be located on the following Superior Court website: www.stanct.org.

Material distributed by the Superior Court Clerk’s Office or Self Help Center IS INTENDED FOR INFORMATIONAL AND EDUCATIONAL PURPOSES ONLY. Such material is NOT LEGAL ADVICE and is not intended to be legal advice as to your specific case. IT IS NOT INTENDED TO TAKE THE PLACE OF LEGAL ADVICE FROM AN ATTORNEY. You are strongly urged to seek the advice of a licensed attorney before starting or completing your case in order to protect valuable legal rights that you may have, of which you may be unaware of. Please contact an attorney of your choice or contact the LAWYERS REFERRAL SERVICE of the Stanislaus County Bar Association at: (209) 571-5727 for a referral. The Clerk’s Office cannot give you legal advice.

http://www.courts.ca.gov/formsrules.htm



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)


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.)

Fill out the forms you need and take them to the court clerk. The clerk will give your forms to the judge. The judge will look at them and decide whether to make (“grant”) the temporary orders. Sometimes the judge will want to talk to you. If so, the clerk will tell you.

Use this form as a checklist. (Look at the numbers at the top of your forms.)

How Do I Ask For a Temporary Restraining Order?DV-505-INFO

Judicial Council of California www.courts.ca.govRevised July 1, 2016


* Read Which Financial Form—FL-155 or FL-150? (form DV-570) to know which one is right for you.

How Do I Ask for a Temporary Restraining Order? (Domestic Violence Prevention)

b. If you have children with the person you want protection from, you also need these forms:

c. If you want child support or spousal/partner support, you also need form:

d. Ask the clerk if your county has special forms or rules.

e. There are other forms you will need later (do not fill them out now):

a. For a restraining order you need these forms:

• Keep one copy with you, always. You may need to show it to the police.Keep another copy in a safe place. Give a copy to anyone else protected by the order. Take copies to places where the restrained party is ordered not to go (school, work, child care, etc.) Give a copy to the security officers in your apartment building and workplace.

••••Restraining orders get entered into CLETS, a statewide computer system that lets police know about your order.The court will send the order to law enforcement or CLETS for you.

What to do with your copies:

Find out if the judge made the temporary restraining orders. Ask the clerk when to come back to see if the judge signed the order form DV-110. The judge must decide by the next business day. If the judge grants a temporary restraining order, check it carefully to see what the orders are. The judge might not order everything you requested. The court will set a hearing date on form DV-109 whether or not the judge grants any temporary orders.

"File" the judge's order. The clerk will keep the original forms for the court and will file-stamp up to three copies for you. If you need more, you may make them yourself.

Name of Person Asking for Ord

DV-109 Notice of Court Hea

Your lawyer in this case (if you

DV-100 Request for Domestic Violence Restraining OrderCLETS-001 (Confidential CLETS Information)DV-109 Notice of Court HearingDV-110 Temporary Restraining Order

DV-105 Request for Child Custody and Visitation OrdersDV-140 Child Custody and Visitation Order

DV-120 Response to Request for Domestic Violence Restraining OrderDV-130 Restraining Order After Hearing (Order of Protection)DV-200 Proof of Personal Service

FL-150* Income and Expense Declaration orFL-155* Financial Statement (Simplified)

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Revised July 1, 2016

Look at form DV-109 for thedate and time of your hearing.You must go to your hearing toget a permanent order.

The order you have now onlylasts for about three weeks. Anyorders made on form DV-110(Temporary Restraining Order) will end on the hearing date.

You have the right to cancel thehearing. Read page 2 of formDV-109 for information.

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Law enforcement will serve the orders for free, but you have to ask.A “process server” is a business you pay to deliver court forms. Look in the YellowPages or on the Internet under “Process Serving.”

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If law enforcement or the process server uses a different proof of service form,make sure the form lists all the forms served.

"Serve" the restrained party.Ask someone you know, a process server, or law enforcement to personally “serve” (give) the restrained party a copy of the notice of hearing, the order, and other papers. You cannot serve the papers yourself. They cannot be sent by mail. The server must:

Know your hearing date: Form DV-109

Be 18 years of age or olderNot be listed in item or of form DV-100,Request for Domestic Violence Restraining Order.

File the Proof of Personal Service (Form DV-200).The Proof of Personal Service shows the judge and police that the restrained person got a copy of the request for orders. Make three copies of the completed Proof of Personal Service. Take the original and copies to the court clerk as soon as possible before your hearing. The clerk will keep the original and give you back the copies stamped “Filed.” Bring a copy to your hearing.

Keep one copy with you and another in a safe place in case you need to show it to the police. Give the other copiesout as you did in . The court will send your completed Proof of Personal Service to law enforcement or CLETSfor you. CLETS is a statewide computer system that lets police know about your order.

If the sheriff serves your order, he or she will send the Proof of Personal Service to the court and to CLETS foryou.

Don’t serve it by mail!

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DV-505-INFO, Page 2 of 3How Do I Ask for a Temporary Restraining Order? (Domestic Violence Prevention)


After serving the orders, the server fills out and signs form DV-200, Proof of Personal Service, and gives it to you.

• File the signed order (form DV-116) with the clerk. Theclerk will send it to law enforcement or CLETS for you.

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Attach form DV-115 and form DV-116 to your othercourt papers and have the restrained party personally served.

Bring a copy of form DV-115 and form DV-116 to your hearing.File the original form DV-200, Proof of Personal Service, and bring a copy to your hearing.

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Need help?

Which Financial Form—FL-155 or FL-150? (form DV-570)

Need more help?

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Revised July 1, 2016 DV-505-INFO, Page 3 of 3How Do I Ask for a Temporary Restraining Order? (Domestic Violence Prevention)

If the restrained party wasn't served . . .The restrained party must be served before the hearing. If the restrained party wasn’t served, fill out formDV-115 (Request to Continue Hearing) and the top of form DV-116 (Order on Request to Continue Hearing)to ask the judge for a new hearing date. Do this beforeor at your hearing. (If you wait until after the hearing, you have to start from the beginning and complete all of the forms again.)

If the judge signs form DV-116, any restraining orders will last until the end of the new hearing.

How Can I Respond to a Request for Domestic Violence Restraining Order? (form DV-120-INFO)

The clerk has information sheets that can help you. Or you can get them at www.courts.ca.gov/forms.

How Do I Ask the Court to Renew My Restraining Order? (form DV-700-INFO)•

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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 ViolenceHotline:

1-800-799-7233 TDD: 1-800-787-3224

It’s free and private. They can help you in more than 100 languages.

What Is “Proof of Personal Service”? (form DV-200-INFO)

How to Enforce Your Restraining Order (form DV-530-INFO)

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

Get Ready for the Court Hearing (form DV-520-INFO)

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Parties who come to court about child custody andvisitation face decisions about parenting plans fortheir children. This information sheet providesgeneral information about child custody andvisitation matters, how to get help resolving acustody dispute or making a parenting plan, whereto find an attorney, and where to find otherresources.

A parenting plan usually includes: Legal custody: who makes major decisions

about the child’s health, education, and welfare;Physical custody: who the child lives with;

Time-share or visitation: when the childspends time with each party.

Legal custody and physical custody mayeach be specified as joint (both parties havecertain responsibilities) or sole (one party hasthe responsibility alone).

If you can’t reach an agreement, the court will referyou to mediation with family court services to try towork out a parenting plan.

FL-314-INFO Child Custody Information Sheet

Judicial Council of California,Revised July 1, 2008, Optional Form

What is a parenting plan?A parenting plan describes how the parties willdivide their responsibilities for taking care of theirchild.

The plan may include a general or specificschedule of days, times, weekends, holidays,vacations, transportation, pick-up/drop-off, limitson travel, and other details.

What are legal and physical custody?

Child Custody Information Sheet FL-314-INFO,

Can we make our own parenting plan?

Yes. You have a right to make a parenting planagreement on your own. This agreement may becalled a stipulation, time-share plan, or parentingplan.

If both parties can agree on a parenting plan, thejudge will probably approve it. The agreementbecomes a court order after it is signed by bothparties, signed by the judge, and filed with thecourt.

What if there is domestic violence or aprotective order?

If there is domestic violence or a protectiveorder, talk with a lawyer, counselor, ormediator before making a parenting plan.

For domestic violence help, call the NationalDomestic Violence Hotline:1-800-799-7233, TDD:1-800-787-3224, or call211 (if available in your area).

What if we don't have a parenting plan?

What is mediation with family court services?

Family court services (FCS) provides mediation tohelp parties resolve disagreements about the care oftheir child. The mediator will meet with you and theother party to try to help you make a parenting plan.This is a free service provided by the court.

If you are concerned about meeting with the otherparty in mediation, or there is domestic violence or aprotective order involving the other party, you mayask to meet alone with the mediator without the otherparty. You may also have a support person with youat mediation. The support person may not speak foryou.

Do we have to agree to a parenting plan inmediation?

No. You do not have to come to an agreement inmediation. When the parties can’t agree, the judgewill decide.

In some courts, the judge will consider the mediator’srecommendations about the parenting plan. Askfamily court services about how the process works inyour court.

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Are there other ways to resolve our dispute?

Yes. There are other Alternative Dispute Resolution(ADR) options you may try, including:

Meet and Confer: Parties and their lawyers (if any)

Where can I get help?

This information sheet gives only basic informationon the child custody process and is not legal advice.If you want legal advice, ask a lawyer for assistance.You may also:

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

FL-314-INFO Child Custody Information Sheet


may meet at any time and as often as necessary to workout a parenting plan without a court hearing. If there isa protective order limiting the contact between theparties, then the “meet and confer” can be throughlawyers or a mediator in separate sessions.

Child Custody Information Sheet FL-314-INFO,

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2. Settlement Conference: In some courts, partiesmay meet with a judge, neutral evaluators, or familylaw lawyers not involved in your case to discusssettlement. Check with your local court to find out ifthis is an option. If there is a protective order, thesettlement discussion can be through lawyers or amediator in separate sessions.

3. Private Mediation: Parties may hire a privatemediator to help them resolve their dispute.

4. Collaborative Law Process: Each party hires alawyer and agrees to resolve the dispute without goingto court. The parties may also hire other experts.

Court Hearing

When the parties cannot agree to a parenting plan ontheir own, in mediation, or in any other ADRprocess, the judge will decide.

If there is domestic violence or a protective order,you may bring a support person with you to thecourt hearing, but the support person may not speakfor you.

1. Contact family court services.

2. Contact the family law facilitator or self-helpcenter for information, court forms, and referrals tolocal legal services providers.

3. Find a lawyer through your local bar association,the State Bar of California at http://calbar.ca.gov, orcall the Lawyer Referral Service at 1-866-442-2529or 415-538-2250.

4. Hire a private mediator for help with yourparenting agreement. A mediator may be a lawyeror counselor. Contact your local bar association,court ADR program, or family court services for areferral to local resources.

5. Find information on the Online Self-Help CenterWeb site: www.courtinfo.ca.gov/selfhelp.

6. For free and low-cost legal help (if you qualify),go to: www.lawhelpcalifornia.org.

7. Find information at your local law library or askat your public library.

8. Ask for a court hearing and let the judge decidewhat is best for your child.

Get Ready for the Court Hearing

Be prepared.

Bring documents that support your case (police or medical reports, rental agreements or receipts, photos, bills, etc.).

Most courtrooms do not allow children. Before the date of the hearing, ask if there is a children’s waiting room in the courthouse if you do not have childcare available.

Don't miss the hearing.

Find the courtroom.When the courtroom opens, go in and tell the court clerk or officer that you are present.

Watch the other cases so you will know what to do.When your name is called, go to the front of the courtroom.

What if you don’t speak English?When you file your papers, tell the clerk you will need an interpreter. If a court interpreter is not available, bring someone to interpret for you. Do not ask a child, a protected person, or a witness to interpret for you.

The judge may ask questions.

Give complete answers.If you don’t understand, say “I don’t understand the question.”Speak only to the judge, unless it is your turn to ask questions.When people are talking, wait for them to finish. Then you can ask them questions about what they said.Do not interrupt other than for legal objections.

Either person can bring a “support” person to the court hearing to feel safer. The support person must not talk for either person in court.

If you are afraid of the other person, tell the officer.

Your hearing may last just a few minutes or up to an hour or more. However, you may be at court several hours, depending on the number of other cases.

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


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DV-520-INFO Get Ready for the Court Hearing

(Domestic Violence Prevention)

If the other person tells a lie, wait until he or she finishes talking, then tell the judge.• Do not sit near or talk to the other person. •

Bring 2 copies of all documents and filed forms, including the Proof of Service. •

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Practice what you want to say to the judge. Make of list of the orders you want or the orders you disagree with. If you get nervous at the hearing, just read from your list.

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If you are the person asking for protection and you miss the hearing, the restraining orders will end and you will have to complete the paperwork all over again.If you are the person to be restrained and you miss the hearing, the judge can still make the orders.

Get there 30 minutes early.

If you are the person to be restrained, complete, file, and serve Form DV-120, Response to Request for Domestic Violence Restraining Order, if you haven’t already. Bring 3 copies of DV-120 to the hearing.

You can bring documents or witnesses to help support your case. Provide the other party with a copy of all documents or witness statements. Your witnesses can write their statements about what they saw or heard, signed under penalty of perjury. They can use form MC-030, Declaration, or a sheet of paper titled “Declaration.”

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• Do not sit near or talk to the other person.

The person to be protected and the person to be restrained or their lawyers may ask questions.•

Tell the truth. Speak slowly. You can read from your list.

Get Ready for the Court Hearing DV-520-INFO, Page 2 of 3

Any orders will be written on Form DV-130. When you receive the signed and filed Form DV-130, read it carefully. If anything is different from what the judge ordered, tell the court clerk right away or talk to your lawyer if you have one for the case.

For person to be protected:

At the hearing, the judge will consider whether denial of any orders will risk the safety of the person asking for protection or the safety of children for whom custody, visitation, or child support orders are requested. Safety concerns about the financial needs of the person asking for protection will also be considered.

Sometimes the court clerk will fill out Form DV-130. If not, ask who should fill it out.

At the end of the hearing, the judge will say what the orders are. The orders will be put on Form DV-130 (Restraining Order After Hearing).

The judge may “continue” your case.

This means you have to come back another day. The judge can do this if:

The judge wants more informationYour hearing is taking longer than planned

The person to be restrained needs time to get a lawyer or prepare an answer

The court may use Notice of New Hearing Date and Order on Reissuance (Form DV-116) for the new hearing.

What about child custody or visitation?

If you need child custody or visitation orders, the judge will send you to Family Court Services which helps parents agree on a plan for custody and visitation that is best for the children.


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The person to be protected may ask the judge to extend the temporary orders until the new hearing date.



If the court clerk fills out Form DV-130, the clerk will bring the form to the judge.

Ask the clerk for the local process to get Form DV-130 filed. After the form is filed, the court clerk will give you up to three copies.Read the signed Form DV-130 carefully. If anything is different from what the judge ordered, tell the court clerk right away or talk to your lawyer if you have one for the case.

If you fill out Form DV-130, bring it to the court clerk when you finish.• • •

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The judge will decide.

If the judge makes orders at the hearing–Form DV-130

For person to be restrained:If the judge makes orders at the hearing you must obey them. If you do not, you could be arrested.•

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If you are sent to Family Court Services, the judge may make the restraining, custody, and visitation orders last until the next hearing or until another court order.

Either parent can ask to meet with Family Court Services separately. The protected person may bring a support person to the meeting. A support person can provide emotional support but cannot speak for the protected person.


Use this checklist to see if you have the right forms for the case:• •

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What if you are 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 Order (Form MC-410). (Civil Code, § 54.8.)

If the restrained person was not at the hearing, but the judge’s orders are the same as the temporary order, you may have him or her served with a copy of Form DV-130 by mail.

What happens after the hearing?

The court clerk will send Form DV-130 to law enforcement or CLETS for you. CLETS is a statewide computer system that lets police know about the order.If the restrained person was at the hearing, you may have him or her served with a copy of Form DV-130 by mail.

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For person to be protected:

Keep a copy of the orders with you at all times. •

If you do not receive a copy of the orders within a few days after the hearing, ask the clerk for a copy.You will be served with the Restraining Order After Hearing (Form DV-130) within a few days, by mail or in person.

• • For person to be restrained:

Keep a copy of the orders with you at all times.

•


•

Which forms will I receive after the hearing?

Form DV-140 (Child Custody and Visitation Order) if the judge ordered child custody or visitation. Sometimes lawyers use different forms.Form FL-342 (Child Support Information and Order Attachment) or Form FL-343 (Spousal, Partner, or Family Support Order Attachment) if the judge orders child support and/or spousal support.

Form DV-130 (Restraining Order After Hearing ) if the judge made orders at the hearing.

Ask the court clerk about free or low-cost legal help.

Need more help?

1-800-799-7233

It’s free and private.They can help you in more than 100 languages.

For a referral to a local domestic violence or legal assistance program, call the National Domestic Violence Hotline:

TDD: 1-800-787-3224

Revised January 1, 2012 Get Ready for the Court Hearing (Domestic Violence Prevention)

If the restrained person was not at the hearing, and the judge’s orders are different from the temporary order, you must have someone serve Form DV-130 in person, not by mail. Ask the server to complete Form DV-200, Proof of Personal Service, and give it back to you.

Get copies.

DV-530-INFO, Page 1 of 1Judicial Council of California, www.courts.ca.govRevised January 1, 2012 How to Enforce Your Restraining Order


DV-530-INFO How to Enforce Your Restraining Order

•••••

When should I call the police?

• Write down what happened, when, where, and the names of any witnesses. Get copies of police reports. If you are hurt, get copies of medical reports.

••

Even if you haven’t served the orders yet, call the police. Show the police a copy of your orders. If the restrained person is there, ask the officer to serve the orders. If the officer serves the orders, he or she will send the Proof of Service to the court and CLETS for you. CLETS is a statewide computer system that lets police know about your orders.

What can the police do?It is a crime to disobey the judge’s orders. The restrained person can be arrested, pay a fine, and/or go to jail or prison.

Ask your local district attorney (D.A.) how he or she will handle your case. The D.A. may file criminal or contempt charges. You can always call the D.A. for information about a criminal case. You can also file a civil contempt action. Ask the court clerk for forms or visit www.courts.ca.gov.

Guns, Other Firearms and AmmunitionThe restrained person cannot• own

havebuy or try to buy

••

a gun or firearm or ammunition while the order is in effect. If the person does any of these things, he or she can go to jail and be ordered to pay a fine of $1,000.

•

Get copies of your restraining order (DV-110 or DV-130) and Proof of Service (Form DV-200 or DV-250) from the court clerk if you don’t already have them:

Always keep a copy with you. You may need to show it to the police.Keep another copy in a safe place and consider keeping a copy in your car. Give a copy to anyone else protected by the order. Take copies to places where you and the other protected people go (e.g. school, work, daycare, etc.). Give a copy to the security officers in your apartment building and workplace.Staple the restraining order (DV-110 or DV-130) to the Proof of Service (DV-200 or DV-250).

Call the police right away if the restrained person violates any of the orders. Also:

A law enforcement officer can give you information about any firearms the restrained person has registered, transferred, or sold. (Penal Code section 11106). You may disclose the information as needed to protect yourself or someone else. Tell law enforcement if you have any information about any guns the restrained person has or where they are located.

Yes, I need an Interpreter!

Sí, necesito un Intérprete!

Name (Nombre): __________________________________

Case Number (Número de caso): _______________________

Language/Dialect Spoken (Que idioma/dialecto habla):

□ Spanish (Español) Dialecto: _________________ □ Other: ___________ Dialect: __________________

Person requesting an Interpreter is: Persona que solicita el intérprete es:

□ Petitioner (Solicitante) □ Respondent (Demandado) □ Protected Person (Persona Protegida) □ Restrained Person (Persona Restringida) □ Other (Otro): ___________________________

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

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:

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

Name: State Bar No.:

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.

1

2

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4 2

Clerk stamps date here when form is filed.

Fill in court name and street address:

Superior Court of California, County of

Court fills in case number when form is filed.

Case Number:

STANISLAUS1100 I STREETP. O. BOX 1098MODESTO, CA 95353

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.


(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:



2

2

2

2

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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.

2

2

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

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17

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.



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2

2

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

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25

26

24 Time for Service (Notice)


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?

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

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.

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272

3

2

2

2

2

2

Attachment to Domestic Violence

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7

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15

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CASE NAME: ____________________________VS_______________________CASE NUMBER: _______________

ATTACHMENT

“DV-100, Item 23-Recent Abuse”

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

DATED: _____________________________

________________________________________________

PETITIONER (signature)

Case Number:Description of AbuseDV-101

Name of person asking for protection:

Name of person you want protection from:

Describe abuse to you or your children.a. Date of abuse:b. Who was there?

c. Describe how the person in abused you or your children:

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

e. Describe any injuries:

f. Did the police or other law enforcement come? No Yes

If yes, did they give you or the person in Yes No I don't know

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

Judicial Council of California, www.courts.ca.gov DV-101, Page 1 of 2Rev. January 1, 2017, Optional Form

Description of AbuseFamily Code, § 6200 et seq.

�(Domestic Violence Prevention)

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

1

2

3

2

2 an Emergency Protective Order?The Emergency Protective Order protects You The person in 2

� �

� � �

� �

Case Number:

Describe abuse to you or your children.

a. Date of abuse:

b. Who was there?

c. Describe how the person in abused you or your children:

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

e. Describe any injuries:

f. Did the police or other law enforcement come? No Yes

Describe abuse to you or your children.

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

title.Rev. January 1, 2012 DV-101, Page 2 of 2

4

2

If yes, did they give you or the person in 2 an Emergency Protective Order? Yes No

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

I don't know

The Emergency Protective Order protects You The person in 2

5

Description of Abuse(Domestic Violence Prevention)

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

� �

� � �

� �

�


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

Your name: Mom Dad Other*

Mom Dad Other*Other parent’s name:

Change Current Court OrderI want to change a current child custody or visitation court order.

Explain your current order and why you want a change.

Child’s Address

Child (a) lived with: Dad OtherMom

Dates lived there:

to presenttototo

DV-105, Page 1 of 3Judicial Council of California, www.courts.ca.govRev. January 1, 2012, Mandatory FormFamily Code, § 3063

Request for Child Custody and Visitation Orders(Domestic Violence Prevention)

Where has the child in (a) lived for the last 5 years? Give each city and state the child has lived unless it is unknown to the other parent and you want to keep it confidential because of domestic violence or child abuse. Start with where the child lives now and work backwards in time. (If the current address is confidential, check the box below and just provide the current state).

Child (a) addresses (city and state):

Case Number:DV-105 Request for Child Custody and

Visitation Orders

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2

4

5

Check here if you need more space. Attach a sheet of paper and write “DV-105, Child’s Address” for a title.

3

33

Confidential

*If Other, specify relationship to child:

Check here if you need more space. Attach a sheet of paper and write “DV-105, Change Current Court Order” for a title.

Child CustodyPhysical Custody to:(Person you want the child to live with)

I ask the court for custody as follows: Legal Custody to: (Personwho makes decisions about health, education, and welfare)

Mom Date of BirthChild’s Namea.b.c.

Check here if you need more space. Attach a sheet of paper and write “DV-105, Child Custody” for a title.

Dad Other Mom Dad Other

3

d.

Case Number (if you have it): ____________________________________ County:______________________

FromFromFromFrom

Check the orders you want .


Case Number:

Other Custody Case Were you involved in, or do you know of, any other custody case for any child listed in this form?

Yes If yes, fill out below and attach a copy of any custody or visitation orders if you have them:Noa. Name of each child in other custody case:

Domestic Violence Divorce Guardianship

Juvenile/Dependencyb. Type of case:

WitnessPartyc. I was a Other (specify):

d. Court (name):

Address: County: State:e. Date of court order:

Other People With or Claiming to Have Custody or Visitation Rights Do you know of anyone who is not involved in this case who has or claims to have custody or visitation

Yes If yes, fill out below:No

Has custody Claims custody rights Claims visitation rightsFor these children (name of each child):

Check here if you need more space. Attach a sheet of paper and write “DV-105, Other People With or Claiming Custody or Visitation” for a title.

DV-105, Page 2 of 3

rights with any child listed on this form? Name and address of that person:

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8

Request for Child Custody and Visitation Orders(Domestic Violence Prevention)

Other (specify):

Case number (if you have it):

Other Children’s AddressesCheck here if the other child’s (or children’s) address information is the same as listed in .If it is different, check here. Attach a sheet of paper and write “DV-105, Other Children’s Addresses” for a title. List other children’s address information, including dates, and name of person child lived with.

65

Visitation

No visitation until the hearinga. No visitation after the hearingb.

I ask the court to order that the person in have the following temporary visitation rights:(Check all that apply)

92

f.

Rev. January 1, 2012

Parentage (Paternity) Child Support

The following visitation until the hearing after the hearingc.(1) (The 1st weekend of the month is the 1st weekend with a Saturday.)Weekends (starting):

1st 2nd 4th3rd 5th weekend of month

(2) Weekdays (starting):

from at ata.m. a.m.p.m. to p.m.(time) (time)(day of week) (day of week)


Responsibility for TransportationThe parent will take or pick up the child or make arrangements for someone else to do so.

Mom Dad take children to the visits.a. Other (name):

Mom Dad pick up children from the visits.b.Drop-off / pick-up of children will be at (address):c.

Travel With Children

Mom Dad must have written permission Other (name):from the other parent, or a court order, to take the children outside of:

The State of Californiaa.b. Other place(s) (list):

Child Abduction Risk

I believe that there is a risk the other parent will take our child out of California and hide the child from me.If you check this box you must fill out and attach Form DV-108, Request for Order: No Travel with Children.

You must tell the court if you find out any other information about a custody case in any court for the children listed on this form.If the court makes a temporary custody order, the parent receiving custody must not take the child out of California without a noticed hearing. (See Family Code §3063.)

Other (name):


Rev. January 1, 2012 DV-105, Page 3 of 3Request for Child Custody and Visitation Orders(Domestic Violence Prevention)

Case Number:

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14

I ask the court to order that:

I ask the court to order that:

County of: ________________________________________________

Other Visitation

Attach a sheet of paper with other visitation days and times, like summer vacation, holidays, and birthdays. List dates and times. Write “DV-105, Visitation” for a title.

Check here if other arrangement. Attach a sheet of paper and write “DV-105, Responsibility for Transportation” for a title.

d.

Supervised Visitationa. I ask that the visitation in be supervised by

c. I ask that any costs for supervision be paid by:Mom Dad% % %Other (name)

12

A professional supervisor Other A non-professional supervisor

10

b. I ask that the visitation in be supervised by

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10

•

•

Name and telephone number, if known: ______________________________________________________

Name and telephone number, if known: ______________________________________________________

A professional supervisor Other A non-professional supervisor

Important Instructions

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:

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:

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

Name: State Bar No.:

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

This is a Court Order.

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


Personal Conduct Orders

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 1

3

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.

Record Unlawful Communications

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 Services

Not ordered now but may be ordered after a noticed hearing.Batterer Intervention Program

Not 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

(Clerk will fill out this part.)

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.

DV-140


Case Number:Child Custody and Visitation Order

DV-130DV-110This form is attached to (check one):

Mom Dad Other*Name of Protected Person:

Mom Dad Other*Other Parent’s Name:

The Court Orders:Physical Custody to:(Person the child lives with. Check at least one.)

Legal Custody to: (Person who makes decisions about health, education. Check at least one.)

Child Custody is ordered as follows:

Mom Dad Other* Mom Dad Other*Date of BirthChild’s Name

a.b.c.

If more children, check here. Attach a sheet of paper and write “DV-140, Child Custody” for a title.

* If Other, specify relationship to child and name of person:

Child Visitation is ordered as follows:Mom DadNo visitation toa. Other (name):

See the attachedb. - page document, dated:The parties must go to mediation at:c.

Mom Dad Other (name):Until the next court order, visitation for will be:d.

(1) (The 1st weekend of the month is the 1st weekend with a Saturday.)Weekends (starting):

1st 2nd 4th3rd 5th weekend of monthfrom at ata.m. a.m.p.m. to p.m.

(time) (time)(day of week) (day of week)

(2) Weekdays (starting):


Other Visitation(3)

Check here and attach a sheet of paper if there are other visitation days and times, like holidays, birthdays, sports events. List dates and times. Write “DV- 140, Other Visitation” for a title.

Supervised Visitation or Exchange

Judicial Council of California, www.courts.ca.govRev. January 1, 2012, Mandatory FormFamily Code, §§ 3020, 3022, 3040–3043, 3100, 6340,7604

DV-140, Page 1 of 2Child Custody and Visitation Order

5

* If Other, specify relationship to child:

1

2

3

4

5


Visits and/or exchanges of children are supervised as specified on Form DV-150, Supervised Visitation and Exchange Order.


Case Number:

Travel with ChildrenMom Dad must have written permission from the Other (name):

other parent, or a court order, to take the children outside of:The State of Californiaa.

Other place(s) (list):

Child AbductionThere is a risk that one of the parents will take the children out of California without the other parent’s permission. The orders in Form DV-145, Order: No Travel with Children, are attached and must be obeyed. (Fill out and attach Form DV-145 to this form.)

Other OrdersCheck here and attach any other orders to this form. Write “DV-140, Other Orders” as a title.

Jurisdiction This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and Enforcement Act (part 3 of the California Family Code starting with § 3400).

Notice and Opportunity to Be Heard The responding party was given reasonable notice and an opportunity to be heard as provided by the laws of the State of California.

Country of Habitual Residence The country of habitual residence of the child or children in this case is The United States of Americaor Other (specify):

Penalties for Violating This Order If you violate this order, you may be subject to civil or criminal penalties, or both.

Rev. January 1, 2012 DV-140, Page 2 of 2

.

Duration of Child Custody, Visitation, and Support OrdersIf this form is attached to Form DV-130 (Restraining Order After Hearing), the custody and visitation orders in this form remain in effect after the restraining orders on Form DV-130 end.

657

658

659

6510

6511

6512

6513

6514

c.

Child Custody and Visitation Order (Domestic Violence Prevention)

The United States of Americab.

Responsibility for Transportation for Visitation“Responsibility for transportation” means the parent will take or pick up the child or make arrangements forsomeone else to do so.

Drop-off / pick-up of children will be at (address):c.

6

Mom Dad take children to the visits.a. Other (name):

Mom Dad pick up children from the visits.b. Other (name):

56

DV-150Case Number:Supervised Visitation and

This form is attached to

Name of Protected Person:1 Mom Dad Other*

Other Parent’s Name: Mom Dad Other*

The Court Orders:

Mediation, Visitation and Exchange

a. Parties must go to mediation at:

b. Visitation of children is supervised.

c. Exchanges of children are supervised.

Schedule of Supervised Visits

a. All visits as provided in the schedule on Form DV-140, item

b. Supervised visits shall be

Provider's Information

Name:

Telephone number:

Address:

Costs Will Be Paid As Follows:

Mom to pay: %

Dad to pay: %

Other:

Contact With Provider

Mom to contact provider before (date):

Dad to contact provider before (date):

Other:

The court also orders (specify):


Judicial Council of California, www.courts.ca.gov DV-150, Page 1 of 1Rev. January 1, 2016, Mandatory Form Supervised Visitation and Exchange OrderFamily Code, § 3100, 3031


Exchange Order

2

3

4

7

DV-110, Temporary Restraining Order

DV-140, Child Custody and Visitation Order

DV-130, Restraining Order After Hearing

*If Other, specify relationship to child:

Parent to be supervised is: Mom Dad Other (name):

4 (d) are to be supervised.

visit(s) per week of hour(s) each, to be arranged with the provider.

c. Other schedule of supervised visits is attached. (Check here and attach a sheet of paper with “DV-150,Other Schedule” for a title.)

5

a.

b. Nonprofessional

Type of Provider

Professional (individual or supervised visitation center)

6

8

9

� �

�

� � �

� � �

�

�

� � �

�

�

�

�

�

�

�

�

�

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DV-109 Notice of Court Hearing

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

Address:City:Telephone:E-Mail Address:

Name of Person to Be Restrained:


The court will fill out the rest of this form.Notice of Court HearingA court hearing is scheduled on the request for restraining orders against the person in

Name and address of court if different from above:

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 FormDV-100, Request for Domestic Violence Restraining Order, are:

All granted until the court hearingAll 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)):

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

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

Name of Person Asking for Order:

State Bar No.:

State: Zip:Fax:

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

Clerk fills in case number when form is filed.Case Number:

Date: Time:Dept.: Room:

a.

(1)(2)(3)

b.

(1)

Judicial Council of California,Revised January 1, 2012, Mandatory FormFamily Code, § 242, Approved by DOJ

Notice of Court Hearing(Domestic Violence Prevention)

DV-109, Page 1 of 3

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 homeaddress private, give a different mailing address instead. You do nothave to give your telephone, fax, or e-mail.):

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

.

STANISLAUS1100 I StreetPO BOX 1098Modesto, CA 95353

Family Law Division

Case Number:

Service of Documents and Time for Service—for Person inAt least

along with a copy of all the forms indicated below:Hearing) to the person in

Form DV-100, Request for Domestic Violence Restraining Order, (file-stamped) with applicable attachmentsForm DV-110, Temporary Restraining Order (file-stamped) with applicable attachments if granted by thejudge

Form DV-120, Response to Request for Domestic Violence Restraining Order (blank form)Form DV-250, Proof of Service by Mail (blank form)

Other (specify):

The court cannot make the restraining orders after the court hearing unless the person in has been

has been served, the person who served the forms must fill out a proof of service form. Form DV-200,

For information about service, read Form DV-210-INFO, What Is “Proof of Personal Service”?If you are unable to serve the person in

Date:

days before the hearing, someone age 18 or older—not you or anyone else to beprotected—must personally give (serve) a court’s file-stamped copy of this form (DV-109, Notice of Court

a.b.

c.d.e.

personally given (served) a copy of your request and any temporary orders. To show that the person in

Judicial Officer

Revised January 1, 2012 DV-109, Page 2 of 3Notice of Court Hearing(Domestic Violence Prevention)

five or

Restraining Order. Fill it out and file it with the court as soon as possible.You may file a new request for orders, onIf you want to cancel the hearing, use Form DV-112, Waiver of Hearing on Denied Request for Temporaryyou can cancel your request for orders so there is no court hearing.the court hearing. The judge may make the orders you want after the court hearing. You can keep the hearing date, orIf item (a)(2) or (a)(3) is checked, the judge has denied some or all of the temporary orders you requested until

on the other person.If you cancel the hearing, do not serve the documents listed in itemthe same or different facts, at a later time.

served on the other personIf you want to keep the hearing date, you must have all of the documents listed in itemwithin the time listed in item .

If you cancel the hearing or do not come to the hearing, any restraining orders made on Form DV-110 will end on theYou must come to the hearing if you want the judge to make restraining orders or continue any orders already made.safety of children for whom you are requesting custody or visitation.At the hearing, the judge will consider whether denial of any requested orders will jeopardize your safety and the

date of the hearing.

Proof of Personal Service may be used.

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.

Case Number:

(Clerk will fill out this part.)

—Clerk’s Certificate—

I certify that this Notice of Court Hearing is a true and correct copy of the original on fileClerk’s Certificate[seal]

Date: Clerk, by , Deputy

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

If you want to respond in writing, mail a copy of your completed Form DV-120, Response to Request for DomesticViolence Restraining Order, to the person inSomeone age 18 or older—not you—must do it.To show that the person in

Revised January 1, 2012 DV-109, Page 3 of 3Notice of Court Hearing(Domestic Violence Prevention)

and file it with the court. You cannot mail Form DV-120 yourself.

has been served by mail, the person who mailed the forms must fill out a proof ofservice form. Form DV-250, Proof of Service by Mail, may be used. File the completed form with the court beforethe hearing and bring it with you to the hearing.For information about responding to a restraining order and filing your answer, read Form DV-120-INFO, HowCan I Respond to a Request for Domestic Violence Restraining Order?.

Whether or not you respond in writing, go to the court hearing if you want the judge to hear from you beforemaking orders. You may tell the judge why you agree or disagree with the orders requested. You may bringwitnesses 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, andproperty and may order you to turn in or sell any firearms that you own or possess.

in the court.

http://www.courts.ca.gov/forms

This is the Form Number

YOUR NAME HERE YOUR STREET ADDRESS HERE

YOUR CITY, STATE, and ZIP CODE HERE

IN PRO PER

COURT’S PHYSICAL ADDRESS HERE COURT’S MAILING ADDRESS HERE

COURT’S CITY, STATE, and ZIP CODE HERE

FILL THIS OUT EXACTLY AS THE INFORMATION APPEARS ON YOUR OTHER DOCUMENTS

COURT CASE NUMBER HERE

FILL OUT YOUR EMPLOYER’S INFORMATION HERE. IF YOU DO NOT HAVE A JOB, GIVE THE INFORMATION

FROM YOUR LAST JOB.

FILL OUT YOUR AGE AND WHAT GRADE IN SCHOOL YOU COMPLETED. IF YOU HAVE ANY SPECIAL LICENSES, FILL OUT THAT

INFORMATION AS WELL.

SAMPLE COUNTY NAME HERE

DATE PRINT SIGN

FILL THIS OUT EXACTLY AS THE INFORMATION APPEARS ON YOUR OTHER DOCUMENTS COURT CASE NUMBER HERE

YOU MUST ATTACH YOUR LAST TWO PAY STUBS. REMEMBER TO CROSS OUT YOUR SOCIAL SECURITY NUMBER.

YOU MUST LIST ALL OF YOUR INCOME, BEFORE TAXES, IN THIS AREA

IN THIS COLUMN YOU WILL LIST WHAT YOU RECEIVED LAST MONTH FOR EACH SOURCE

IN THIS COLUMN YOU WILL LIST THE AVERAGE YOU RECEIVED

FROM THE LAST 12 MONTHS FOR EACH SOURCE

YOU MUST LIST ALL OF YOUR INVESTMENT INCOME, BEFORE

TAXES, IN THIS AREA

IF YOU ARE SELF-

EMPLOYED YOU MUST

PROVIDE THE INFORMATION REQUESTED.

DO NOT FORGET TO ATTACH A TWO YEAR PROFIT &

LOSS STATEMENT/S

CHEDULE C

CHECK THIS BOX IF YOU RECEIVED A ONE-TIME SOURCE OF INCOME, LIKE LOTTERY OR

INHERITANCE, AND WRITE WHERE YOU RECEIVE THE MONEY AND HOW MUCH YOU RECEIVED

CHECK THIS BOX IF YOU HAVE HAD A SIGNIFICANT CHANGE IN INCOME AND

STATE WHAT THAT CHANGE WAS

WRITE IN ANY DEDUCTIONS YOU PAID LAST MONTH FOR THE ITEMS LISTED

STATE WHAT YOU HAVE IN YOUR SAVINGS AND CHECKING ACCOUNTS,

ANY STOCKS, BONDS, AND/OR REAL/PERSONAL PROPERTY


WRITE DOWN WHO LIVE WITH YOU, THEIR AGE AND RELATION TO YOU, HOW MUCH THEY MAKE BEFORE TAXES, AND WHETHER THEY PAY ANY EXPENSES FOR THE HOME

LIST ALL OF YOUR MONTHLY EXPENSES HERE FOR THE ITEMS LISTED

ADD UP ALL OF THE EXPENSES YOU

LISTED FOR A TOTAL TO PUT HERE

WRITE HOW MUCH OF THE EXPENSES ARE

PAID BY OTHERS

LIST HERE ANY PAYMENTS YOU ARE MAKING FOR CAR LOANS, STUDENT LOANS, MORTGAGES, CREDIT CARDS, ETC., THE NAME OF THE COMPANY

YOU ARE PAYING, HOW MUCH YOU PAY EACH MONTH, WHAT IS STILL OWED, AND THE DATE OF YOUR LAST PAYMENT


FILL OUT THIS PAGE ONLY IF YOU ARE PAYING CHILD SUPPORT

WRITE IN THE NUMBER OF CHILDREN UNDER 18 YOU ARE/WILL BE PAYING CHILD SUPPORT FOR AND HOW

MUCH TIME EACH PARENT SPENDS WITH THEM

CHECK WHETHER YOU DO OR DO NOT HAVE HEALTH INSURANCE FOR THE CHILDREN. IF YOU DO HAVE HEALTH INSURANCE, WRITE IN HOW

MUCH YOU PAY, NOT HOW MUCH YOUR EMPLOYER PAYS

WRITE IN ANY OTHER EXPENSES YOU PAY FOR THE CHILDREN

WRITE DOWN ANY EXTREME HARDSHIPS YOU HAVE IN THIS AREA. WRITE DOWN THE AMOUNT AND FOR HOW MANY MONTHS.

FL-150ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) : FOR COURT USE ONLY

TELEPHONE NO.:

E-MAIL ADDRESS (Optional) :

ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

OTHER PARENT/CLAIMANT:

CASE NUMBER:INCOME AND EXPENSE DECLARATION

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

Attach copies a. Employer:

of your pay b. Employer's address:

stubs for last c. Employer's phone number:

two months d. Occupation:

(black out e. Date job started:

social f. If unemployed, date job ended:

security g. I work about hours per week.

numbers). h. I get paid $ gross (before taxes) per month per week per hour.

(If you have more than one job, attach an 8 1/2-by-11-inch sheet of paper and list the same information as above for your otherjobs. Write "Question 1 - Other Jobs" at the top.)

2. Age and educationa. My age is (specify):b. I have completed high school or the equivalent: Yes No If no, highest grade completed (specify):c. Number of years of college completed (specify): Degree(s) obtained (specify):d. Number of years of graduate school completed (specify): Degree(s) obtained (specify):e. I have: professional/occupational license(s) (specify):

vocational training (specify):3. Tax information

a. I last filed taxes for tax year (specify year): b. My tax filing status is single head of household married, filing separately

married, filing jointly with (specify name):c. I file state tax returns in California other (specify state):d. I claim the following number of exemptions (including myself) on my taxes (specify):

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

(If you need more space to answer any questions on this form, attach an 8 1/2-by-11-inch sheet of paper and write thequestion number before your answer.) Number of pages attached:

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

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

Page 1 of 4

Form Adopted for Mandatory Use INCOME AND EXPENSE DECLARATION Family Code, §§ 2030-2032,Judicial Council of California 2100-2113, 3552, 3620-3634,

FL-150 [Rev. January 1, 2007] 4050-4076, 4300-4339www.courtinfo.ca.gov

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In Pro PerStanislaus

1100 I StreetP. O. Box 1098Modesto, CA 95353

FL-150PETITIONER/PLAINTIFF: CASE NUMBER:



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

5. Income (For average monthly, add up all the income you received in each category in the last 12 months Averageand divide the total by 12.) Last month monthlya. Salary or wages (gross, before taxes) ...........................................................................................................................................$b. Overtime (gross, before taxes) ...........................................................................................................................................................$c. Commissions or bonuses .........................................................................................................................................................................$d. Public assistance (for example: TANF, SSI, GA/GR) currently receiving .............................................$e. Spousal support from this marriage from a different marriage .......................................................$f. Partner support from this domestic partnership from a different domestic partnership $g. Pension/retirement fund payments ...................................................................................................................................................$h. Social security retirement (not SSI) .................................................................................................................................................$i. Disability: Social security (not SSI) State disability (SDI) Private insurance. $j. Unemployment compensation ...............................................................................................................................................................$k. Workers' compensation .............................................................................................................................................................................$l. Other (military BAQ, royalty payments, etc.) (specify) : ....................................................................................................$

6. Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.)a. Dividends/interest .........................................................................................................................................................................................$

b. Rental property income ..............................................................................................................................................................................$

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

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

7. Income from self-employment, after business expenses for all businesses ........................................$I am the owner/sole proprietor business partner other (specify) :Number of years in this business (specify) :Name of business (specify) :Type of 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 yoursocial security number. If you have more than one business, provide the information above for each of your businesses.

8. Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source andamount) :

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

10. Deductions Last montha. Required union dues ......................................................................................................................................................................................................................$b. Required retirement payments (not social security, FICA, 401(k), or IRA) ..........................................................................................$c. 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 ..........................................................................................................$f. Partner support that I pay by court order from a different domestic partnership ..............................................................................$g. Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g") ......$

11. Assets Totala. Cash and checking accounts, savings, credit union, money market, and other deposit accounts .......................................$b. Stocks, bonds, and other assets I could easily sell ...............................................................................................................................................$c. All other property, real and personal (estimate fair market value minus the debts you owe) $

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

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12. The following people live with me:

Name Age How the person is That person's gross Pays some of therelated to me? (ex: son) monthly income household expenses?

a. Yes Nob. Yes Noc. Yes Nod. Yes Noe. Yes No

13. Average monthly expenses Estimated expenses Actual expenses Proposed needsa. Home:

h. Laundry and cleaning .............................................$(1) Rent or mortgage ..................$

i. Clothes ............................................................................$If mortgage:(a) average principal: $ j. Education ..........................................................................$(b) average interest: $

k. Entertainment, gifts, and vacation ................$(2) Real property taxes ......................................$

l. Auto expenses and transportation(3) Homeowner's or renter's insurance (insurance, gas, repairs, bus, etc.) ..............$

(if not included above) ...............................$m. Insurance (life, accident, etc.; do not

include auto, home, or health insurance) $(4) Maintenance and repair .............................$

n. Savings and investments ....................................$b. Health-care costs not paid by insurance $

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

c. Child care .......................................................................$ p. Monthly payments listed in item 14(itemize below in 14 and insert total here) $

d. Groceries and household supplies ...............$q. Other (specify) : ........................................................$

e. Eating out .......................................................................$r. TOTAL EXPENSES (a-q) (do not add in $

f. Utilities (gas, electric, water, trash) ...........$ the amounts in a(1)(a) and (b))

g. Telephone, cell phone, and e-mail ...............$ s. Amount of expenses paid by others $

14. Installment payments and debts not listed above

Paid to For Amount Balance Date of last payment$ $$ $$ $$ $$ $$ $

15. Attorney fees (This is required if either party is requesting attorney fees.):a. To date, I have paid my attorney this amount for fees and costs (specify) : $b. The source of this money was (specify) :c. I still owe the following fees and costs to my attorney (specify total owed) : $d. My attorney's hourly rate is (specify) : $

I confirm this fee arrangement.

Date:

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


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

16. Number of childrena. I have (specify number) : children under the age of 18 with the other parent in this case.b. The children spend percent of their time with me and percent of their time with the other parent.

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

17. Children's health-care expensesa. I do I do not have health insurance available to me for the children through my job.b. Name of insurance company:c. Address of insurance company:

d. The monthly cost for the children's health insurance is or would be (specify) : $(Do not include the amount your employer pays.)

18. Additional expenses for the children in this case Amount per montha. Child care so I can work or get job training ....................................................................................$b. Children's health care not covered by insurance ........................................................................$c. Travel expenses for visitation ..................................................................................................................$d. Children's educational or other special needs (specify below) : ....................................$

19. Special hardships. I ask the court to consider the following special financial circumstances(attach documentation of any item listed here, including court orders) :

Amount per month For how many months?a. Extraordinary health expenses not included in 18b ...................................................................$

b. Major losses not covered by insurance (examples: fire, theft, otherinsured loss) .........................................................................................................................................................$

c. (1) Expenses for my minor children who are from other relationships andare living with me ......................................................................................................................................$

(2) Names and ages of those children (specify) :

(3) Child support I receive for those children ...............................................................................$

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

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


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DV-200-INFO, Page 1 of 2Judicial Council of California, www.courts.ca.govRevised July 1, 2016 What Is "Proof of Personal Service"?


• What orders you are asking forThe hearing dateHow to respond

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Who can serve?Ask someone you know, a process server, or a law enforcement agency (forexample, a sheriff) to personally serve (give) a copy of the orders to the party tobe restrained. You cannot send the forms to that person by mail.The server must:

• Be 18 years of age or overNot be you or anyone to be protected by the orders•

How does the server "serve" the legal papers?

Walk up to the person to be served.Make sure it’s the right person. Ask the person’s name. •Give the person copies of all papers checked on form DV-200,Proof of Personal Service.Fill out and sign form DV-200.Give the signed form DV-200 to you.

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What if the person won't take the papers or tearsthem up?• If the person won’t take the papers, just leave them near him or her.

It doesn’t matter if the person tears them up. •

• The police cannot arrest anyone for violating an order unless the restrained party knows about the order.The judge cannot make the orders permanent unless the restrained party was served.•

A sheriff can serve the order at no cost to you.A “registered process server” is a business you pay to deliver court forms.Look for “Process Serving” in the Yellow Pages or on the Internet.(Note: If a law enforcement agency or the process server uses a different proof of service form, make sure it lists the forms served.)

Ask the server to:

Why do I have to get the orders served?

What is "service"? Service is the act of giving your legal papers to the other party in the case. There are many kinds of service—in person, by mail, and others. This form is about personal, or “in-person,” service. The Notice of Court Hearing (form DV-109), Request for Domestic Violence Restraining Order (form DV-100), and Temporary Restraining Order (formDV-110) must be served “in person.” That means someone—not you or anyone else protected by the order—must personally “serve” (give) the party to be restrained a copy of the forms. You cannot send them by mail. Service lets the other party know:

Don’t serve it by mail!

DV-200-INFO What Is "Proof of Personal Service"?

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When do the orders have to be served?It depends. To know the exact date, you have to look at two things on form DV-109:

First, look at the hearing date on page 1. Next, look at the number of days written in item on page 2.


Look at a calendar. Subtract the number of days in item from the hearing date. That’s the final date to have the ordersserved. It’s always OK to serve earlier than that date.

Who signs the Proof of Personal Service?Only the person who serves the orders can sign the Proof of Personal Service (form DV-200). You do not sign it. Theperson to be restrained does not sign it.

What do I do with the completed Proof of Personal Service?

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If possible, file the original Proof of Personal Service (form DV-200) with the court at least two days before your hearing. If you were unable to do so, bring the original Proof of Personal Service to your hearing.The clerk will send it to CLETS.Always keep an extra copy of the restraining orders with you for your safety.

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If someone other than the sheriff serves the orders, you should:

If the sheriff serves the orders, he or she will send the Proof of Personal Service to the court and CLETS (CaliforniaLaw Enforcement Telecommunications System), a statewide computer system that lets police know about your order,for you.

Bring a copy of the original Proof of Personal Service (form DV-200) to your hearing.

What happens if I cannot get the papers served before the hearing date?

You must attach a copy of form DV-115 and DV-116 to a copy of your original order. That way, the police will knowyour orders are still in effect. And the restrained party will be served with notice of the new hearing date. For moreinformation on getting a new hearing date, read form DV-115-INFO, How to Ask for a New Hearing Date.

If nothing is written in item , you must have the papers served at least five days before the hearing.

Forms DV-100, DV-109, and DV-110 must be personally served before the hearing. If not, before your hearing, fill out and file a Request to Continue Hearing (form DV-115) and Order on Request to Continue Hearing (form DV-116). These forms ask the judge for a new hearing date and make any temporary orders last until the end of the new hearing. Ask the clerk for the forms, or go to www.courts.ca.gov.

Service of Documents and Time for At least five or ___ days before the h

protected—must personally give (serve) a couHearing) to the person in along with a copy

Form DV-100, Request for Domestic Viola.

Form DV-120, Response to Requc.

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Form DV-110, Temporary Restrainb.

Form DV-250, Proof of

Notice of Court Hearing A court hearing is scheduled on the reque

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Date: Time:

Room:Dept.:Hearing

Date

judge

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DV-200-INFO, Page 2 of 2What Is "Proof of Personal Service"? (Domestic Violence Prevention)

DV-200-INFO What Is "Proof of Personal Service"?

DV-200, Page 1 of 1Judicial Council of California, www.courts.ca.govRevised July 1, 2016, Optional Form Family Code, §§ 243, 245, and 6345

Proof of Personal Service (CLETS) (Domestic Violence Prevention)

Proof of Personal Service

1 Name of Party Asking for Protection:

2 Name of Party to Be Restrained:




Court clerk fills in case number when form is filed.

Case Number:

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DV-200

Notice to Server3The server must:

Be 18 years of age or older.•Not be listed in items or ofform DV-100, Request for DomesticViolence Restraining Order.

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Give a copy of all documents checked in to the restrained party in (you cannot send them by mail). Then complete and sign this form,and give or mail it to the party in .

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I gave the party in a copy of all the documents checked:2

a. DV-109 with DV-100 and a blank DV-120 (Notice of Court Hearing; Request for Domestic Violence Restraining Order; blankResponse to Request for Domestic Violence Restraining Order)

b. DV-110 (Temporary Restraining Order)c. DV-105 and DV-140 (Request for Child Custody and Visitation Orders, Child Custody and Visitation Order)d. FL-150 with a blank FL-150 (Income and Expense Declaration)e. FL-155 with a blank FL-155 (Financial Statement (Simplified))f. DV-115 (Request to Continue Hearing)g. DV-116 (Order on Request to Continue Hearing)h. DV-130 (Restraining Order After Hearing)i.

5 I personally gave copies of the documents checked above to the party in on:2

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

At this address:c.City: State: Zip:

6 Server's InformationName:Address:City: State: Zip:Telephone:(If you are a registered process server):County of registration: Registration number:

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

Date:

Type or print server’s name Server to sign here

Other (specify):
