CH-110 1 Temporary Restraining Order Clerk stamps date here when form is filed. Person in 1 must complete items 1 , 2 , and 3 only. Protected Person a. Your Full Name: Your Lawyer (if you have one for this case): Name: State Bar No.: Firm Name: b. Your Address (If you have a lawyer, give your lawyer's information. If you do not have a lawyer and want to keep your home address private, you may give a different mailing address instead. You do not have to give telephone, fax, or e-mail.): Address: City: Telephone: E-Mail Address: State: Fax: Court fills in case number when form is filed. Fill in court name and street address: Superior Court of California, County of Zip: 2 Restrained Person Full Name: Description: Sex: M F Height: Weight: Eye Color: Age: State: Case Number: Date of Birth: Race: Zip: Hair Color: Home Address (if known): City: Relationship to Protected Person: 3 Additional Protected Persons In addition to the person named in 1 , the following family or household members of that person are protected by the temporary orders indicated below: Sex Age Household Member? Relation to Protected Person Full Name Yes No Yes Yes No No Check here if there are additional persons. List them on an attached sheet of paper and write "Attachment 3-- Additional Protected Persons" as a title. You may use form MC-025, Attachment. The court will complete the rest of this form. 4 Expiration Date This Order expires at the end of the hearing scheduled for the date and time below: Date: Time: a.m. p.m. This is a Court Order. Judicial Council of California, www.courts.ca.gov Revised January 1, 2017, Mandatory Form Code of Civil Procedure, §§ 527.6 and 527.9 Approved by DOJ Temporary Restraining Order (CLETS-TCH) (Civil Harassment Prevention) CH-110, Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: To the Person in 2 : The court has granted the temporary orders checked as granted 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. 5 Personal Conduct Orders Not Requested Denied Until the Hearing Granted as Follows: a. You must not do the following things to the person named in 1 and to the other protected persons listed in 3 : (1) (2) Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy personal property of, or disturb the peace of the person. Contact the person, either directly or indirectly, in any way, including, but not limited to, in person, by telephone, in writing, by public or private mail, by interoffice mail, by e-mail, by text message, by fax, or by other electronic means. Take any action to obtain the person's address or location. If this item (3) is not checked, the court has found good cause not to make this order. Other (specify): Other personal conduct orders are attached at the end of this Order on Attachment 5a(4). (3) (4) b. 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. However, you may have your papers served by mail on the person in 1 . 6 Stay-Away Order Not Requested a. You must stay at least (1) The person in 1 (2) (3) (4) (5) (6) Each person in 3 Denied Until the Hearing (7) (8) (9) Granted as Follows: yards away from (check all that apply): The place of child care of the children of the person in 1 The vehicle of the person in 1 Other (specify): The home of the person in 1 The job or workplace of the person in 1 The school of the person in 1 The school of the children of the person in 1 b. This stay-away order does not prevent you from going to or from your home or place of employment. 7 No Guns or Other Firearms and Ammunition a. You cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, other firearms, or ammunition. b. You must: (1) Sell to or store with a licensed gun dealer, or turn in to a law enforcement agency, any guns or other firearms in your immediate possession or control. This must be done within 24 hours of being served with this Order. This is a Court Order. Revised January 1, 2017, Mandatory Form Temporary Restraining Order (CLETS-TCH) (Civil Harassment Prevention) CH-110, Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: (2) File a receipt with the court within 48 hours of receiving this Order that proves that your guns or firearms have been turned in, sold, or stored. (You may use form CH-800, Proof of Firearms Turned In, Sold, or Stored, for the receipt.) c. 8 The court has received information that you own or possess a firearm. Possession and Protection of Animals Not Requested a. Denied Until the Hearing Granted as Follows (specify): The person in 1 is given the sole possession, care, and control of the animals listed below, which are owned, possessed, leased, kept, or held by him or her, or reside in his or her household. (Identify animals by, e.g., type, breed, name, color, sex.) b. The person in 2 must stay at least yards away from, and not take, sell, transfer, encumber, conceal, molest, attack, strike, threaten, harm, or otherwise dispose of, the animals listed above. 9 Other Orders Not Requested Denied Until the Hearing Granted as Follows (specify): Additional orders are attached at the end of this Order on Attachment 9. To the Person in 1 : 10 Mandatory Entry of Order Into CARPOS Through CLETS This Order must be entered into the California Restraining and Protective Order System (CARPOS) through the California Law Enforcement Telecommunications System (CLETS). (Check one): a. b. c. The clerk will enter this Order and its proof-of-service form into CARPOS. The clerk will transmit this Order and its proof-of-service form to a law enforcement agency to be entered into CARPOS. By the close of business on the date that this Order is made, the person in 1 or his or her lawyer should deliver a copy of the Order and its proof-of-service form to the law enforcement agency listed below to enter into CARPOS: Name of Law Enforcement Agency Address (City, State, Zip) Additional law enforcement agencies are listed at the end of this Order on Attachment 10. This is a Court Order. Revised January 1, 2017, Mandatory Form Temporary Restraining Order (CLETS-TCH) (Civil Harassment Prevention) CH-110, Page 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 11