FL-412 PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT: CASE NUMBER: AFFIDAVIT OF FACTS CONSTITUTING CONTEMPT Domestic Violence/Custody and Visitation Attachment to Order to Show Cause and Affidavit for Contempt (form FL-410) 1. The Citee has violated the restraining order issued on (date): by contacting, molesting, harassing, attacking, striking, threatening, sexually assaulting, battering, telephoning, sending any messages to, following, stalking, destroying the personal property of, disturbing the peace of, keeping under surveillance, or blocking movements in public places and thoroughfares of me or any other person protected by the restraining order. (Specify which order was violated, how the order was violated, and when the violation occurred): 2. Continued on Attachment 1. The Citee has violated the restraining order issued on (date): by not moving from and staying away from the residence as ordered by the court. (Specify how the order was violated and when the violation occurred): Continued on Attachment 2. The Citee has violated the restraining order issued on (date): by not staying (specify): yards away from me, the other protected persons, my residence, my place of work, the children's school or place of child care, my vehicle, or other (specify): (Specify which order was violated, how the order was violated, and when the violation occurred): 3. 4. Continued on Attachment 3. The Citee has violated the restraining order issued on (date): by not relinquishing his or her firearm(s) as ordered by the court. (Specify which order was violated, how the order was violated, and when the violation occurred): 5. Continued on Attachment 4. The Citee has violated the restraining order issued on (date): by failure to complete court-ordered batterer's treatment/anger management class (specify how the order was violated): 6. Continued on Attachment 5. The Citee has violated order issued on (date): by violating the following custody or visitation order (specify which order was violated, how the order was violated, and when the violation occurred): Continued on Attachment 6. 7. The Citee has violated the order issued on (date): order was violated and how the order was violated): by violating other orders (specify which Continued on Attachment 7. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE) Page 1 of 1 Form Adopted for Mandatory Use Judicial Council of California FL-412 [Rev. January 1, 2003] AFFIDAVIT OF FACTS CONSTITUTING CONTEMPT Domestic Violence/Custody and Visitation Family Code, § 292; Code of Civil Procedure, §§ 1211.5, 2015.5 www.courtinfo.ca.gov 2003 © American LegalNet, Inc.