SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE INDIO 46-200 Oasis St., Indio, CA 92201 RIVERSIDE 4050 Main St., Riverside, CA 92501 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number and Address) TEMECULA 41002 County Center Dr., #100, Temecula, CA 92591 RI-PR086 FOR COURT USE ONLY TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: REQUEST TO MODIFY TERMINATE ELDER OR DEPENDENT ADULT ABUSE RESTRAINING ORDER 1. Party Seeking Modification/Termination a. Full Name: b. Protected person Restrained Person Other Party a. Full Name: b. Address (if known): City: Conservator/Other 2. State: Zip: 3. Current Order a. The current order is an: Elder or Dependent Adult Abuse Restraining Order After Hearing (form EA-130) Order Renewing Elder or Dependent Adult Abuse Restraining Order (Form EA-730) b. The current order expires on (date): c. A copy of the current order is attached. a. Request to Modify Restraining Order I ask the court to modify the current order as follows (specify requested changes referring to the item number in order that you want to change or delete): Check here if there is not enough space for your answer. Attach a sheet of paper and write "Attachment 4a ­ Requested Changes" for a title. You may use form MC-025, Attachment. 4. Page 1 of 3 Approved for Optional Use Riverside Superior Court Form RI-PR086 [Rev. 05/09/17] REQUEST TO MODIFY/TERMINATE ELDER OR DEPENDENT ADULT ABUSE RESTRAINING ORDER (Elder or Dependent Adult Abuse Prevention) Welfare and Institutions Code § 15657.03(i) Riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: b. I ask the court to modify the order because (explain below): Check here if there is not enough space for your answer. Attach a sheet of paper and write "Attachment 4b ­ Reasons for Requested Changes" for a title. You may use form MC-025, Attachment. The person in item 2 has indicated that he/she agrees to the above modifications. 5. Request to Terminate Restraining Order I ask the court to terminate the order because (explain below): Check here if there is not enough space for your answer. Attach a sheet of paper and write "Attachment 5 ­ Reasons to Terminate Order" for a title. You may use form MC-025, Attachment. The person in item 2 has indicated that he/she agrees to terminate the current order. Page 2 of 3 Approved for Optional Use Riverside Superior Court Form RI-PR086 [Rev. 05/09/17] REQUEST TO MODIFY/TERMINATE ELDER OR DEPENDENT ADULT ABUSE RESTRAINING ORDER (Elder or Dependent Adult Abuse Prevention) Welfare and Institutions Code § 15657.03(i) Riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: CASE NUMBER: 6. Lawyer's Fees and Costs I ask the court to order payment of my: The amounts requested are: Item $ $ $ a. Lawyer's fees b. Item Court costs Amount Amount $ $ $ Check here if there are more items. Put the items and amounts on the attached sheet of paper or form MC-025 and write "Attachment 6 ­ Lawyer's Fees and Costs" for a title. Notice to the Restrained Person: If you are requesting a modification or termination of the restraining order, you must have the protected person personally served with this Request and file a proof of service with the court before the hearing. You may use form EA-200, Proof of Personal Service. I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: (TYPE OR PRINT YOUR NAME) (SIGN YOUR NAME) Page 3 of 3 Approved for Optional Use Riverside Superior Court Form RI-PR086 [Rev. 05/09/17] REQUEST TO MODIFY/TERMINATE ELDER OR DEPENDENT ADULT ABUSE RESTRAINING ORDER (Elder or Dependent Adult Abuse Prevention) Welfare and Institutions Code § 15657.03(i) Riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com