Form DV-100, Request for Domestic Violence Restraining Order Instructions

Check this box if you do not know whether the police came on the day of the most recent abuse.

Check this box if the police did not come on the day of the most recent abuse.

Check this box if the police came on the day of the most recent abuse (if the police gave you a restraining order, list it in ④).

Provide detailed information about how the person in ② was abusive on this day, including what was said, done, or sent to you (for example, text messages, emails, or pictures) and how often something happened.

Provide detailed information about how the person in ② was abusive on the day of the most recent incident, including what was said, done, or sent (for example, text messages, emails, or pictures) and how often it occurred.

Provide detailed information about how the person in box 2 was abusive on this day, including what was said, done, or sent to you (such as text messages, emails, or pictures) and how often incidents occurred.

Check this box if you need more space to describe the abuse.

Check this box if the person in ② abused you two to five times.

Check this box if the person in ② abused you on a weekly basis.

Check this box if the frequency of abuse does not match the other options and provide the specific pattern and dates.

Enter how often the abuse occurred when the Other option is selected. Fill only if the 'Other' is 'Yes'.

Enter the date when the abusive incident occurred (give an estimate if you don’t know the exact date).

Check this box if you do not know whether the police came on the day of the incident.

Check this box if the police did not come on the day of the incident.

Check this box if the police came on the day of the incident.

Check this box if you don’t know whether anyone else heard or saw what happened on this day.

Check this box if no one else heard or saw what happened on this day.

Check this box if someone else heard or saw what happened on this day.

List the names of any people who heard or saw what happened on the date of the most recent abuse. Fill only if the 'Did anyone else hear or see what happened on this day?' is Yes.

Check this box if you do not know whether the person in 2 has firearms, firearm parts, or ammunition.

Check this box if the person in 2 does not have firearms, firearm parts, or ammunition.

Check this box if the person in 2 has firearms, firearm parts, or ammunition.

Check this box if the person listed in 2 holds the rights to your or your child’s wireless phone account and you want the judge to transfer the account to you.

Check this box if you want the judge to transfer your wireless phone account number to you.

Check this box if you want the judge to transfer your child’s wireless phone account number to you.

Check this box if you are asking the court to prohibit the person in 2 from taking, selling, hiding, molesting, attacking, striking, threatening, harming, getting rid of, transferring, or borrowing against the animals.

Check to request that the court give you sole possession, care, and control of the animals.

Check if the person listed in (2) abuses the animals. Fill only if the 'Give sole possession, care, and control of the animals' is 'Yes'.

Check if you are the one who takes care of these animals. Fill only if the 'Give sole possession, care, and control of the animals' is 'Yes'.

Check if you purchased these animals. Fill only if the 'Give sole possession, care, and control of the animals' is 'Yes'.

Check if there is another reason and explain it on the line provided. Fill only if the 'Give sole possession, care, and control of the animals' is 'Yes'.

Enter an explanation for the "Other" reason you are requesting sole possession of the animals. Fill only if the 'Other (please explain)' is 'Yes'.

Enter any additional details explaining the "Other" reason for requesting sole possession of the animals. Fill only if the 'Other (please explain)' is 'Yes'.

Enter the primary color or colors of the first animal (for example, black, white and brown, calico).

Enter the name or other way to identify the second animal you want the court to protect. Fill only if the 'Protect Animals' box is 'Yes'.

Enter the type of the second animal you want the court to protect (for example, dog, cat, bird). Fill only if the 'Protect Animals' box is 'Yes'.

Enter the breed of the second animal if known. Fill only if the 'Protect Animals' box is 'Yes'.

Enter the color of the second animal. Fill only if the 'Protect Animals' box is 'Yes'.

Enter the name or other way to identify the third animal you are asking the court to protect.

Enter the type or species of the third animal you are asking the court to protect.

Enter the breed of the third animal you are asking the court to protect, if known.

Enter the color of the third animal you are asking the court to protect.

Enter the name or other identifying information for the fourth animal you are asking the court to protect.

Enter the species or type (for example, dog, cat) of the fourth animal you are asking the court to protect.

Enter the breed of the fourth animal, if known.

Enter the color of the fourth animal.

Check this box to request that the person in (2) be ordered to stay away from the animals listed above by a minimum distance.

Check this box to specify a stay-away distance of 100 yards (300 feet). Fill only if the 'Stay away from the animals by at least' is 'Yes'.

Check this box to specify a different stay-away distance in yards. Fill only if the 'Stay away from the animals by at least' is 'Yes'.

Enter the number of yards the restrained person must stay away from the protected animals. Fill only if the 'Other (number of yards)' checkbox is Yes.

Enter the name of the first animal you want the court to protect or another way to identify it (for example, a microchip number or distinctive mark).

Enter the species or general type of the first animal (for example, dog, cat, horse, etc.).

Enter the breed of the first animal if you know it (for example, Labrador Retriever, Siamese, Quarter Horse).

Enter the total number of extra pages or forms attached to this DV-100 request.

Enter the full name of the petitioner’s lawyer.

Enter the State Bar number of the petitioner’s lawyer.

Enter the name of the law firm representing the petitioner’s lawyer.

Enter the unique case number assigned by the court for this restraining order request.

Enter the court-assigned case number for this domestic violence restraining order request.

Enter the court-assigned case number for your domestic violence restraining order request.

Enter the court-assigned case number for your domestic violence restraining order request.

Enter the court-assigned case number for this domestic violence restraining order request.

Enter the court-assigned case number for this domestic violence restraining order proceeding.

Enter the court-assigned case number for this domestic violence restraining order request.

Enter the official court case number assigned to this domestic violence restraining order request.

Enter the court-assigned case number for this domestic violence restraining order request.

Check this box if you have a child with the person in 2 and want the judge to make or change a child custody or visitation order. You must fill out form DV-105, Request for Child Custody and Visitation Orders, and attach it to this form.

Check this box if you have a minor child with the person in (2) and you want a child support order.

Check if you do not have a child support order and you want the court to issue one. Fill only if the 'Child Support' is 'Yes'.

Check if you have a child support order and you want the court to change it (attach a copy if you have one). Fill only if the 'Child Support' is 'Yes'.

Check if you receive or have applied for TANF, Welfare, or CalWORKS. Fill only if the 'Child Support' is 'Yes'.

Check this box if you want the judge to allow you to record calls or communications the person in 2 makes to you when those calls or communications violate this restraining order.

Enter the telephone number where the court may contact you (optional).

Enter the fax number where the court may contact you (optional).

Enter your email address where the court may contact you (optional).

Check this box if you are requesting the judge to transfer billing responsibility and rights for your phone number on the second wireless phone account (item b).

Check this box if you are requesting the judge to transfer billing responsibility and rights for your child’s phone number on the second wireless phone account (item b).

Check this box to ask the judge to transfer your own wireless phone number under the third Transfer of Wireless Phone Account request.

Check this box to ask the judge to transfer the wireless phone number of a child in your care under the third Transfer of Wireless Phone Account request.

Check this box if you want the judge to order the wireless service provider to transfer your number in the Fourth Wireless Phone Transfer section to you.

Check this box if you want the judge to order the wireless service provider to transfer the number of your child in your care in the Fourth Wireless Phone Transfer section to you.

Enter the name of the Superior Court (including the county) and its full street address where this restraining order will be filed.

Enter the court-assigned case number for this domestic violence restraining order once it has been filed.

Check this box if you want the judge to order the person in item 2 to not abuse you or anyone listed in item 8.

Check this box if you want the judge to order the person in item 2 to not contact you or anyone listed in item 8.

Check this box to ask the judge to order the person listed in 2 to go to a 52-week batterer intervention program.

Check this box if you know how the person in (2) made the debt or debts. Fill only if the 'Do you want the judge to make this special decision (finding)?' is 'Yes'.

Provide a detailed explanation of how the person in 2 made the debt or debts. Fill only if the 'Do you know how the person in 2 made the debt or debts?' is 'Yes'.

Check this box if you do not want the judge to make a special decision (finding) about the debt.

Check this box if you want the judge to make a special decision (finding) about the debt.

Enter the due date for the first debt payment (for example, MM/DD/YYYY).

Enter the name of the person or organization to whom the second debt payment should be made.

Enter what the second payment is for (for example, rent, mortgage, or car payment).

Enter the dollar amount owed for the second debt payment.

Enter the date by which the second debt payment must be made.

Enter the name of the person or organization to whom you want the person in (2) to make the third payment.

Enter what the third payment is for (for example, rent, mortgage, or car payment).

Enter the dollar amount you want the person in (2) to pay for the third debt.

Enter the due date for the third payment.

Explain why you want the person in (2) to pay the debts listed above. Fill only if the 'Pay Debts (Bills) Owed for Property' is 'Yes'.

Check this box if there are no restraining orders currently in place or that have expired in the last six months.

Check this box if there are restraining orders currently in place or that have expired in the last six months.

Enter the date when the first existing restraining order was issued (e.g., MM/DD/YYYY).

Enter the date when the first existing restraining order expires (e.g., MM/DD/YYYY).

Enter the date when the second restraining order was issued. Fill only if the 'Restraining orders currently in place or expired in the last six months' is 'Yes'.

Check if you and the person in 2 have one or more children together and list their names on the line provided.

Enter the full name of the first child you have together with the person in section 2. Fill only if the 'We have a child or children together' is 'Yes'.

Enter the full name of the second child you have together with the person in section 2. Fill only if the 'We have a child or children together' is 'Yes'.

Check this box if the person identified in section 2 is your parent, stepparent, or parent-in-law. Fill only if the 'f. We are related' is Yes.

Check this box if the person identified in section 2 is your brother, sister, sibling, stepsibling, or sibling-in-law. Fill only if the 'f. We are related' is Yes.

Check this box if the person identified in section 2 is your child, stepchild, or legally adopted child. Fill only if the 'f. We are related' is Yes.

Check this box if the person identified in section 2 is your grandparent, step-grandparent, or grandparent-in-law. Fill only if the 'f. We are related' is Yes.

Check this box if the person identified in section 2 is your child's spouse. Fill only if the 'f. We are related' is Yes.

Check this box if the person identified in section 2 is your grandchild, step-grandchild, or grandchild-in-law. Fill only if the 'f. We are related' is Yes.

Provide the city, state, or tribe where the criminal case was filed, the year it was filed, and the case number. Fill only if the 'Are you involved in any other court case with the person in ②?' is 'Yes'.

Enter the kind of other court case you and the person in 2 are involved in. Fill only if the 'Are you involved in any other court case with the person in 2?' is 'Yes'.

Enter the court-assigned case number for this domestic violence restraining order request.

Enter the name of the person or organization to whom the court should order payment for the fourth expense.

Provide a brief description of what the fourth expense is for (for example, medical care, counseling, temporary housing).

Enter the dollar amount you are requesting for the fourth expense.

Check this box if you want the judge to order the person in ② to pay any debts owed for property, such as rent, mortgage, car payments, or similar bills.

Provide the name of the person or organization to whom the first debt payment should be made.

Describe what the first debt payment is for (for example, rent, mortgage, or car payment).

Enter the dollar amount of the first debt payment to be paid.

Check this box if you want the judge to order the person in (2) to pay for expenses directly caused by the abuse (damaged property, medical care, counseling, temporary housing, etc.).

Enter the name of the person or organization to whom the first expense payment should be made.

Provide a brief description of the expense (for example medical care or property repair) for the first payment.

Enter the dollar amount you are requesting for the first expense payment.

Enter the name of the person or entity to whom the second expense payment should be made. Fill only if the 'Pay Expenses Caused by the Abuse' is 'Yes'.

Enter a brief description of the second expense caused by the abuse (for example, medical care or property damage). Fill only if the 'Pay Expenses Caused by the Abuse' is 'Yes'.

Enter the dollar amount you are requesting for the second expense payment. Fill only if the 'Pay Expenses Caused by the Abuse' is 'Yes'.

Enter the full name of the person or entity to whom you want the third expense payment made. Fill only if the 'Pay Expenses Caused by the Abuse' is 'Yes'.

Provide a brief description of the third expense caused directly by the person in 2 (for example, damaged property or medical care). Fill only if the 'Pay Expenses Caused by the Abuse' is 'Yes'.

Enter the dollar amount you are requesting for the third expense caused by the abuse. Fill only if the 'Pay Expenses Caused by the Abuse' is 'Yes'.

Describe the sixth firearm, firearm part, or ammunition known to be owned by the person in question. Fill only if the 'Question 9c' is 'Yes'.

Enter the number or amount of the sixth firearm, firearm part, or ammunition described above. Fill only if the 'Question 9c' is 'Yes'.

Provide the known location of the sixth firearm, firearm part, or ammunition. Fill only if the 'Question 9c' is 'Yes'.

Enter a description of the first firearm, firearm part, or ammunition the person in item 2 has. Fill only if the 'Does person in 2 have firearms (guns), firearm parts, or ammunition? Yes' is 'Yes'.

Enter a description of the second firearm, firearm part, or ammunition. Fill only if the 'Does person in ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Enter a description of the third firearm, firearm part, or ammunition. Fill only if the 'Does person in ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Describe the type, model, or caliber of the fourth firearm, firearm part, or ammunition known to be possessed by the person listed in section ②. Fill only if the 'Does person in section ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Enter the make, model, type, caliber, or other identifying details of the fifth firearm, firearm part, or ammunition. Fill only if the 'Does person in ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Click this button to print the completed form.

Click this button to save your progress or a copy of the form.

Click this button to clear or reset all entered information within the form.

For your protection and privacy: after printing the form, click this button to clear all data from the form.

Check this box if the person abused you only once.

Check this box if the person abused you two to five times.

Check this box if the person abused you on a weekly basis.

Check this box if the abuse frequency does not fit the other options and specify the frequency on the line.

Specify a custom frequency of abuse not covered by “Just this once,” “2–5 times,” or “Weekly” (for example, daily or monthly). Fill only if the 'Other' checkbox is 'Yes'.

Check this box if the respondent’s gender is male.

Check this box if the respondent’s gender is female.

Check this box if the respondent’s gender is nonbinary.

Enter the number of additional months you have lived at this address. Fill only if the 'I have lived at this address for' is 'Yes'.

Check this box if your name is on the lease for this address.

Check this box if you pay for some or all of the rent or mortgage at this address.

Check this box if you live at this address with your child or children.

Check this box for any other reason you have a right to live at this address and explain in the space provided.

Explain any other reason you have a right to live at this address (first line). Fill only if the 'Other (please explain)' is 'Yes'.

Continue explaining any other reason you have a right to live at this address (second line). Fill only if the 'Other (please explain)' is 'Yes'.

Check this box if you own the home at this address.

Check this box if you have lived at this address for the number of years and months indicated.

Enter the number of whole years you have lived at this address. Fill only if the 'I have lived at this address for' is 'Yes'.

Check this box if you are asking the judge to order the person listed in item 2 to move out of the home at the specified address.

Provide the full address of the home that you are asking the judge to order the person named in field ② to move out of.

Enter the date when the most recent incident of abuse occurred (give an estimate if you don’t know the exact date).

Check this box if the abuse occurred just this once.

Check this box if the abuse occurred between two and five times.

Check this box if the abuse occurred on a weekly basis.

Check this box if the frequency of abuse is not listed and specify the frequency on the provided line.

Enter the specific frequency of abuse when the provided options don’t apply. Fill only if the 'Other' checkbox is 'Yes'.

Provide the dates or approximate time periods when the abuse incidents occurred, if known.

Enter the dates or approximate dates when the abuse incidents occurred, if known.

Enter the date of the new abuse incident, providing your best estimate if you do not know the exact date.

Check this box if you don't know whether anyone else heard or saw what happened on this day.

Check this box if no one else heard or saw what happened on this day.

Enter the dates or time estimates of when the abuse occurred, if known.

Check this box if the person in ② abused you just this one time.

Check this box if the person in ② did not cause you any emotional or physical harm.

Check this box if the person in ② caused you any emotional or physical harm.

Describe the emotional or physical harm you experienced from the incident. Fill only if the 'Did the person in ② cause you any emotional or physical harm?' is Yes.

Check this box if the person in 2 did not cause you any emotional or physical harm.

Check this box if the person in 2 caused you any emotional or physical harm. If yes, describe the harm on the lines below.

Describe any emotional or physical harm the person in ② caused you on this day. Fill only if the 'Did the person in ② cause you any emotional or physical harm?' is 'Yes'.

Check this box if you want the judge to order the person in 2 to not make any changes to any insurance or other coverage for you, the person in 2, or your children, including cancelling, cashing, borrowing against, transferring, disposing of, or changing the beneficiaries.

Check this box if you are not involved in any other court case with the person in 2.

Check this box if you are involved in any other court case with the person in 2.

Check this box if you are involved in a custody case with the person in 2. Fill only if the 'Are you involved in any other court case with the person in 2?' is 'Yes'.

Enter where the custody case was filed (city, state, or tribe), the year it was filed, and the case number. Fill only if the 'Are you involved in any other court case with the person in ②?' is 'Yes'.

Check this box if you are involved in a divorce case with the person in (2). Fill only if the 'Are you involved in any other court case with the person in (2)?' is 'Yes'.

Enter the jurisdiction (city, state, or tribe), the year the divorce case was filed, and the case number. Fill only if the 'Other court case involvement' is 'Yes'.

Check this box if you are involved in a juvenile case (child welfare or juvenile justice) with the person in ②. Fill only if the 'Are you involved in any other court case with the person in ②?' is Yes.

Enter the city, state, or tribe where the juvenile (child welfare or juvenile justice) case was filed, the year it was filed, and the case number.

Check this box if you are involved in a guardianship court case with the person in ②. Fill only if the 'Are you involved in any other court case with the person in ②?' is 'Yes'.

Provide the city, state, or tribe where the guardianship case was filed, the year it was filed, and the case number. Fill only if the 'Are you involved in any other court case with the person in ②?' is 'Yes'.

Check this box if you are involved in a criminal court case with the person in ②. Fill only if the 'Are you involved in any other court case with the person in ②?' is 'Yes'.

Check this box if the type of court case you are involved in with the person in ② is not one of the listed categories (Custody, Divorce, Juvenile, Guardianship, or Criminal). Fill only if the 'Are you involved in any other court case with the person in ②?' is 'Yes'.

Check this box if you do not want the restraining order to protect your children, family, or someone you live with.

Enter the case number assigned by the court for this domestic violence restraining order request.

Enter the court-assigned case number for this domestic violence restraining order request.

Provide the date the lawyer signed the form.

Enter the full name of your lawyer.

Check this box if you currently live together or used to live together with the person named in item 2.

Check this box if you have lived together with the person in item 2 as a family or household (more than just roommates). Fill only if the 'We live together or used to live together' is 'Yes'.

Check this box if you have not lived together with the person in item 2 as a family or household (more than just roommates). Fill only if the 'We live together or used to live together' is 'Yes'.

Check this box if you and the person in 2 do not live together or live close to each other.

Check this box if you and the person in 2 live together or live close to each other.

Check this box if you and the person in 2 live together. Fill only if the 'Yes' is 'Yes'.

Check this box if you and the person in 2 live in the same building but not in the same home. Fill only if the 'Yes' is 'Yes'.

Check this box if you and the person in 2 live in the same neighborhood. Fill only if the 'Yes' is 'Yes'.

Check this box if you have a different living arrangement and will explain it. Fill only if the 'Yes' is 'Yes'.

Enter the known location of the first firearm, firearm part, or ammunition the person in item 2 has. Fill only if the 'Does person in 2 have firearms (guns), firearm parts, or ammunition? Yes' is 'Yes'.

Enter the known location of the described second firearm item, if known. Fill only if the 'Does person in ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Enter the location of the third firearm, firearm part, or ammunition, if known. Fill only if the 'Does person in ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Provide the known location of the fourth described firearm, firearm part, or ammunition, if you know it. Fill only if the 'Does person in section ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Check this box if you need more time to give notice (serve) the person identified in (2).

Explain why you need more time to serve the person identified in section 2. Fill only if the 'Extend my deadline to give notice to person in 2' is 'Yes'.

Use this link to access the online self-help resource for understanding how the sheriff may serve your restraining order request.

Enter the expiration date of the second restraining order. Fill only if the 'Restraining orders currently in place or expired in the last six months' is 'Yes'.

Check this box to describe any additional orders you want the judge to make to keep you, your children, or the people named in section 8 safe.

Describe any additional orders you want the judge to make to keep you, your children, or the people in section 8 safe.

Check this box if you don’t know whether the police came on that day.

Check this box if the police did not come on that day.

Check this box if the police did come on that day.

Check this box if someone else heard or saw what happened on this day; then list their names.

Provide the full names of all persons who heard or saw what happened on that day. Fill only if the 'Did anyone else hear or see what happened on this day?' is Yes.

Check this box if you don’t know whether anyone else heard or saw what happened on this day.

Check this box if no one else heard or saw what happened on this day.

Check this box if someone else heard or saw what happened on this day.

Enter the names of any individuals who heard or saw what happened on that day. Fill only if the '7b Witness Presence Response' is 'Yes'.

Enter the respondent’s date of birth if known.

Provide the race or ethnicity of the person you are requesting protection from.

Enter the full legal name of the person asking for protection.

Enter the current age of the person asking for protection.

Enter the street address where the petitioner can receive court papers.

Enter the city where the petitioner can receive court papers.

Enter the state where the petitioner can receive court papers.

Enter the zip code where the petitioner can receive court papers.

Check this box if the person in 2 did not cause you any emotional or physical harm.

Check this box if the person in 2 caused you any emotional or physical harm.

Describe any emotional or physical harm the person in 2 caused you, including details of injuries, emotional distress, or psychological impact. Fill only if the '7d Did the person in 2 cause you any emotional or physical harm?' is 'Yes'.

Enter the number or amount of the fifth firearm, firearm part, or ammunition you are reporting. Fill only if the 'Does person in ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Enter the known location of the fifth firearm, firearm part, or ammunition if you have that information. Fill only if the 'Does person in ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Check this box if you want the judge to order the person to stay away from your vehicle.

Check this box if you want the judge to order the person to stay away from another location not listed above and then describe that location.

Provide a description of any other place you want the person in field ② to stay away from.

Check this box if you request that the judge give you temporary use, possession, and control of the property you describe in part 17a.

Describe the property you are asking the court to give you temporary use, possession, and control of.

Explain why you want temporary use, possession, and control of the property you listed.

Check this box to ask the judge to order the person in (2) not to borrow against, sell, hide, or destroy any possessions or property (except in the usual course of business or for necessities of life) and to notify you of any new or big expenses and explain them to the court, only if you are married or a registered domestic partner with that person.

Describe your relationship to the third other protected person (for example, child, parent, roommate). Fill only if the 'Yes (If yes, complete the section below)' is 'Yes'.

Check this box if the third other protected person lives with you. Fill only if the 'Other Protected People – Yes' is 'Yes'.

Check this box if the third other protected person does not live with you. Fill only if the 'Other Protected People – Yes' is 'Yes'.

Enter the full legal name of the fourth person you want the restraining order to protect. Fill only if the 'Yes' is 'Yes'.

Enter the age in years of the fourth person you want the restraining order to protect. Fill only if the 'Yes' is 'Yes'.

Enter the relationship of the fourth protected person to you (for example, child, sibling, roommate). Fill only if the 'Yes' is 'Yes'.

Check this box if the fourth other protected person lives with you. Fill only if the 'Protect other people – Yes' is 'Yes'.

Check this box if the fourth other protected person does not live with you. Fill only if the 'Protect other people – Yes' is 'Yes'.

Check this box if you need to list more people; use a separate piece of paper titled "DV-100, Other Protected People" and attach it to this form. Fill only if the 'Other protected people' is 'Yes'.

Check this box if you want the restraining order to protect your children, family, or someone you live with; then complete the section below.

Enter the full name of the first additional person you want the restraining order to protect.

Enter the age in years of the first additional person you want the restraining order to protect.

Enter how the first additional person you want protected is related to you (for example, child, sibling, roommate).

Select this box if the first other protected person lives with you. Fill only if the 'Do you want the restraining order to protect your children, family, or someone you live with?' is 'Yes'.

Select this box if the first other protected person does not live with you. Fill only if the 'Do you want the restraining order to protect your children, family, or someone you live with?' is 'Yes'.

Enter the full legal name of the second person you want the restraining order to protect.

Enter the age in years of the second person you want the restraining order to protect.

Enter how the second person you want protected is related to you (for example, child, parent, roommate).

Check this box if the second other protected person lives with you. Fill only if the 'Protect other people' is 'Yes'.

Check this box if the second other protected person does not live with you. Fill only if the 'Protect other people' is 'Yes'.

Enter the full legal name of the third person you want the restraining order to protect. Fill only if the 'Yes (If yes, complete the section below)' is 'Yes'.

Enter the age in years of the third other protected person. Fill only if the 'Yes (If yes, complete the section below)' is 'Yes'.

Check this box to ask the court to protect your animals, your children’s animals, or the person listed in field 2’s animals.

Enter an explanation of why the additional protected people listed need protection under this restraining order.

Check this box if you want the judge to order the person to stay away from you.

Check this box if you want the judge to order the person to stay away from your school.

Check this box if you want the judge to order the person to stay away from your home.

Check this box if you want the judge to order the person to stay away from each person listed in section 8.

Check this box if you want the judge to order the person to stay away from your job or workplace.

Check this box if you want the judge to order the person to stay away from your children’s school or childcare.

Enter the number or amount of the first firearm, firearm part, or ammunition the person in item 2 has. Fill only if the 'Does person in 2 have firearms (guns), firearm parts, or ammunition? Yes' is 'Yes'.

Enter the number or amount of the described second firearm item. Fill only if the 'Does person in ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Enter the number or amount for the third firearm, firearm part, or ammunition. Fill only if the 'Does person in ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Enter the quantity or amount for the fourth described firearm, firearm part, or ammunition. Fill only if the 'Does person in section ② have firearms (guns), firearm parts, or ammunition?' is 'Yes'.

Select this option if you are including form DV-110 as part of your restraining order request.

Select this option if you are including form DV-109 as part of your restraining order request.

Select this option if you are including form CLETS-001 as part of your restraining order request.

Select this option if you are including form DV-105 as part of your restraining order request.

Select this option if you are including form DV-140 as part of your restraining order request.

Select this option if you are including form SER-001 as part of your restraining order request.

Select this option if you are including form FL-150 as part of your restraining order request.

Select this option if you are including form FL-155 as part of your restraining order request.

Select this option if you are including form DV-570 as part of your restraining order request.

Check this box if you and the person in ② are currently married or registered domestic partners.

Check this box if you and the person in ② used to be married or registered domestic partners.

Check this box if you and the person in ② are currently dating or used to date.

Check this box if you and the person in ② are or used to be engaged to be married.

Check this box if you and the person identified in section 2 are related.

Check this box if the debt you listed as item a(1) resulted from the abuse. Fill only if the 'Do you want the judge to make this special decision (finding)?' is 'Yes'.

Check this box if the debt you listed as item a(2) resulted from the abuse. Fill only if the 'Do you want the judge to make this special decision (finding)?' is 'Yes'.

Check this box if the debt you listed as item a(3) resulted from the abuse. Fill only if the 'Do you want the judge to make this special decision (finding)?' is 'Yes'.

Check this box if you do not know how the person in (2) made the debt or debts. Fill only if the 'Do you want the judge to make this special decision (finding)?' is 'Yes'.

Enter the full legal name of the person you want protection from.

Enter the respondent’s age, giving an estimate if you do not know the exact age.

Provide an explanation of any other way you and the person in ② live together or close to each other. Fill only if the 'Do you and the person in ② live together or live close to each other?' is 'Yes'.

Check this box if you and the person do not share the same workplace or attend the same school.

Check this box if you and the person share the same workplace or attend the same school.

Check this box if you and the person work together at the same company and specify the company name. Fill only if the 'Yes' is 'Yes'.

Enter the name of the company where you and the person in field 2 work together. Fill only if the 'Do you and the person in 2 have the same workplace or go to the same school?' is 'Yes'.

Check this box if you and the person attend the same school and specify the school name. Fill only if the 'Yes' is 'Yes'.

Enter the name of the school where you and the person in field 2 attend together. Fill only if the 'Do you and the person in 2 have the same workplace or go to the same school?' is 'Yes'.

Check this box if you share another type of workplace or school arrangement and explain. Fill only if the 'Yes' is 'Yes'.

Describe any other workplace or school you and the person in field 2 share. Fill only if the 'Do you and the person in 2 have the same workplace or go to the same school?' is 'Yes'.

Enter the date on which you sign this form.

Type or print your full legal name exactly as you want it to appear on this form.

Check this box if you want the judge to order the person in item 2 to stay away from you, your home, your school, or each person listed in item 8.

Check this box if you want the restrained person to stay 100 yards (300 feet) away from all the places you checked above. Fill only if the 'Stay-Away Order' is 'Yes'.

Check this box if you want to specify a custom stay-away distance in yards. Fill only if the 'Stay-Away Order' is 'Yes'.

Type the custom distance in yards that you want the judge to order the restrained person to stay away from the places you checked under the Stay-Away Order.

Check this box if you are married or a registered domestic partner with the person in 2 and you want the judge to order that person to provide you financial assistance.

Check this box to ask the judge to order the person in (2) to pay for some or all of your lawyer’s fees and costs.

Enter the first wireless phone number you want transferred, including the area code.

Enter the telephone number, including area code, for the second wireless phone account you are asking the judge to transfer to you.

Enter the wireless phone number for the third line (item c), including the area code, that you are asking the court to transfer to you.

Enter the full wireless phone number, including area code, for the fourth account you are asking the judge to transfer to you.

Check this box if the person in (2) did not use or threaten to use a gun or other weapon.

Check this box if the person in (2) used or threatened to use a gun or other weapon.

Enter details describing the gun or weapon the person in ② used or threatened to use. Fill only if the 'Did the person in ② use or threaten to use a gun or other weapon?' is 'Yes'.

Check this box if the person in (2) did not use or threaten to use a gun or other weapon.

Check this box if the person in (2) did use or threaten to use a gun or other weapon.

Provide a description of any gun or other weapon used or threatened by the person identified in item 2. Fill only if the 'Did the person in 2 use or threaten to use a gun or other weapon?' is 'Yes'.

Check this box if the person in (2) did not use or threaten to use a gun or other weapon.

Check this box if the person in (2) did use or threaten to use a gun or other weapon.

Describe the gun or other weapon that the person identified in question 2 used or threatened to use. Fill only if the '7c. Use or threatened to use a gun or weapon' is 'Yes'.