1 Protected Person
a. Your Full Name:
Your Lawyer (if you have one for this case):
Name: State Bar No.:
Firm Name:
b. Your Address (If you have a lawyer, give your lawyer’s information.
If you do not have a lawyer and want to keep your home address Fill in court name and street address:
private, you may give a different mailing address instead. You do not Superior Court of California, County of
have to give telephone, fax, or email.):
Address:
City: State: Zip:
Telephone: Fax:
Email Address: Court fills in case number when form is filed.
Case Number:
2 Restrained Person
(Give all the information you know. Information with a star (*) is required
to add this order to the California police database. If age is unknown, give an estimate.)
*Full Name: *Age: Date of Birth:
*Race: Height: Weight: Hair Color: Eye Color:
*Gender: M F Nonbinary Home Address:
City: State: Zip:
Relationship to Protected Person:
To the Person in 2 :
The court has granted the temporary orders checked as granted below. If you do not obey these orders, you can be
arrested and charged with a crime. You may be sent to jail for up to one year, pay a fine of up to $1,000, or both.
b. Peaceful written contact through a lawyer or a process server or other person for service of legal papers related
to a court case is allowed and does not violate this order. However, you may have your papers served by mail
on the person in 1 .
6 Stay-Away Order
Not Requested Denied Until the Hearing Granted as Follows:
a. You must stay at least yards away from (check all that apply):
(1) The person in 1 (7) The place of child care of the children of
(2) Each person in 3 the person in 1
(3) The home of the person in 1 (8) The vehicle of the person in 1
(4) The job or workplace of the person (9) Other (specify):
in 1
(5) The school of the person in 1
(6) The school of the children of the
person in 1
b. This stay-away order does not prevent you from going to or from your home or place of employment.
8 No Body Armor
You cannot own, possess, or buy body armor (defined in Penal Code section 16288). You must relinquish any body
armor you have in your possession.
b. The person in 2 must stay at least yards away from, and not take, sell, transfer, encumber,
conceal, molest, attack, strike, threaten, harm, or otherwise dispose of, the animals listed above.
10 Other Orders
Not Requested Denied Until the Hearing Granted as Follows (specify):
Additional orders are attached at the end of this Order on Attachment 10.
To the Person in 1 :
11 Mandatory Entry of Order Into CARPOS Through CLETS
This Order must be entered into the California Restraining and Protective Order System (CARPOS) through the
California Law Enforcement Telecommunications System (CLETS). (Check one):
a. The clerk will enter this Order and its proof-of-service form into CARPOS.
b. The clerk will transmit this Order and its proof-of-service form to a law enforcement agency to be entered
into CARPOS.
c. By the close of business on the date that this Order is made, the person in 1 or his or her lawyer should
deliver a copy of the Order and its proof-of-service form to the law enforcement agency listed below to
enter into CARPOS:
Name of Law Enforcement Agency Address (City, State, Zip)
Additional law enforcement agencies are listed at the end of this Order on Attachment 11.
Date:
Judicial Officer
Read form CH-120-INFO, How Can I Respond to a Request for Civil Harassment Restraining Orders?, to learn how
to respond to this Order.
If you want to respond, fill out form CH-120, Response to Request for Civil Harassment Restraining Orders, and file
it with the court clerk. You do not have to pay any fee to file your response if the Request claims that you inflicted or
threatened violence against or stalked the person in 1 .
You must have form CH-120 served by mail on the person in 1 or that person’s attorney. You cannot do this
yourself. The person who does the mailing should complete and sign form CH-250, Proof of Service by Mail. File the
completed proof of service with the court clerk before the hearing date or bring it with you to the hearing.
In addition to the response, you may file and have declarations served, signed by you and other persons who have
personal knowledge of the facts. You may use form MC-030, Declaration, for this purpose. It is available from the
clerk’s office at the court shown on page 1 of this form or at . If you do not know how to
prepare a declaration, you should see a lawyer.
Whether or not you file a response, you should attend the hearing. If you have any witnesses, they must also go to the
hearing.
At the hearing, the judge can make restraining orders against you that last for up to five years. Tell the judge why you
disagree with the orders requested.
Notice/Proof of Service
The law enforcement agency must first determine if the restrained person had notice of the order. Consider the restrained
person “served” (given notice) if (Pen. Code, § 836(c)(2)):
The officer sees a copy of the Proof of Service or confirms that the Proof of Service is on file; or
The restrained person was informed of the order by an officer.
An officer can obtain information about the contents of the order and proof of service in CARPOS. If proof of service on
the restrained person cannot be verified, the agency must advise the restrained person of the terms of the order and then
enforce it.