AT T O RN E Y OR PAR T Y WIT H O U T AT T O R N E Y ( N a m e & A d dress) : Telephone N o.: Fax No.: E - Mail Address: AT T O RN E Y FO R (N a m e ): Bar No: FOR COURT USE ONLY SUPERI O R C O URT OF CALI F O R N I A, C O U N TY OF O RA NGE Centr a l Justice Center 700 C ivic C e nter Dr. W est Santa A n a, CA 927 0 1 - 4 045 PETITIONER: RESPOND E NT: E X P A R T E A PPLI C A T I O N & DEC L A R A T IO N T O A M EN D O R TERM I N A T E ELDE R OR D EPEN D E N T A DU L T A BUS E R EST R A I N I N G O R DER CASE NUMBER: 1. I am the Elder/Dependent Adult the Person Authorized to Act on behalf of the Elder/Dependent Adult an Additional Person protected by the restraining order the Respondent in this matter. Notice of this Application is not required when/where I am the person protected by the restraining order. (CRC Rule 3.1204(b)(3)) 2. On (date) the Court issued a Temporary 5-Year Permanent Elder or Dependent Adult Abuse Restraining Order in this matter. (Attach a copy of the Restraining Order) 3. I move the Court to: Terminate this Restraining Order Amend this Restraining Order as follows: Note: Amendment must not make a Permanent Restraining Order more restrictive. 4. I request that this termination or amendment be made effective as of (date): 5. I am making this Application for the following reason(s): Check here if there is not enough space for your answer, then put your complete answer on an attached sheet of paper or Form MC-025. Note: This application may be denied unless the Elder/Dependent Adult, and/or Additional Protected Person, is personally present with a valid photo ID. I respectfully ask the Court to grant this application, as well as any other relief that may be just and proper. I understand that I am required to personally appear in Court before the requested relief may be granted. 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 OF DECLARANT) Approved for Optional use Form L-2702 (Revised October 2017) EX PARTE APPLICATION & DECLARATION TO AMEND OR TERMINATE ELDER OR DEPENDENT ADULT ABUSE RESTRAINING ORDER Welfare & Institutions Code 24715657.03(i) California Rules of Court, rule 3.1204(b) www.occourts.org American LegalNet, Inc. www.FormsWorkFlow.com