DV-101 Description of Abuse Case Number: អ This form is attached to DV-100, Item 21. ✔ 1 Your name: 2 Name of person you want protection from (restrained person): 3 Describe the 2nd most recent abuse. a. Date of 2nd most recent abuse: b. Who was there? c. What did the person in ❷ do or say to you that made you afraid? d. Describe any use or threatened use of guns or other weapons. e. Describe any injuries. f. Did the police come? អ No អ Yes If yes, did they give you an Emergency Protective Order? អ Yes អ No អ I don’t know Attach a copy if you have one. Judicial Council of California, www.courtinfo.ca.gov New January 1, 2003, Optional Form Family Code, § 6200 et seq. Description of Abuse (Domestic Violence Prevention) DV-101, Page 1 of 2 ➔ 2003 © American LegalNet, Inc. Case Number: Your name: 4 Describe other recent abuse. a. Date of other recent abuse: b. Who was there? c. What did the person in ❷ do or say to you that made you afraid? d. Describe any use or threatened use of guns or other weapons. e. Describe any injuries. f. Did the police come? អ No អ Yes If yes, did they give you an Emergency Protective Order? អ Yes អ No អ I don’t know Attach a copy if you have one. 5 អ Describe other abuse against you or your children. អ If you need more space, check the box and attach Form MC-020. Or attach a sheet of paper and write “DV-101 — Description of Abuse” at the top. New January 1, 2003 Description of Abuse DV-101, Page 2 of 2 (Domestic Violence Prevention) 2003 © American LegalNet, Inc.