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FORM DV-100 INSTRUCTIONS

REQUEST FOR ORDER (DV-100)



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NOTE:
You will need a copy of the English-language Judicial Council form DV-100 to follow these instructions. Also:

 



Filling out the Caption on your form

Leave Blank. The clerk will stamp this area when the form is filed.
SUPERIOR COURT OF CALIFORNIA, COUNTY OF” – write the name of the County where you are filing your case. Click here for location of courts.
Case Number:  Leave blank. A court clerk will fill in your case number.

 



Filling out the rest of your form

Request for Order

This form tells the court what kind of protection you want for the next several months or years. Judges are willing to consider restricting (stopping) people from doing certain things for a period of time when it seems this will help each person to stay safe as they handle responsibilities for their children and other parts of their lives that they shared.


1.    Write the name of the person who wants to get a protection order from the court (this can only be one person.) This person is called the “Protected Person.” If the Protected Person does not have an attorney, write the P.O. box or mailing address where court papers can be delivered.

IMPORTANT: If you are the Protected Person and you do not want others to know where you live, be sure to use a different address where you will just get mail.

2.    Write the name of the person who you want the court to restrain (stop from doing something). Check the box next to M if the person to be restrained is a man (male), or check the box next to F if this person is a woman (female). Write how tall the person is on the line next to “Height”. Write how much the person weighs on the line next to “Weight”. Write the person’s race, and write the color of his or her hair and eyes, age, and the date when he or she was born, on the blank lines.

3.    Write the names and ages of any other people who live with you all the time who also need to be protected from the person to be restrained. Write how each person is related to you (for example, they might be your child, relative, or roommate). They should be ready to not see or talk to the person to be restrained while the Restraining Order is in effect. These people are sometimes called “Other Protected Persons.” Only list names of people who live with you all the time.

Check this box if you need to list more than 4 other people who need protection. You can either use an Additional Page (Form MC-020) (to be attached to any form) or a separate blank sheet of paper. On either one, at the top write: “DV-100, Item 3 – Protected People.” Then list the rest of the people who need protection, their ages, whether or not they live with you, and how they are related to you.

NOTE: If the judge grants (approves) this court order, all people listed here should be given a copy of the final court order.

4.    Relationship Between the Parties:

Check all of the boxes that describe your relationship with the Restrained Person.

  1. Check this box if you and the person to be restrained are married to each other now or if you and your partner are currently in a Registered Domestic Partnership.
  2. Check this box if you and the person to be restrained were married to each other in the past or if you and the person to be restrained were in a Registered Domestic Partnership in the past.
  3. Check this box also if you and the person to be restrained live together now.
  4. Check this box if you and the person to be restrained lived together in the past.
  5. Check this box if you and the person to be restrained are relatives. Describe the relationship between you and the person to be restrained on the line provided.


    NOTE: 
    The Domestic Violence Prevention Act (Family Code Sections 6200-6219) includes people related to you by blood, marriage, or adoption “to the 2nd degree.” People related to you by blood, marriage or adoption in the first degree are your parents and children; and also stepparents or stepchildren. People related to you in the second degree are your brothers, sisters, grandparents, grandchildren and also half relatives of this type, for example, a half-sister; plus in-laws. You may list any of these relatives, if living with you, as persons to be protected.

  6. Check this box if you and the person to be restrained are dating each other now, or used to date in the past. (It does not have to be an intimate or sexual relationship.)
  7. Check this box if you and the person to be restrained are engaged to be married to each other or were engaged to be married to each other in the past.
  8. Check this box if you and the person to be restrained are the parents together of any children under the age of 18. Write each child’s name and the date that he or she was born.

    If you and the person to be restrained have more than 3 children together under the age of 18, check the box. Use an Additional Page (to be attached to any form) (Form MC-020) or, use a separate blank sheet to add your other children. On either one, at the top write: “DV-100, Item 4.” Then write the names and dates of birth of your other children.
  9. Check this box if you and the person to be restrained have filled out a Voluntary Declaration of Paternity (Form CS 909). (Attach a copy of the completed form.)


At the top of page 2, DV-100

 

  Fill out the caption boxes as follows:
Write your name.
Case Number:  Write in the case number (the same number as on page 1).


5.    Other Court Cases:

  1. Check this box next to “No” or “Yes” to tell the judge if you and the person to be restrained have been involved in any other court cases.

    If you checked the box next to “Yes”, write the name of the county and state where the court case happened. Write the case number or numbers if you know them.

    Check this box or boxes that show what kind of court case or cases these were. If the type of case that you and the person to be restrained were involved in is not listed, check the box next to “Other” and write in the kind of case that you had.
  2. Check this box next to “No” or “Yes” to tell the judge if there are any restraining or protective orders that affect you or the person to be restrained. Attach a copy of any protection or restraining order you have.

What orders do you want? In this part, numbers 6 through 10, check all of the boxes that describe orders you want the judge to apply to your case.


6.    Personal Conduct Orders:

Check this box to tell the judge what actions you want the court to limit.

  1. Check this box if you want the judge to order the person to be restrained not to: harass, attack, strike, threaten, assault, hit, follow, stalk, molest, destroy personal property, disturb the peace of, keep under surveillance or block you (or your movements) or do these actions to the other persons you listed in 3 (Other Protected Persons).
  2. Check this box if you want the judge to order the person to be restrained not to contact you or the other protected persons (directly or indirectly) by telephone, mail, or e-mail.


7.   Stay-Away Order:

Check this box if you want the judge to order the person to be restrained to stay away from you, your children, or other people who live with you. Write the number of yards that you would like the person to be restrained to be ordered to stay away from you and any people you listed in 3.  (Usually people write 100 yards. 100 yards is the length of a football field.  It is 91.44 meters.)

  1. Check this box if you want the judge to order the person to be restrained to stay the certain distance away from you that you just wrote in the line above.
  2. Check this box if you want the judge to order the person to be restrained to stay the certain distance away from the Other Protected Persons listed in 3.
  3. Check this box if you want the judge to order the person to be restrained to stay the certain distance away from your home.
  4. Check this box if you want the judge to order the person to be restrained to stay the certain distance away from your job or workplace.
  5. Check this box if you want the judge to order the person to be restrained to stay the certain distance away from your children’s school or place of child care.
  6. Check this box if you want the judge to order the person to be restrained to stay the certain distance away from your car.
  7. Check this box if you want the judge to order the person to be restrained to stay a certain distance away from any other places. (For example, your church, synagogue or mosque, a place where you play sports, or any other place you go regularly.)

    (Be aware that the judge may or may not order the distance you requested. The judge may order a greater or lesser distance depending on your circumstances.)


8.     Move-Out Order:

Check this box if you want the person to be restrained to be ordered to move out of the home you share. If you check this box, write the address of the shared home and answer the second part of this question.

If you ask for the move-out order, you must explain to the judge why you should live at the home you share with the person to be restrained.
For example:

  • You have a legal right to the home, you own the home, or have lived there for a
    long time.
  • The person to be restrained has hurt, or threatened to hurt you or someone in
    your care.
  • You or a person under your care will be physically or emotionally harmed if the person to be restrained does not move out.

NOTE: If the judge orders the person to be restrained to move out of the shared home, he or she will be allowed to take their personal clothing and belongings, but cannot move back into your home.


9.     Child Custody, Visitation and Child Support:

Check this box if you and the person to be restrained are the parents together of one or more children under the age of 18 years and you want the judge to include decisions regarding child custody, visitation, and child support in this restraining order. If you check this box, you must then fill out a Child Custody, Visitation, and Support Request (Form DV-105) and attach it to this Request for Order form.


10.    Spousal Support

Check this box if you are married, or are in a registered domestic partnership, now, and you want the judge to order that the person to be restrained pay you spousal support. You may be entitled to this support, if there is no other spousal support order already. If you check this box, you must then fill out an Income and Expense Declaration (Form FL-150) and file the completed form before the court hearing date.

DV-100 continued on Page 2