Form DV-100 "Request for Domestic Violence Restraining Order" - California

What Is Form DV-100?

This is a legal form that was released by the California Superior Court - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2016;
  • The latest edition provided by the California Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

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

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Download Form DV-100 "Request for Domestic Violence Restraining Order" - California

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Request for Domestic
Clerk stamps date here when form is filed.
DV-100
Violence Restraining Order
You must also complete Form CLETS-001, Confidential CLETS Information,
and give it to the clerk when you file this Request.
Name of Person Asking for Protection:
1
Age:
Your lawyer in this case (if you have one):
Name:
State Bar No.:
Firm Name:
Address (If you have a lawyer for this case, give your lawyer’s
Fill in court name and street address:
information. If you do not have a lawyer and want to keep your home
Superior Court of California, County of
address private, give a different mailing address instead. You do not have
to give your telephone, fax, or e-mail.):
Address:
City:
State:
Zip:
Telephone:
Fax:
E-Mail Address:
Court fills in case number when form is filed.
Name of Person You Want Protection From:
2
Case Number:
Description of person you want protection from:
Sex:
M
F
Height:
Weight:
Hair Color:
Eye Color:
Race:
Age:
Date of Birth:
Address (if known):
City:
State:
Zip:
Do you want an order to protect family or household members?
Yes
No
3
If yes, list them:
Full name
Sex
Age
Lives with you?
Relationship to you
Yes
No
Yes
No
Yes
No
Check here if you need more space. Attach a sheet of paper and write “DV-100, Protected People” for a title.
What is your relationship to the person in
?
2
(Check all that apply):
4
We are now married or registered domestic partners.
a.
If you do not have one of these relationships,
We used to be married or registered domestic partners.
b.
the court may not be able to consider your
c.
We live together.
request. Read Form
DV-500-INFO
for help.
We used to live together.
d.
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:
Child’s Name:
Date of Birth:
Child’s Name:
Date of Birth:
Child’s Name:
Date of Birth:
Check here if you need more space. Attach 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.
Judicial Council of California, www.courts.ca.gov
DV-100,
Request for Domestic Violence Restraining Order
Page 1 of 6
Revised July 1, 2016, Mandatory Form
Family Code, § 6200 et seq.
(Domestic Violence Prevention)
Request for Domestic
Clerk stamps date here when form is filed.
DV-100
Violence Restraining Order
You must also complete Form CLETS-001, Confidential CLETS Information,
and give it to the clerk when you file this Request.
Name of Person Asking for Protection:
1
Age:
Your lawyer in this case (if you have one):
Name:
State Bar No.:
Firm Name:
Address (If you have a lawyer for this case, give your lawyer’s
Fill in court name and street address:
information. If you do not have a lawyer and want to keep your home
Superior Court of California, County of
address private, give a different mailing address instead. You do not have
to give your telephone, fax, or e-mail.):
Address:
City:
State:
Zip:
Telephone:
Fax:
E-Mail Address:
Court fills in case number when form is filed.
Name of Person You Want Protection From:
2
Case Number:
Description of person you want protection from:
Sex:
M
F
Height:
Weight:
Hair Color:
Eye Color:
Race:
Age:
Date of Birth:
Address (if known):
City:
State:
Zip:
Do you want an order to protect family or household members?
Yes
No
3
If yes, list them:
Full name
Sex
Age
Lives with you?
Relationship to you
Yes
No
Yes
No
Yes
No
Check here if you need more space. Attach a sheet of paper and write “DV-100, Protected People” for a title.
What is your relationship to the person in
?
2
(Check all that apply):
4
We are now married or registered domestic partners.
a.
If you do not have one of these relationships,
We used to be married or registered domestic partners.
b.
the court may not be able to consider your
c.
We live together.
request. Read Form
DV-500-INFO
for help.
We used to live together.
d.
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:
Child’s Name:
Date of Birth:
Child’s Name:
Date of Birth:
Child’s Name:
Date of Birth:
Check here if you need more space. Attach 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.
Judicial Council of California, www.courts.ca.gov
DV-100,
Request for Domestic Violence Restraining Order
Page 1 of 6
Revised July 1, 2016, Mandatory Form
Family Code, § 6200 et seq.
(Domestic Violence Prevention)
Case Number:
Other Restraining Orders and Court Cases
5
Are there any restraining/protective orders currently in place OR that have expired in the last six months
a.
(emergency protective orders, criminal, juvenile, family)?
No
Yes
(date of order):
and (expiration date):
(Attach a copy if you have one).
b.
Have you or any other person named in
3
been involved in another court case with the person in
2
?
If yes, check each kind of case and indicate where and when each was filed:
No
Yes
Kind of Case
County or Tribe Where Filed
Year Filed
Case Number (if known)
Divorce, Nullity, Legal Separation
Civil Harassment
Domestic Violence
Criminal
Juvenile, Dependency, Guardianship
Child Support
Parentage, Paternity
Other (specify):
Check here if you need more space. Attach a sheet of paper and write “DV-100, Other Court Cases” for a
title.
þ
Check the orders you want.
Personal Conduct Orders
6
I ask the court to order the person in
2
not to do the following things to me or anyone listed in
3
:
a.
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
b.
Contact, either directly or indirectly, in any way, including but not limited to, by telephone, mail or e-mail
or other electronic means
The person in
will be ordered not to take any action to get the addresses or locations of any protected
2
person unless the court finds good cause not to make the order.
Stay-Away Order
7
a.
I ask the court to order the person in
2
to stay at least
yards away from (check all that apply):
Me
My school
My home
Each person listed in
3
My job or workplace
The child(ren)’s school or child care
My vehicle
Other (specify):
If the person listed in
is ordered to stay away from all the places listed above, will he or she still be able to
b.
2
Yes
No (If no, explain):
get to his or her home, school, job, workplace, or vehicle?
Move-Out Order
8
(If the person in
lives with you and you want that person to stay away from your home, you must ask for
2
this move-out order.)
I ask the court to order the person in
to move out from and not return to (address):
2
I have the right to live at the above address because (explain):
This is not a Court Order.
Revised July 1, 2016
DV-100,
Request for Domestic Violence Restraining Order
Page 2 of 6
(Domestic Violence Prevention)
Case Number:
Guns or Other Firearms or Ammunition
9
I believe the person in
2
owns or possesses guns, firearms, or ammunition.
Yes
No
I don’t know
If the judge approves the order, the person in
2
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.
Record Unlawful Communications
10
I ask for the right to record communications made to me by the person in
2
that violate the judge’s orders.
Care of Animals
11
I ask for the sole possession, care, and control of the animals listed below. I ask the court to order the person in
2
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 Visitation
12
I do not have a child custody or visitation order and I want one.
a.
b.
I have a child custody or visitation order and I want it changed.
If you ask for orders, you must fill out and attach Form DV-105, Request for Child Custody and Visitation Orders.
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).
Child Support
(Check all that apply):
13
I do not have a child support order and I want one.
a.
I have a child support order and I want it changed.
b.
I now receive or have applied for TANF, Welfare, CalWORKS, or Medi-Cal.
c.
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).
Property Control
14
I ask the court to give only me temporary use, possession, and control of the property listed here:
Debt Payment
15
I ask the court to order the person in
to make these payments while the order is in effect:
2
Check here if you need more space. Attach a sheet of paper and write “DV-100, Debt Payment” for a title.
Pay to:
For:
Amount: $
Due date:
16
Property Restraint
2
I am married to or have a registered domestic partnership with the person in
. I ask the judge to order
that the person in
not borrow against, sell, hide, or get rid of or destroy any possessions or property, except
2
in the usual course of business or for necessities of life. I also ask the judge to order the person in
to notify
2
me of any new or big expenses and to explain them to the court.
Spousal Support
17
I am married to or have a registered domestic partnership with the person in
and no spousal support order
2
exists. I ask the court to order the person in
2
to pay spousal support. (You must complete, file, and serve
Form
FL-150, Income and Expense Declaration, before your hearing).
This is not a Court Order.
Revised July 1, 2016
DV-100,
Request for Domestic Violence Restraining Order
Page 3 of 6
(Domestic Violence Prevention)
Case Number:
Rights to Mobile Device and Wireless Phone Account
18
Property control of mobile device and wireless phone account
a.
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
:
(including area code):
my number
number of child in my care
(including area code):
my number
number of child in my care
(including area code):
my 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.
Debt Payment
b.
I ask the court to order the person in
2
to make the payments for the wireless phone accounts listed in 18a
because:
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.
Transfer of Wireless Phone Account
c.
I 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
.
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.
Insurance
19
2
I 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
2
, or our child(ren), for
whom support may be ordered, or both.
Lawyer’s Fees and Costs
20
I ask that the person in
pay some or all of my lawyer’s fees and costs.
2
You must complete, file, and serve
form
FL-150, Income and Expense Declaration, before your hearing.
Payments for Costs and Services
21
I ask the court to order the person in
2
to pay the following:
You can ask for lost earnings or your costs for services caused directly by the person in
2
(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: $
Batterer Intervention Program
22
I ask the court to order the person listed in
to go to a 52-week batterer intervention program and show proof
2
of completion to the court.
Other Orders
23
What other orders are you asking for?
Check here if you need more space. Attach a sheet of paper and write “DV-100, Other Orders” for a title.
This is not a Court Order.
Revised July 1, 2016
DV-100,
Request for Domestic Violence Restraining Order
Page 4 of 6
(Domestic Violence Prevention)
Case Number:
Time for Service (Notice)
24
The papers must be personally served on the person in
2
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”?
No Fee to Serve (Notify) Restrained Person
25
If you want the sheriff or marshal to serve (notify) the restrained person about the orders for free, ask the court
clerk what you need to do.
Court Hearing
26
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.
Describe Abuse
27
2
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.)
a.
Date of most recent abuse:
1.
Who was there?
2.
Describe how the person in
abused you or your child(ren):
2
Check here if you need more space. Attach a sheet of paper and write “DV-100, Recent Abuse” for a title.
3.
Did the person in
use or threaten to use a gun or any other weapon?
No
Yes (If yes, describe):
2
4.
Describe any injuries:
5.
Did the police come?
No
Yes
If yes, did they give you or the person in
2
an Emergency Protective Order?
Yes
No
I don’t know
Attach a copy if you have one.
The order protects
you or
the person in
2
This is not a Court Order.
DV-100,
Request for Domestic Violence Restraining Order
Page 5 of 6
Revised July 1, 2016
(Domestic Violence Prevention)
Page of 6