DV-101 Description of Abuse Case Number: This form is attached to DV-100, Request for Domestic Violence Restraining Order . 1 2 3 Name of person asking for protection: Name of person you want protection from: Describe abuse to you or your children. a. Date of abuse: b. Who was there? Describe how the person in 2 abused you or your children: d. Describe any use or threatened use of guns or other weapons: e. Describe any injuries: f. Did the police or other law enforcement come? No Yes If yes, did they give you or the person in 2 an Emergency Protective Order? The Emergency Protective Order protects You The person in 2 Attach a copy of the Emergency Protective Order if you have one. Yes No I don't know Judicial Council of California, www.courts.ca.gov Rev. January 1, 2017, Optional Form Family Code, § 6200 et seq. Description of Abuse (Domestic Violence Prevention) DV-101, Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 4 Describe abuse to you or your children. Has the person in 2 abused you (or your children) other times? a. Date of abuse: b. Who was there? c. Describe how the person in 2 abused you or your children: d. Describe any use or threatened use of guns or other weapons: e. Describe any injuries: No Yes f. Did the police or other law enforcement come? If yes, did they give you or the person in 2 an Emergency Protective Order? The Emergency Protective Order protects You The person in 2 Attach a copy of the Emergency Protective Order if you have one. 5 Describe abuse to you or your children. Yes No I don't know Check here if you need more space. Attach a sheet of paper and write "DV-101--Description of Abuse" for a title. Rev. January 1, 2017 Description of Abuse (Domestic Violence Prevention) DV-101, Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com