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ATTACHMENT CV-5014
NAME AND ADDRESS OF PARTY OR ATTORNEY FOR PARTY: TELEPHONE NUMBER: FOR COURT USE ONLY
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AWORNE FOR Self—Represented
(Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA
STREET ADDRESS: CA
San Jose,
191 North First Sheet, 95113
MAILING ADDRESS: 191 North
First Street
CITY AND ZIP CODE: San José,CA 95113
BRANCH NAME: Downtown Courthouse
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Person FromWhom Protection
DECLARATION IN
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Person/Entity Seeking Protection:
Sought:
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€ 9A4 mm/Ax
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SUPPORT OF EX PARTE APPLICATION FOR
CIVIL RESTRAINING ORDERS
VUQ CASE NUMBER:
19811008589
DEPT #1
I.the undersigned. declare:
1. lam (choose one): D attorney for Person or Entity Seeking Protection
m self—represented Person or Entity Seeking Protection
D other (explain):
2. The opposing partyisrepresented by an attorney: D Yes $ No
you checked
(If “yes". the attorney‘s name, address, and telephone number.
fill in you checked
If “no", in
fillthe other party’s
name address, and telephone number.
namezifiu
Party/Attorney mm A ( RRM\ VMA
Addressflelephone number:
‘
(1‘9, bl.” HP yd HI?“ {My {:4 QCUZZ
3. OTHER CASES: Have the case been involved
parties to this with
in litigation each otherinanother Family, Probate
Civil,
Case?
Juvenile, or Criminal Court D Yes No lf “yes”, case(s) number(s):
4. NOTICE
a. lHAVE given notice to the opposing party andlor their attorney by the following method:
D Personal deliveryD Overnight CarrierU Class Mail
First D Other:
Date:_____________ Time:
|
my
have received confirmation that the other party has received
papers as follows:
(describe)
b. |HAVE NOT given notice of the request for orders because (Check that apply.
all You must explain below):
m Thisisan application Harassment Prevention
for Civil Act,ElderAbuse, Private Postsecondary School Violence,
Housing Misconduct, or Workplace Violence Act
Transitional restraining orders and:
m Great or irreparable can be heard on notice.
injury will result before the matter
D Itisimpossible to give notice.
D The otherparty agrees to the orders requested.
D Other:
c. Explanation:
D A hearing between the parties is already set
l am asking that this same
motion be heard at the time.
D |am unabie to serve the other party in the time required by iaw.
m my
Ifear for physical safety (and that of others,
ifapplicable).
D Other:
ldeclare under penalty of perjury that the forgoing
istrueand correct.
01101
Date
5W flank}
Name
Print
'
TENS
V firm 2 Lv/
fignarure
REV 09/18/16
CV-5014 DECLARATION INSUPPORT 0F EX PARTE APPLICATION FOR Page1ofz
CIVIL RESTRAINING ORDERS
ATTACHMENT CV-5014
INSTRUCTIONS
Please refer to Santa Clara County Local Civil Rules for more information. This form is not for use in
restraining order applications filed at Family Court.
This form is required inSanta Clara County, ifyou are asking the Judge to make immediate orders without
the other party being present for a hearing. These orders are called ex parte orders. This form must be
completed in any case where ex parte orders are requested. If you have given notice to the other side of
your case, you must state the form of notice given. Notice means providing the other side of the case, either
the attorney or a self—represented party, with copies of any papers that you want the Judge to review and
any orders that you are requesting, If you have not given notice, you must explain why you have not given
notice. There are some circumstances when notice may be waived, such as cases involving allegations of
domestic violence where the safety of a party or a child might be at risk ifnotice is given. Itis up to the
Judge in your case to determine whether notice will be required or not.
SECTION #1
State whether you are the Petitioner or the Respondent in the case. Once a case is filed,the parties keep
the same status in the case. You do not change from the Respondent to the Petitioner by filinga new
motion in the case. If you do not have an attorney, you are considered self—represented.
SECTION #2
Ifthe other party isrepresented by an attorney, you must provide the Court with the attorney’s name and
address. Ifthe other party is not represented by an attorney, you must provide the Court with the other
party’s address.
SECTION #3
It is very important to list all other cases in which you and the other party have been involved with the courts.
This would include other Family Law, Probate, Juvenile, Restraining Order, Child Support, Civil,or Criminal
matters. If you do not have the case number, please put unknown and list thecounty and the year of the
filing, possible.
if
SECTION #4A
Unless notice is excused by the Court, you must provide notice of this motion to the other party
before you deliver a copy to the Court. When you give such notice, specify how you did it (by
courier or personally, for example) and at what time and date. Also, please explain how you know
that the other side received copies of your papers and what response you were given.
SECTION #4B
lfyou did not give notice of this application, explain why in this section. Check as many boxes as
apply. You may also write out any further explanation of your reasons for not giving notice.
After this form iscompleted, attach itto your restraining order application and submit them as follows:
o lf Civil Harassment, Workplace Violence. Private Postsecondary School Violence, or Transitional
Housing Misconduct; to the CivilDivision Clerk's Office at 191 North First Street,San José, CA 95113
o IfElder or Dependant Adult Abuse; to the Family Division Clerk's Office at 201 North First Street,
San José, CA 95113
CV50“ REV 09/18/16 DECLARATION IN SUPPORT OF EX PARTE APPLICATION FOR Page 2 0‘2
CIVIL RESTRAINING ORDERS
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ATTACHMENT CV-5014 NAME AND ADDRESS OF PARTY OR ATTORNEY FOR PARTY: TELEPHONE NUMBER: FOR COURT USE ONLY 13mm ‘1 €35” Mex , on jams HA a WMm cm aCW. V ¢ AWORNE FOR Self—Represented (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: CA San Jose, 191 North First Sheet, 95113 MAILING ADDRESS: 191 North First Street CITY AND ZIP CODE: San José,CA 95113 BRANCH NAME: Downtown Courthouse r C: flv’ig Person FromWhom Protection DECLARATION IN is FYU‘ ku Person/Entity Seeking Protection: Sought: u q 1 € 9A4 mm/Ax .2 SUPPORT OF EX PARTE APPLICATION FOR CIVIL RESTRAINING ORDERS VUQ CASE NUMBER: 19811008589 DEPT #1 I.the undersigned. declare: 1. lam (choose one): D attorney for Person or Entity Seeking Protection m self—represented Person or Entity Seeking Protection D other (explain): 2. The opposing partyisrepresented by an attorney: D Yes $ No you checked (If “yes". the attorney‘s name, address, and telephone number. fill in you checked If “no", in fillthe other party’s name address, and telephone number. namezifiu Party/Attorney mm A ( RRM\ VMA Addressflelephone number: ‘ (1‘9, bl.” HP yd HI?“ {My {:4 QCUZZ 3. OTHER CASES: Have the case been involved parties to this with in litigation each otherinanother Family, Probate Civil, Case? Juvenile, or Criminal Court D Yes No lf “yes”, case(s) number(s): 4. NOTICE a. lHAVE given notice to the opposing party andlor their attorney by the following method: D Personal deliveryD Overnight CarrierU Class Mail First D Other: Date:_____________ Time: | my have received confirmation that the other party has received papers as follows: (describe) b. |HAVE NOT given notice of the request for orders because (Check that apply. all You must explain below): m Thisisan application Harassment Prevention for Civil Act,ElderAbuse, Private Postsecondary School Violence, Housing Misconduct, or Workplace Violence Act Transitional restraining orders and: m Great or irreparable can be heard on notice. injury will result before the matter D Itisimpossible to give notice. D The otherparty agrees to the orders requested. D Other: c. Explanation: D A hearing between the parties is already set l am asking that this same motion be heard at the time. D |am unabie to serve the other party in the time required by iaw. m my Ifear for physical safety (and that of others, ifapplicable). D Other: ldeclare under penalty of perjury that the forgoing istrueand correct. 01101 Date 5W flank} Name Print ' TENS V firm 2 Lv/ fignarure REV 09/18/16 CV-5014 DECLARATION INSUPPORT 0F EX PARTE APPLICATION FOR Page1ofz CIVIL RESTRAINING ORDERS ATTACHMENT CV-5014 INSTRUCTIONS Please refer to Santa Clara County Local Civil Rules for more information. This form is not for use in restraining order applications filed at Family Court. This form is required inSanta Clara County, ifyou are asking the Judge to make immediate orders without the other party being present for a hearing. These orders are called ex parte orders. This form must be completed in any case where ex parte orders are requested. If you have given notice to the other side of your case, you must state the form of notice given. Notice means providing the other side of the case, either the attorney or a self—represented party, with copies of any papers that you want the Judge to review and any orders that you are requesting, If you have not given notice, you must explain why you have not given notice. There are some circumstances when notice may be waived, such as cases involving allegations of domestic violence where the safety of a party or a child might be at risk ifnotice is given. Itis up to the Judge in your case to determine whether notice will be required or not. SECTION #1 State whether you are the Petitioner or the Respondent in the case. Once a case is filed,the parties keep the same status in the case. You do not change from the Respondent to the Petitioner by filinga new motion in the case. If you do not have an attorney, you are considered self—represented. SECTION #2 Ifthe other party isrepresented by an attorney, you must provide the Court with the attorney’s name and address. Ifthe other party is not represented by an attorney, you must provide the Court with the other party’s address. SECTION #3 It is very important to list all other cases in which you and the other party have been involved with the courts. This would include other Family Law, Probate, Juvenile, Restraining Order, Child Support, Civil,or Criminal matters. If you do not have the case number, please put unknown and list thecounty and the year of the filing, possible. if SECTION #4A Unless notice is excused by the Court, you must provide notice of this motion to the other party before you deliver a copy to the Court. When you give such notice, specify how you did it (by courier or personally, for example) and at what time and date. Also, please explain how you know that the other side received copies of your papers and what response you were given. SECTION #4B lfyou did not give notice of this application, explain why in this section. Check as many boxes as apply. You may also write out any further explanation of your reasons for not giving notice. After this form iscompleted, attach itto your restraining order application and submit them as follows: o lf Civil Harassment, Workplace Violence. Private Postsecondary School Violence, or Transitional Housing Misconduct; to the CivilDivision Clerk's Office at 191 North First Street,San José, CA 95113 o IfElder or Dependant Adult Abuse; to the Family Division Clerk's Office at 201 North First Street, San José, CA 95113 CV50“ REV 09/18/16 DECLARATION IN SUPPORT OF EX PARTE APPLICATION FOR Page 2 0‘2 CIVIL RESTRAINING ORDERS