(This document must be filed by noon on the day of the ex parte hearing) NAME, ADDRESS & TELEPHONE NUMBER FOR COURT USE ONLY TELEPHONE NO: ATTORNEY FOR (NAME): FAX NO: SUPERIOR COURT OF CALIFORNIA COUNTY OF YUBA 215 FIFTH STREET, SUITE 200 MARYSVILLE, CA 95901-5737 (530) 749-7600 PLAINTIFF/PETITIONER: vs. DEFENDANT/RESPONDENT: REQUEST FOR WAIVER OF NOTICE WITH DECLARATION IN SUPPORT THEREOF CIVIL HARASSMENT ELDER ABUSE TEMPORARY RESTRAINING ORDERS CASE NUMBER: CIVIL HARASSMENT TEMPORARY RESTRAINING ORDERS I request that notice NOT be given by me. In support of this request, I provide the following statements pursuant to CCP section 527.6 (d) outlining the facts that show: Reasonable proof of harassment: and ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Great or irreparable harm would result by giving notice: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ELDER ABUSE TEMPORARY RESTRAINING ORDERS I request that notice NOT be given by me. In support of this request I provide the following statements per Welfare & Institutions Code section 15657.03: Reasonable proof of a past act or acts of abuse against me, an elder, are: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ The reason temporary orders are needed to prevent a recurrence of abuse are: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ I am also asking for an immediate order excluding defendant from the elder's residence. The facts in support of that request are: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Form Adopted for Mandatory Use Yuba County Superior Court Effective 3/1/14; Revised 3/26/14 REQUEST FOR WAIVER OF NOTICE WITH DECLARATION IN SUPPORT THEREOF CIVIL HARASSMENT ELDER ABUSE TEMPORARY RESTRAINING ORDER FL14074 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com (This document must be filed by noon on the day of the ex parte hearing) SHORT TITLE: CASE NUMBER: I have a right to possession of the premises. Title to the property is not in the sole name of the party to be excluded or in the name of the party to be excluded and any other party besides me and: ________________________________________________________________________________________ ________________________________________________________________________________________ _______________________________________________________________________________________ Defendant has assaulted or threatens to assault me, other named family or household members or my conservator, if any, as outlined below and: ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Physical or emotional harm would otherwise result. Other information ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: ________________________________________ Printed Name _____________________________________________ Signature of Declarant ________________________________________________________________________________________ ORDER GOOD CAUSE APPEARING, THE COURT ORDERS that waiver of the notice of the ex parte hearing ( Civil Harassment temporary restraining orders Elder abuse temporary restraining orders) is hereby: Granted Denied Date:______________ _________________________________ JUDGE OF THE SUPERIOR COURT Form Adopted for Mandatory Use Yuba County Superior Court Effective 3/1/14; Revised 3/26/14 REQUEST FOR WAIVER OF NOTICE WITH DECLARATION IN SUPPORT THEREOF CIVIL HARASSMENT ELDER ABUSE TEMPORARY RESTRAINING ORDER FL14074 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com