Form TH-100 "Petition for Order Prohibiting Abuse or Program Misconduct" - California

What Is Form TH-100?

This is a legal form that was released by the California Superior Court - a government authority operating within California. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on September 1, 2018;
  • The latest edition provided by the California Superior Court;
  • Easy to use and ready to print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form TH-100 by clicking the link below or browse more documents and templates provided by the California Superior Court.

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Download Form TH-100 "Petition for Order Prohibiting Abuse or Program Misconduct" - California

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TH-100
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE BAR NUMBER:
FOR COURT USE ONLY
NAME:
FIRM NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE NO.:
FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PROGRAM OPERATOR:
PARTICIPANT:
PETITION FOR ORDER PROHIBITING ABUSE
OR PROGRAM MISCONDUCT
CASE NUMBER:
Application for Temporary Restraining Order
Modification of Previous Order
(date):
(THIS IS NOT AN ORDER)
• Read the Instructions for Program Operators before completing this form.
• You must have a copy served on the participant at least two days before the hearing.
1. Jurisdiction. This suit is filed in this county because participant resides in this county.
2.
Program operator (name):
operates a "transitional housing program" as defined in Health and Safety Code section 50582(g).
a.
Governmental agency (specify):
Manager or operator
b.
Private nonprofit corporation receiving program funds from a governmental agency
Manager or operator
The funding agency is (specify):
3.
Program site (specify street address, city, ZIP Code):
a.
Dwelling unit of participant
(address optional):
Other locations of the program (addresses):
b.
4. Participant to be restrained or excluded is a "homeless person" dwelling at a "program site" as defined in Civil Code section
1954.12 (name all to be restrained or excluded):
Name
Age (if under 18)
5.
Persons living with participant in participant's dwelling unit who are not to be restrained or excluded (name all below).
If none, check this box:
Age (if under 18)
Family relationship
Name
6.
Participant has signed a contract with the program operator. The contract includes (attach a copy of the signed contract)
a.
Program rules and regulations.
b. A statement of program operator's right of control over and access to the program unit occupied by participant.
c.
A summary of the requirements and procedures of Civil Code sections 1954.10-1954.18.
(Continued on reverse)
Page 1 of 4
Form Adopted for Mandatory Use
PETITION FOR ORDER PROHIBITING ABUSE
Civil Code, § 1954.13
Judicial Council of California
www.courts.ca.gov
OR PROGRAM MISCONDUCT
TH-100 [Rev. September 1, 2018]
(Transitional Housing Misconduct)
TH-100
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE BAR NUMBER:
FOR COURT USE ONLY
NAME:
FIRM NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE NO.:
FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PROGRAM OPERATOR:
PARTICIPANT:
PETITION FOR ORDER PROHIBITING ABUSE
OR PROGRAM MISCONDUCT
CASE NUMBER:
Application for Temporary Restraining Order
Modification of Previous Order
(date):
(THIS IS NOT AN ORDER)
• Read the Instructions for Program Operators before completing this form.
• You must have a copy served on the participant at least two days before the hearing.
1. Jurisdiction. This suit is filed in this county because participant resides in this county.
2.
Program operator (name):
operates a "transitional housing program" as defined in Health and Safety Code section 50582(g).
a.
Governmental agency (specify):
Manager or operator
b.
Private nonprofit corporation receiving program funds from a governmental agency
Manager or operator
The funding agency is (specify):
3.
Program site (specify street address, city, ZIP Code):
a.
Dwelling unit of participant
(address optional):
Other locations of the program (addresses):
b.
4. Participant to be restrained or excluded is a "homeless person" dwelling at a "program site" as defined in Civil Code section
1954.12 (name all to be restrained or excluded):
Name
Age (if under 18)
5.
Persons living with participant in participant's dwelling unit who are not to be restrained or excluded (name all below).
If none, check this box:
Age (if under 18)
Family relationship
Name
6.
Participant has signed a contract with the program operator. The contract includes (attach a copy of the signed contract)
a.
Program rules and regulations.
b. A statement of program operator's right of control over and access to the program unit occupied by participant.
c.
A summary of the requirements and procedures of Civil Code sections 1954.10-1954.18.
(Continued on reverse)
Page 1 of 4
Form Adopted for Mandatory Use
PETITION FOR ORDER PROHIBITING ABUSE
Civil Code, § 1954.13
Judicial Council of California
www.courts.ca.gov
OR PROGRAM MISCONDUCT
TH-100 [Rev. September 1, 2018]
(Transitional Housing Misconduct)
(THIS IS NOT AN ORDER)
TH-100
CASE NUMBER:
PROGRAM OPERATOR:
PARTICIPANT:
Participant to be restrained or excluded (names):
7.
(Program misconduct) has intentionally violated the program rules and regulations. The violation substantially interferes
a.
with the orderly operation of the program AND involves (check at least one and cite the rule number):
(1)
drunkenness on the program site (rule no.):
(2)
unlawful use or sale of controlled substances (drugs) (rule no.):
(3)
theft (rule no.):
(4)
arson (rule no.):
(5)
destruction of property of the program operator, program employees, other participants, or persons living within 100
feet of the program site (names and relationships to program and rule no.):
(6)
violence or threats of violence and harassment of program employees, other participants, or persons living within
100 feet of the program site (names and relationships to program and rule no.):
b.
(Abuse) has intentionally or recklessly
(1)
caused or attempted bodily injury
(2)
caused or attempted sexual assault
(3)
caused fear of serious bodily injury
to program employees, other participants, or persons living within 100 feet of the program site (names and relationships to
program):
c. FACTS. Describe in detail the most recent incidents of program misconduct or abuse. State what happened, the dates and
times, and who did what to whom. Describe any injuries or damage. For alleged program misconduct, cite the rules and
regulations violated by each incident of misconduct. If more space is needed, attach additional pages and check this box:
(You may use form MC-031 (on the reverse of form MC-030) as an attachment or for the declarations (affidavits) of
witnesses.)
(Continued on next page)
TH-100 [Rev. September 1, 2018]
PETITION FOR ORDER PROHIBITING ABUSE
Page 2 of 4
OR PROGRAM MISCONDUCT
(Transitional Housing Misconduct)
(THIS IS NOT AN ORDER)
TH-100
CASE NUMBER:
PROGRAM OPERATOR:
PARTICIPANT:
PROGRAM OPERATOR REQUESTS THE COURT TO MAKE THE ORDERS INDICATED BY THE CHECK MARKS IN THE BOXES
BELOW.
8.
PROGRAM MISCONDUCT RESTRAINING ORDERS (BREAKING RULES). Participant must not intentionally violate the
program rules and regulations so as to interfere substantially with the orderly operation of the program and specifically the
rules and regulations on
a.
drunkenness on the program site (rule no.):
b.
unlawful use or sale of controlled substances (drugs) (rule no.):
c.
theft (rule no.):
d.
arson (rule no.):
e.
destruction of property (rule no.):
f.
violence or threats of violence and harassment (rule no.):
9.
ABUSE RESTRAINING ORDERS. Participant must not attack, strike, batter, or sexually assault, or threaten to attack,
strike, batter, or sexually assault
a.
program employees
b.
program participants
c.
persons living within 100 feet of the program site
and specifically the following persons (names):
10.
PROGRAM SITE EXCLUSION ORDERS. Participant must immediately move from and must not return to the program
site and the dwelling unit assigned to participant (address optional):
and may take participant's personal property needed until the hearing.
11.
STAY-AWAY ORDERS.Participant must stay at least 200 feet away from the following places:
a.
Dwelling unit assigned to participant (address optional):
b.
Other program site locations (addresses):
12.
OTHER ORDERS (specify other orders you request to help carry out the orders requested in items 8-11):
13.
I request that copies of orders be given to the following law enforcement agencies (specify all with jurisdiction over the program
sites):
Address
Law Enforcement Agency
14.
PREVIOUS PETITIONS. I have asked for restraining orders against participant before (specify case numbers and dates):
(Continued on next page)
TH-100 [Rev. September 1, 2018]
PETITION FOR ORDER PROHIBITING ABUSE
Page 3 of 4
OR PROGRAM MISCONDUCT
(Transitional Housing Misconduct)
(THIS IS NOT AN ORDER)
TH-100
CASE NUMBER:
PROGRAM OPERATOR:
PARTICIPANT:
REQUEST FOR TEMPORARY RESTRAINING ORDER
To Be Effective From Now Until the Hearing
8
9
11
12
I request that the orders requested in items
10
be effective
15.
from now until the hearing. (Note: Temporary exclusion orders under items 10-11 require an emergency.)
a. Participant
(date of contract):
(1)
has not been under contract with the program for more than six months
(2)
has been under contract with the program for more than six months, but
(i)
a restraining order is in effect and subject to further orders (specify in item 14).
(ii)
an action is pending against participant (specify in item 14).
b. Notice to participant.
Program operator
Operator's attorney (attach attorney's affidavit)
(1)
informed participant or his or her attorney on (date):
at (time):
of the date, time, and place this petition would be filed.
made the following good-faith efforts to inform participant or his or her attorney of the date, time, and place this
(2)
petition would be filed (specify efforts):
should not be required to inform the participant or his or her attorney of the date, time, and place this petition would
(3)
be filed because (specify reasons):
c.
NEED FOR IMMEDIATE ORDER BEFORE THE HEARING. Program operator, program participants, or persons living within
100 feet of the program site will suffer great and irreparable harm before this petition can be heard in court unless the court
makes those orders requested above effective now and until the hearing. (Specify the harm and why it will occur before the
hearing. For temporary exclusion orders under items 10-11, show emergency and need to prevent imminent serious bodily
injury.)
16.
Number of pages attached:
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
(SIGNATURE OF PROGRAM OPERATOR)
(TYPE OR PRINT NAME)
TITLE of person signing:
TH-100 [Rev. September 1, 2018]
Page 4 of 4
PETITION FOR ORDER PROHIBITING ABUSE
OR PROGRAM MISCONDUCT
(Transitional Housing Misconduct)
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