WV-110 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): TELEPHONE NO.: FOR COURT USE ONLY FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): COURT SUPERIOR COURT OF CALIFORNIA, COUNTY OF COUNTY . . STREET ADDRESS: . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : MAILING ADDRESS: CITY AND ZIP CODE: Index No. : BRANCH NAME: PLAINTIFF: Plaintiff(s) DEFENDANT: -against- EMPLOYEE: RESPONSE TO PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (Workplace Violence) Defendant(s) Calendar No. : JUDICIAL SUBPOENA : : : CASE NUMBER: : ...................................................... This response will be considered by the judge at the court hearing. You must still obey any orders granted until the hearing. Read the Instructions for Petitions to Prohibit Workplace Violence (form WV-150) before completing this form. I respond to the Petition of Employer for Injunction Prohibiting Violence or Threats of Violence Against Employee as follows: THE PEOPLE OF THE STATE OF NEW YORK 1. PERSONAL CONDUCT ORDERS a. I consent toTO order requested. the I do not consent to the order requested. b. I consent to the following order (specify): c. GREETINGS: 2. 3. 4. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before STAY-AWAY ORDERS , the Honorable at the Court I consent to the orders requested. a. located at County of I do not consent to the orders requested. b. in room , on the day of , 20 , at o'clock in the noon, and at any recessed I consent toor adjourned date, to testify and give evidence as a witness in this action on the part of the the following orders (specify): c. FIREARMS PROHIBITION AND RELINQUISHMENT ORDER subpoena is punishable as a contempt of court and will make you liable to Your failure to comply with this the party on whose behalf this subpoena I do not own, possess, or control any firearms. was issued for a maximum penalty of $50 and all damages sustained as a a. I consent toresult of your failure to comply. the orders requested. b. I do not consent to the orders requested. c. Witness, Honorable , one of the Justices of the I consent to the following orders (specify): d. Court in County, day of , 20 OTHER ORDERS I consent to the other orders requested in the petition. a. b. I do not consent to the other orders requested in the petition. I consent to the following orders (specify): c. (Attorney must sign above and type name below) Attorney(s) for 5. DENIAL Office and P.O. Address a. I deny doing all of the acts stated in item 5 of the petition. I deny doing some of the acts stated in item 5 of the petition. (Specify the acts you deny doing): b. Form Adopted for Mandatory Use Judicial Council of California WV-110 [Rev. July 1, 2004] I Telephone No.: Facsimile No.: E-Mail RESPONSE TO PETITION OF EMPLOYER Address: Mobile FOR INJUNCTION PROHIBITING VIOLENCE Tel. No.: OR THREATS OF VIOLENCE AGAINST EMPLOYEE (Workplace Violence) Page 1 of 2 Code of Civil Procedure, § 527.8 American LegalNet, Inc. www.USCourtForms.com CASE NUMBER: PLAINTIFF (Name): DEFENDANT(Name): 6. a. JUSTIFICATION OR EXCUSE I have done some or all of the acts of which I am accused, but the actions are justified or excused for the following reasons: My acts were lawful acts of self-defense or defense of others (specify): COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : b. My acts served a legitimate purpose (specify): : Plaintiff(s) -againstc. Index No. Calendar No. : JUDICIAL SUBPOENA : My acts were constitutionally protected (specify): : : Defendant(s) : ...................................................... 7. INJUNCTION An injunction should not be granted for the following additional reasons (specify): THE PEOPLE OF THE STATE OF NEW YORK TO (If more space is needed, check the box and add additional pages as Attachment 7.) GREETINGS: 8. EXPENSES AND COSTS I request the court to order WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court a. expenses incurred as the result of the issuance of a temporary restraining order without sufficient supporting facts. located at County of The expenses are as follows: on the in room , day of , 20 , at o'clock in the noon, and at any recessed Item Amount or adjourned date, to testify and give evidence as a witness in this action on the part of the b. c. 9. costs. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Additional relief as may be proper.Honorable Witness, Court in County, , one of the Justices of the day of , 20 NO FILING FEE I am not required to pay a filing fee for this response because the petition alleges that I have inflicted or threatened violence against an employee of the plaintiff, or stalked the employee, or acted or spoke in any other manner that has placed the (Attorney injunctions and type name below) employee in reasonable fear of violence, and seeks protective or restraining orders or must sign aboverestraining stalking or future violence or threats of violence under Code of Civil Procedure section 527.8 (Signature of attorney, if any): (TYPE OR PRINT NAME OF ATTORNEY) Attorney(s) for (SIGNATURE OF ATTORNEY) Office true and correct. I declare under penalty of perjury under the laws of the State of California that the foregoing isand P.O. Address Date: (TYPE OR PRINT NAME) WV-110 [Rev. July 1, 2004] I Telephone No.: Facsimile No.: E-Mail Address: OF DEFENDANT) (SIGNATURE Mobile Tel. No.: RESPONSE TO PETITION OF EMPLOYER FOR INJUNCTION PROHIBITING VIOLENCE OR THREATS OF VIOLENCE AGAINST EMPLOYEE (Workplace Violence) Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com