SV-110 1 a. Name: Temporary Restraining Order Clerk stamps date here when form is filed. Petitioner (Educational Institution Officer or Employee) Lawyer for Petitioner (if any, for this case): Name: State Bar No.: Firm Name: b. Your Address (If you have a lawyer, give your lawyer's information.): Address: City: Telephone: E-Mail Address: State: Fax: Zip: Fill in court name and street address: Superior Court of California, County of 2 3 Student (Protected Person) Full Name: Court fills in case number when form is filed. Respondent (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 Student: 4 Additional Protected Persons In addition to the student, the following family or household members or other students are protected by the temporary orders indicated below: Relation to Student Sex Age Household Member? Full Name Yes No Yes Yes No No Additional protected persons are listed at the end of this Order on Attachment 4. 5 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, §§ 527.85 and 527.9 Approved by DOJ Temporary Restraining Order (CLETS--TSV) (Private Postsecondary School Violence Prevention) SV-110, Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: To the Person in 2 : The court has issued 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 have to go to jail for up to one year, pay a fine of up to $1,000, or both. 6 Personal Conduct Orders Not Requested Denied Until the Hearing Granted as Follows: a. You are ordered not do the following things to the student and to the other protected persons listed in 4 : (1) (2) (3) (4) (5) (6) (7) Harass, molest, strike, assault (sexually or otherwise), batter, abuse, destroy personal property of, or disturb the peace of the person. Commit acts of violence or make threats of violence against the person. Follow or stalk the person during school hours or to or from the school. 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 e-mail, by fax, or by other electronic means. Enter the person's school. Take any action to obtain the person's address or locations. If this item 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 6a(7). 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 petitioner. 7 Stay-Away Order Not Requested a. You must stay at least (1) (2) (3) (4) (5) (6) The student Each other protected person listed in 4 The school The student's home The student's job or workplace The student's children's school Denied Until the Hearing (7) (8) (9) Granted as Follows: yards away from (check all that apply): The student's children's place of child care The student's vehicle Other (specify): b. This stay-away order does not prevent you from going to or from your home or place of employment. This is a Court Order. Revised January 1, 2017 Temporary Restraining Order (CLETS--TSV) (Private Postsecondary School Violence Prevention) SV-110, Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 8 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. (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 SV-800, Proof of Firearms Turned In, Sold, or Stored for the receipt.) c. The court has received information that you own or possess a firearm. 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 petitioner or the petitioner's lawyer should deliver a copy of the Order and its proof-of-service form to the law enforcement agencies 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. Ordered 11 No Fee to Serve (Notify) Restrained Person The sheriff or marshal will serve this Order without charge because: a. b. The Order is based on a credible threat of violence or stalking. The petitioner is entitled to a fee waiver. Not Ordered This is a Court Order. Revised January 1, 2017 Temporary Restraining Order (CLETS--TSV) (Private Postsecondary School Violence Prevention) SV-110, Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 12 Number of pages attached to this Order, if any: Date: Judicial Officer Warnings and Notices to the Restrained Person in 2 You Cannot Have Guns or Firearms You cannot own, have, possess, buy or try to buy, receive or try to receive, or otherwise get guns, other firearms, or ammunition while this Order is in effect. If you do, you can go to jail and pay a $1,000 fine. You must sell to or store with a licensed gun dealer or turn in to a law enforcement agency any guns or other firearms that you have or control as stated in item 8 above