ATTORNEY OF RECORD OR PARTY WITHOUT ATTORNEY (Name and Address) For Court Use Only TELEPHONE NO; ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA , COUNTY OF SACRAMENTO th 720 9 Street Sacramento, CA 95814 Gordon D. Schaber Sacramento County Courthouse Case Number: REQUEST AND ORDER FOR FREE SERVICE OF RESTRAINING ORDER 1. Your name (person asking for protection): _________________________________________________________ Your address (skip if you have a lawyer): (If you want your address to be private, give a mailing address): Address: ________________________________________________ City: __________________________ State: ______ Zip: ________ Telephone (optional): ___________________ Your lawyer (if you have one): (Name, address, telephone number, and State Bar number): Name: ______________________________________________________ Address: ____________________________________________________ City: _____________________________ State: _______ Zip: _________ Telephone: ___________________________ 2. Name of person you want protection from: ___________________________________________________________ 3. I am entitled to free service of the restraining orders by the sheriff or marshal because I asked for a Civil Harassment, Workplace Violence or Private Postsecondary School Violence restraining order and my request was based on my fear of (check at least one box, if applicable): (1) credible threat of violence (2) stalking (If you are not entitled to free service you may be eligible under a fee waiver or may pay the sheriff or marshal to serve the restraining order.) 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 4. 5. ______________________________________ Sign your name The sheriff or marshal shall serve the restraining order without cost to the party, pursuant to item 3 above. The sheriff or marshal shall serve the restraining order with cost to the party. IT IS SO ORDERED: Date: _____________ ______________________________________________ Judge of the Superior Court 1 of 1 Request and Order for Free Service of Restraining Order CV\E-RO-01 (Rev. 2/29/2016) Optional American LegalNet, Inc. www.FormsWorkFlow.com