Family Law & Probate - Superior Court of California · 2019-06-26 · Family Law & Probate DVRO...

Superior Court of California, County of Sacramento Family Law & Probate

DVRO with Minor Children of 2

Cover Sheet: Request for Domestic Violence Restraining Order for Parties with Minor Children in Common

Effective Date: January 17, 2018

Last Revision Date: August 15, 2018

Purpose: A Domestic Violence Restraining Order seeks to protect intimate partners and close relations from abuse or threats of abuse.

Review the forms closely or contact the Self Help Center to determine if this is the correct type of Restraining Order for your situation.

Assistance: The Court offers a workshop to help parties who do not have attorneys to complete these forms. The workshop is offered every Monday, Wednesday and Friday (excluding Court holidays) at 8:45 am and no appointment is necessary. Please arrive early as space is limited. Children are not permitted in the workshop.

Required Forms: All forms are Judicial Council forms, unless otherwise indicated: • Domestic Violence Date of Birth Verification, local form FL/E-

LP-640 • Family Law Case Participant Enrollment Form (Party), local

form FL/E-LP-665 • Notice of Court Hearing, DV-109 • Request for Domestic Violence Restraining Order, DV-100 • Attachment to Request for Domestic Violence Restraining

Order, local form FL/E-LP-613 • Temporary Restraining Order, DV-110 (please complete items

1, 2 and 3 only) • Confidential CLETS Information, CLETS-001 • Restraining Order After Hearing, DV-130

Optional Forms: These forms are needed only if you are requesting orders regarding child custody, support or transfer of a cellular telephone account:

• Request for Child Custody and Visitation Orders, DV-105 • Request for Order: No Travel with Children, DV-108 • Declaration Under Uniform Child Custody Jurisdiction and

Enforcement Act (UCCJEA), FL-105 • Parent-Child Relationship Declaration, local from FL/E-LP-616 • Child Custody and Visitation Order, DV-140 (complete twice) • Order: No Travel with Children, DV-145 (complete twice) • Supervised Visitation, DV-150 (complete twice) • Child Support Information and Order Attachment, FL-342 • Spousal, Partner, or Family Support Order Attachment, FL-

343

Superior Court of California, County of Sacramento Family Law & Probate

DVRO with Minor Children of 2

• Income and Expense Declaration, FL-150 • Order Transferring Wireless Phone Account, DV-900

Filing Fee: None.

Copies: The Court does not require additional copies of these forms.

Before You File: The Court requires that you include an address on your forms where you can receive mail regarding the case you are filing. This address does not have to be the place where you live. Court documents and court files are public record and whatever address is included on your forms will be seen by the other party and anyone else who looks at the Court file.

Attach copies of any photographs or other evidence to the Request for Domestic Violence Restraining Order that you would like the Court to consider when granting the Temporary Restraining Order. All pages must be 8.5 by 11 inches.

Filing: All forms must be typewritten or printed in blue or black ink. (See California Rules of Court 2.100-2.119).

Bring the completed forms to 3341 Power Inn Road, Sacramento, CA 95826.

If the forms are filed before 2:00 pm, you will receive a response from the Judge on the same day.

You must obtain a service ticket from Reception by 4:00 pm in order to file these documents.

Next Steps: After filing these documents, you must return to the courthouse by 3:45 pm the same day if you filed before 2:00 pm or 3:45 pm the next day if you filed after 2:00 pm to pick up your documents and receive the hearing date.

You must obtain a service ticket from Reception by 4:00 pm in order to pick up your documents.

What is a “domestic violence restrainingorder”?

Can I get a domestic violence restraining order?You can ask for one if:

A person has abused you or threatened to abuse you andYou have one of the following relationships with that person: married, divorced, separated, registered domestic partnership, have a child together, dating or used to date, live together or used to live together*; Or you are related within the second degree of affinity or consanguinity. This means: mother or mother-in-law, father or father-in-law, child or stepchild or legally adopted child, grandparent or grandparent-in-law, grandchild or grandchild-in-law, sister or sister-in-law, brother or brother-in-law, stepparent, daughter-in-law or son-in-law. The in-law must be through a current marriage. (See Family Code § 6211).

* You have to regularly reside in the household.

DV-500-INFO, Page 1 of 3

It is a court order that can help protect people who have been abused or threatened with abuse.

Judicial Council of California, www.courts.ca.govRevised January 1, 2012

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Can a Domestic Violence Restraining Order Help Me?

Can a Domestic Violence Restraining Order Help Me? (Domestic Violence Prevention)

Obey child custody and visitation orders Pay child support Pay spousal support Obey orders about property

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How will the restraining order help me?The court can order the restrained person to:

Not contact or go near you, your children, otherrelatives, or others who live with youNot have any guns or ammunition Move out of your house

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The forms are available at any California courthouse or county law library or at: www.courts.ca.gov/forms.

How do I ask for a domestic violence restraining order?

You may get assistance in completing and filing your request from the court’s self-help center or a legal aid association.

After completing the forms, give them to the clerk of the court. The clerk will write a hearing date on the Notice of Court Hearing (Form DV-109). If your request for temporary orders is granted, the clerk will also give you a copy of the Temporary Restraining Order (DV-110) signed by a judicial officer.

How soon can I get the order? The judge will decide within one business day whether or not to make any temporary orders. Sometimes the judge decides sooner. Ask the clerk if you should wait or come back later to get copies of the Notice of Court Hearing (Form DV-109) and Temporary Restraining Order (Form DV-110).

Ask the court clerk for the forms you need for these special kinds of orders, or visit www.courts.ca.gov. You may also want to talk to a lawyer.

What is abuse?

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Abuse means to intentionally or recklessly cause or attempt to cause bodily injury to you; or sexually assault you; or to place you or another person in reasonable fear of imminent serious bodily injury; or to molest, attack, hit, stalk, threaten, batter, harass, telephone, or contact you; or to disturb your peace; or destroy your personal property. Abuse can be spoken, written, or physical. (See Family Code §§ 6203, 6320).

See Form DV-505-INFO, How Do I Ask for a Temporary Restraining Order? to know which forms you need and for steps to follow after you complete the forms.

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DV-500-INFO

What if I don’t have the relationship necessary to qualify for a domestic violence restraining order?There are other kinds of orders you can ask for:

Civil harassment order (can be used for neighbors,roommates, cousins, uncles, and aunts)Dependent adult or elder abuse restraining orderWorkplace violence order

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Having a lawyer is always a good idea, especially if you have children, but it is not required. You are not entitled to a free court-appointed lawyer. Ask the court clerk about free and low cost legal services and domestic violence help centers in your county. You can also go to the Family Law Facilitator for help with child support.

Do I need to bring a witness to the court hearing?

Do I need a lawyer?

No. But it helps to have proof of the abuse. You can bring: A written statement from a witness, made under oath Witnesses Photos Medical or police reports Damaged property Threatening letters, e-mails, or telephone messages

••••••

Can a Domestic Violence Restraining Order Help Me?

You can get a restraining order even if you are not a U.S. citizen. If you are worried about deportation, talk to an immigration lawyer.

What if I don’t have a green card?

How will the person to be restrained know about the order?Someone who is at least 18—not you or anyoneelse to be protected by the order—must “serve” (give)the person to be restrained a copy of the order in person. The sheriff or marshal will do it for free, but you have to ask. For help with service, ask the court clerk for form DV-200-INFO, What Is “Proof of Personal Service”? orvisit www.courts.ca.gov.

Call the police. The restrained person can be arrested and charged with a crime.

What if the restrained person doesn't obeythe order?

Yes. Go to court on the date the clerk gives you. If you do not, your order will end.

Do I have to go to court?

Will I see the restrained person at the court hearing?If the restrained person comes to the hearing, yes. But that person does not have the right to speak to you. If you are afraid, tell the court officer. Read Get Ready for the Court Hearing (Form DV-520-INFO).

Yes. You can bring someone to sit with you during the court hearing. But that person cannot speak for you in court. Only you or your lawyer (if you have one) can speak for you.

Can I bring someone with me to court?

When you file your papers, ask the clerk if a court interpreter is available. If the interpreter is not available for your court date, bring someone to interpret for you. Do not ask a child, or anyone to be protected by the order, to interpret for you.

What if I don’t speak English?

How much does it cost? Nothing.

DV-500-INFO

DV-500-INFO, Page 2 of 3Can a Domestic Violence Restraining Order Help Me? (Domestic Violence Prevention)

Revised January 1, 2012

The judge may or may not let a witness speak at the hearing.So if possible, you should bring their written statement under oath to the hearing. (You can use Form MC-030, Declaration, for this purpose.)

If the judge makes a temporary order, it will last until the hearing date. At that time, the judge will decide to continue or cancel the order. The restraining order can last up to 5 years. Child custody, visitation, child support, and spousal support orders can last longer than 5 years and they do not end when the restraining order ends.

How long does the order last?

Can I use the restraining order to get divorced or terminate a registered domestic partnership?No. These forms will not end your marriage or registered domestic partnership. You must file other forms to end your marriage or registered domestic partnership.

If you get a temporary restraining order that includes an order for custody, the parent with custody may not remove the child from California before notice to the other parent and a court hearing on the request to establish or modify custody. Read the order and Form DV-140, Child Custody and Visitation Order, if issued, for any other limits. There are some exceptions. Ask a lawyer.

The restraining order is valid anywhere in the United States. If you move out of California, contact the local police so they will know about your orders.

Ask the court clerk about free or low-cost legal help.For a referral to a local domestic violence or legal assistance program, call the National Domestic Violence Hotline:

1-800-799-7233 TDD: 1-800-787-3224

It’s free and private.They can help you in more than 100 languages.

Can the order stop the other parent from taking our children away?

What if I want to leave the county or state?

Need more information?

DV-500-INFO Can a Domestic Violence Restraining Order Help Me?

No. After the order is issued, only the judge can change or cancel it.

Can the restrained person and I agree tocancel the order?

DV-500-INFO, Page 3 of 3Can a Domestic Violence Restraining Order Help Me? (Domestic Violence Prevention)


What if I am deaf or hard of hearing?Assistive listening systems, computer- assisted real-time captioning, or sign language interpreter services are available if you ask at least five days before the proceeding. Contact the clerk's office or go to www.courts.ca.gov/forms for Request for Accommodations by Persons With Disabilities and Response (Form MC-410). (Civil Code, § 54.8.)

Local Form Adopted for Mandatory Use FAMILY LAW CASE PARTICIPANT ENROLLMENT FORM

CONFIDENTIAL FOR COURT USE ONLY

CASE PARTICIPANT

NAME: STATE BAR NO:

FIRM NAME:

ADDRESS:

CITY: STATE: ZIP CODE:

E-MAIL ADDRESS: (must be legible) TELEPHONE NO.:

ATTORNEY FOR (Name): FAX NO. (Optional):

NAME OF COURT:

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

CLAIMANT:

FAMILY LAW CASE PARTICIPANT ENROLLMENT FORM CASE NUMBER:

You may access some Findings and Orders After Hearing for law and motion hearings, and mediation reports prepared by Family Court Services on or after January 26, 2015 using the court's online Public Case Access System. Free access is available for 72 hours from the time the order is issued or the report is prepared, or from the time the court creates your case subscription. After 72 hours, you may still access but you will be required to pay for copies of orders and reports.

INSTRUCTIONS

To setup your account you must:

I,

declare that my private email address is (must be legible):

I understand, if I change my email address I must file a new enrollment form with the court.

, request the court create an account and/or subscription to my Family Law case. I

I would like to unsubscribe from my case and have attached a copy of my driver license, state or federal issued photo identification.

I acknowledge that confidential mediation reports contain private information that is not part of the public court file. I understand that without a court order, I must not disclose any contents of the Report to anyone (including any minor children) other than the parties to my case (petitioner/respondent/claimant) and their attorneys and court professionals. I acknowledge that the court may impose a penalty for any unauthorized disclosure of any content of the Family Court Services report.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

• File this form with the court and be prepared to show your driver license or a state or federal issued photo identification card.• A separate form must be filed for each of your Family Law cases.• Once the court has created your subscription to your Family Law case, you will receive a confirming email. You must follow the

instructions in that email to complete the process.

www.saccourt.ca.govFL/E-LP-665 (Rev 2/5/18)

(Please use Ø for zero, 1 for one and clearly differentiate i, L, S, 5, 3 and 8's).

PARTY

PARTY

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Once your subscription is completed, you will receive an email notification each time an order or report is added to your case.You must also complete and file this form, with a copy of your driver license, if you wish to unsubscribe to your Family Law case.

FL/E-LP-640

Page 1FL\E-LP-640 (Revised 12/16/2011 ) Domestic Violence Date of Birth Verification Mandatory www.saccourt.ca.gov

SPACE RESERVED FOR FILED/ENDORSED STAMP

DOMESTIC VIOLENCE DATE OF BIRTH VERIFICATION

CASE NUMBER: ____________________________________

PLAINTIFF'S NAME: ____________________________________

PLAINTIFF'S DATE OF BIRTH: ____________________________________

DEFENDANT'S NAME: ____________________________________

DEFENDANT'S DATE OF BIRTH ____________________________________

Temporary Restraining Orders for personal conduct and stay-away orders as requested in form DV-100, Request for Domestic Violence Restraining Order, are (check only one box below):

Notice of HearingA court hearing is scheduled on the request for restraining orders against the person in :

a.

(1)(2)(3)

Temporary Restraining Orders (Any orders granted are attached on form DV-110.)

The court will fill out the rest of this form.

Clerk stamps date here when form is filed.

Fill in court name and street address:

Superior Court of California, County of

Court fills in case number when form is filed.

Case Number:

All GRANTED until the court hearing.All DENIED until the court hearing. (Specify reasons for denial in b, below.)Partly GRANTED and partly DENIED until the court hearing. (Specify reasons for denial in b, below.)

DV-109 Notice of Court Hearing

Judicial Council of California, www.courts.ca.gov Revised January 1, 2019, Mandatory Form Family Code § 242 Approved by DOJ

Notice of Court Hearing (Domestic Violence Prevention)

DV-109, Page 1 of 3

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Name of Person Asking for Order:

Address (If you have a lawyer for this case, give your lawyer’s information. If you do not have a lawyer and want to keep your home address private, give a different mailing address instead. You do not have to give your telephone, fax, or e-mail.)

Firm Name:

Your lawyer in this case (if you have one):Name: State Bar No.:

Telephone:

Address:

Fax:E-Mail Address:

Zip:State:City:

Name of Person to Be Restrained:

Reasons for denial of some or all of those personal conduct and stay-away orders as requested in form DV-100, Request for Domestic Violence Restraining Order, are:

b.

(1) The facts as stated in form DV-100 do not show reasonable proof of a past act or acts of abuse. (Family Code, §§ 6320 and 6320.5.)

(2)

(3) Further explanation of reason for denial, or reason not listed above:

The facts do not describe in sufficient detail the most recent incidents of abuse, such as what happened, the dates, who did what to whom, or any injuries or history of abuse.

Date: Time:Room:Dept.:

Hearing Date

Name and address of court if different from above:

è

At least days before the hearing, someone age 18 or older—not you or anyone to be protected—must personally give (serve) a court file-stamped copy of this form (DV-109, Notice of Court Hearing) to the person in along with a copy of all the forms indicated below:

Service of Documents by the Person in

DV-100, Request for Domestic Violence Restraining Order (file-stamped)a.

DV-120, Response to Request for Domestic Violence Restraining Order (blank form)c.

e.DV-120-INFO, How Can I Respond to a Request for Domestic Violence Restraining Order?

g.

d.

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b.

DV-250, Proof of Service by Mail (blank form)

Date:

Judicial Officer

five

DV-110, Temporary Restraining Order (file-stamped) IF GRANTED

Revised January 1, 2019 Notice of Court Hearing (Domestic Violence Prevention)

DV-109, Page 2 of 3

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Case Number:

Confidential Information Regarding Minora. A Request to Keep Minor's Information Confidential (form DV-160) was made and GRANTED (see form

DV-165, Order on Request to Keep Minor's Information Confidential, served with this form.)

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If the request was granted, the information described on the order (form DV-165, item ) must be kept CONFIDENTIAL. The disclosure or misuse of the information is punishable as contempt of court, with a fine of up to $1,000 or possible sanctions.

b.

f. DV-170, Notice of Order Protecting Information of a Minor, and DV-165, Order on Request to Keep Minor's Information Confidential (file-stamped), IF GRANTED

Right to Cancel Hearing: Information for the Person in 1

At the hearing, the judge will consider whether denial of any requested orders will jeopardize your safety and the safety of children for whom you are requesting custody or visitation.

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You must come to the hearing if you want the judge to make restraining orders or continue any orders already made. If you cancel the hearing or do not come to the hearing, any restraining orders made on form DV-110 will end on the date of the hearing.

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If item (a)(2) or (a)(3) is checked, the judge has denied some or all of the temporary orders you requested until the court hearing. The judge may make the orders you want after the court hearing. You can keep the hearing date, or you can cancel your request for orders so there is no court hearing.

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If you want to cancel the hearing, use form DV-112, Waiver of Hearing on Denied Request for Temporary Restraining Order. Fill it out and file it with the court as soon as possible. You may file a new request for orders, on the same or different facts, at a later time.

If you want to keep the hearing date, you must have all of the documents listed in item served on the other person within the time listed in item .

If you cancel the hearing, do not serve the documents listed in item on the other person.•

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Other (specify):

—Clerk's Certificate—

I certify that this Notice of Court Hearing is a true and correct copy of the original on file in the court.

Clerk, by , Deputy

(Clerk will fill out this part.)

Date:

Request for AccommodationsAssistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if you ask at least five days before the hearing. Contact the clerk’s office or go to www.courts.ca.gov/forms for Request for Accommodations by Persons with Disabilities and Response (form MC-410). (Civ. Code, § 54.8.)

If you want to respond in writing, mail a copy of your completed form DV-120, Response to Request for Domestic Violence Restraining Order, to the person in and file it with the court. You cannot mail form DV-120 yourself. Someone age 18 or older — not you — must do it.

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Whether or not you respond in writing, go to the hearing if you want the judge to hear from you before making an order. You may tell the judge why you agree or disagree with the orders requested. You may bring witnesses and other evidence.At the hearing, the judge may make restraining orders against you that could last up to five years.

To show that the person in has been served by mail, the person who mailed the form must fill out a proof of service form. Form DV-250, Proof of Service by Mail, may be used. File the completed form with the court before the hearing and bring a copy with you to the hearing.

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Clerk’s Certificate[seal]

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Revised January 1, 2019 Notice of Court Hearing (Domestic Violence Prevention)

DV-109, Page 3 of 3

To the Person in :2

Case Number:

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• If you are unable to serve the person in in time, you may ask for more time to serve the documents. Read form DV-115-INFO, How to Ask for a New Hearing Date.

• For information about service, read form DV-200-INFO, What Is “Proof of Personal Service”?

The court cannot make the restraining orders after the court hearing unless the person in has been personally given (served) a copy of your request and any temporary orders. To show that the person in has been served, the person who served the forms must fill out a proof of service form. form DV-200, Proof of Personal Service, may be used.

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To the Person in :1

2

1

• For information about responding to a restraining order and filing your answer, read form DV-120-INFO, How Can I Respond to a Request for Domestic Violence Restraining Order?.

The judge may also make other orders about your children, child support, spousal support, money, and property and may order you to turn in or sell any firearms that you own or possess.

Request for Domestic Violence Restraining Order (Domestic Violence Prevention)

Request for Domestic Violence Restraining Order

What is your relationship to the person in ? (Check all that apply):

You must also complete form CLETS-001, Confidential CLETS Information, and give it to the clerk when you file this Request.

Age:

Name of Person You Want Protection From:

Full name

Sex:

Address (if known):Race: Date of Birth:

City:

Age:

Do you want an order to protect family or household members?

Description of person you want protection from:

Weight: Hair Color: Eye Color:

State: Zip:

Sex Age Lives with you? Relationship to youIf yes, list them:

If you do not have one of these relationships, the court may not be able to consider your request. Read form DV-500-INFO for help.

Child’s Name: Date of Birth:Child’s Name: Date of Birth:Child’s Name: Date of Birth:

Judicial Council of California, www.courts.ca.gov Revised July 1, 2016, Mandatory Form Family Code, § 6200 et seq.

DV-100, Page 1 of 6

DV-100

Name of Person Asking for Protection:

Address (If you have a lawyer for this case, give your lawyer’s information. If you do not have a lawyer and want to keep your home address private, give a different mailing address instead. You do not have to give your telephone, fax, or e-mail.):

Firm Name:


Telephone:

Address:

Fax:E-Mail Address:

Zip:State:City:

M F Height:

Yes No

Yes NoYes NoYes No

Check here if you need more space. Attach a sheet of paper and write “DV-100, Protected People” for a title.

a.b.

We are now married or registered domestic partners.We used to be married or registered domestic partners.

c. We live together.d. We used to live together.e. We are related by blood, marriage, or adoption (specify relationship):f. We are dating or used to date, or we are or used to be engaged to be married.g. We are the parents together of a child or children under 18:

Check here if you need more space. Attach a sheet of paper and write “DV-100, Additional Children” for a title.

h. We have signed a Voluntary Declaration of Paternity for our child or children. (Attach a copy if you have one).

This is not a Court Order.

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Case Number:

http://www.courts.ca.gov/documents/dv500info.pdf

Check the orders you want.

I ask the court to order the person in to stay at least yards away from (check all that apply):MeMy homeMy job or workplace

My school

My vehicleThe child(ren)’s school or child careEach person listed in

Other (specify):

a.

b.

Revised July 1, 2016

(If the person in lives with you and you want that person to stay away from your home, you must ask for this move-out order.)

I ask the court to order the person in not to do the following things to me or anyone listed in :

Other Restraining Orders and Court Cases

Have you or any other person named in been involved in another court case with the person in ?If yes, check each kind of case and indicate where and when each was filed:

Kind of Case County or Tribe Where Filed Year Filed Case Number (if known)

DV-100, Page 2 of 6

The person in will be ordered not to take any action to get the addresses or locations of any protected person unless the court finds good cause not to make the order.

If the person listed in is ordered to stay away from all the places listed above, will he or she still be able to get to his or her home, school, job, workplace, or vehicle?

Case Number:

b.No Yes

Divorce, Nullity, Legal SeparationCivil HarassmentDomestic ViolenceCriminalJuvenile, Dependency, GuardianshipChild SupportParentage, PaternityOther (specify):Check here if you need more space. Attach a sheet of paper and write “DV-100, Other Court Cases” for a title.

Move-Out Order

I ask the court to order the person in to move out from and not return to (address):

I have the right to live at the above address because (explain):

This is not a Court Order.Request for Domestic Violence Restraining Order

(Domestic Violence Prevention)

Harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy personal property, disturb the peace, keep under surveillance, impersonate (on the Internet, electronically or otherwise), or block movements

Personal Conduct Ordersþ

a.

b. Contact, either directly or indirectly, in any way, including but not limited to, by telephone, mail or e-mail or other electronic means

Stay-Away Order

Yes No (If no, explain):

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2

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Are there any restraining/protective orders currently in place OR that have expired in the last six months (emergency protective orders, criminal, juvenile, family)?

a.

YesNo (date of order): and (expiration date): (Attach a copy if you have one).

I believe the person in owns or possesses guns, firearms, or ammunition.

I ask for the right to record communications made to me by the person in that violate the judge’s orders.

Revised July 1, 2016 DV-100, Page 3 of 6

If you ask for orders, you must fill out and attach form DV-105, Request for Child Custody and Visitation Orders.

If you ask for child support orders, you must fill out and attach form FL-150, Income and Expense Declaration or form FL-155, Financial Statement (Simplified).

You and the other parent may tell the court that you want to be legal parents of the children (use form DV-180,Agreement and Judgment of Parentage).

If the judge approves the order, the person in will be ordered not to own, possess, purchase, or receive a firearm or ammunition. The person will be ordered to sell to, or store with, a licensed gun dealer, or turn in to law enforcement, any guns or firearms that he or she owns or possesses.

Case Number:

Guns or Other Firearms or AmmunitionYes No I don’t know

Record Unlawful Communications

Care of AnimalsI ask for the sole possession, care, and control of the animals listed below. I ask the court to order the person in to stay at least yards away from and not take, sell, transfer, encumber, conceal, molest, attack, strike, threaten, harm, or otherwise dispose of the following animals:

I ask for the animals to be with me because:

Child Custody and Visitationa.b.

I do not have a child custody or visitation order and I want one.I have a child custody or visitation order and I want it changed.

Child Support (Check all that apply):a.b.

I do not have a child support order and I want one.I have a child support order and I want it changed.

c. I now receive or have applied for TANF, Welfare, CalWORKS, or Medi-Cal.

Property ControlI ask the court to give only me temporary use, possession, and control of the property listed here:



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Debt Payment

Check here if you need more space. Attach a sheet of paper and write “DV-100, Debt Payment” for a title.I ask the court to order the person in to make these payments while the order is in effect:

Pay to: For: Amount: $ Due date:

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Property RestraintI am married to or have a registered domestic partnership with the person in . I ask the judge to order that the person in not borrow against, sell, hide, or get rid of or destroy any possessions or property, except in the usual course of business or for necessities of life. I also ask the judge to order the person in to notify me of any new or big expenses and to explain them to the court.

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I am married to or have a registered domestic partnership with the person in and no spousal support order exists. I ask the court to order the person in to pay spousal support. (You must complete, file, and serve form FL-150, Income and Expense Declaration, before your hearing).

Spousal Support2

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http://www.courts.ca.gov/documents/dv150.pdf





What other orders are you asking for?

I ask the court to order the person in to pay the following: You can ask for lost earnings or your costs for services caused directly by the person in (damaged property, medical care, counseling, temporary housing, etc.). You must bring proof of these expenses to your hearing. Pay to: For: Amount: $ Pay to: For: Amount: $

I ask the court to order the person listed in to go to a 52-week batterer intervention program and show proof of completion to the court.

Revised July 1, 2016 DV-100, Page 4 of 6

I ask that the person in pay some or all of my lawyer’s fees and costs. You must complete, file, and serve form FL-150, Income and Expense Declaration, before your hearing.

Case Number:

InsuranceI ask the court to order the person in NOT to cash, borrow against, cancel, transfer, dispose of, or change the beneficiaries of any insurance or coverage held for the benefit of me or the person in , or our child(ren), for whom support may be ordered, or both. Lawyer’s Fees and Costs

Payments for Costs and Services

Batterer Intervention Program

Other Orders

Check here if you need more space. Attach a sheet of paper and write “DV-100, Other Orders” for a title.



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2

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Rights to Mobile Device and Wireless Phone Account

(including area code):

(including area code):(including area code):

my number number of child in my care

my number number of child in my caremy number number of child in my care

Check here if you need more space. Attach a sheet of paper and write “DV-100, Rights to Mobile Device and Wireless Phone Account” for a title.

If the judge makes this order, you will be financially responsible for these accounts, including monthly service fees and costs of any mobile devices connected to these phone numbers. You may be responsible for other fees. You must contact the wireless service provider to find out what fees you will be responsible for and whether you are eligible for an account.

I ask the court to give only me temporary use, possession, and control of the following mobile devices: and the wireless phone account for the following wireless phone numbers because the account currently belongs to the person in :2

18a. Property control of mobile device and wireless phone account

b. Debt PaymentI ask the court to order the person in to make the payments for the wireless phone accounts listed in 18a because:

2

Name of the wireless service provider is: Amount: $ Due Date:If you are requesting this order, you must complete, file, and serve form FL-150, Income and Expense Declaration, before your hearing.

c. Transfer of Wireless Phone AccountI ask the court to order the wireless service provider to transfer the billing responsibility and rights to the wireless phone numbers listed in 18a to me because the account currently belongs to the person in .2



Describe how the person in abused you or your child(ren):


Describe how the person in abused you. Abuse means to intentionally or recklessly cause or attempt to cause bodily injury to you; or to place you or another person in reasonable fear of imminent serious bodily injury; or to harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, keep you under surveillance, impersonate (on the Internet, electronically or otherwise), batter, telephone, or contact you; or to disturb your peace; or to destroy your personal property. (For a complete definition, see Fam. Code, §§ 6203, 6320.)

Date of most recent abuse:Who was there?

Did the person in use or threaten to use a gun or any other weapon?2

Describe any injuries:

Did the police come?If yes, did they give you or the person in an Emergency Protective Order?Attach a copy if you have one.The order protects

DV-100, Page 5 of 6

Case Number:

Describe Abuse

a.1.

2.

Check here if you need more space. Attach a sheet of paper and write “DV-100, Recent Abuse” for a title.

3.

4.

5.

No Yes (If yes, describe):

No Yes

you or the person in


I don’t knowYes No

No Fee to Serve (Notify) Restrained PersonIf you want the sheriff or marshal to serve (notify) the restrained person about the orders for free, ask the court clerk what you need to do.

The court will schedule a hearing on your request. If the judge does not make the orders effective right away (“temporary restraining orders”), the judge may still make the orders after the hearing. If the judge does not make the orders effective right away, you can ask the court to cancel the hearing. Read form DV-112, Waiver of Hearing on Denied Request for Temporary Restraining Order, for more information.

Court Hearing

The papers must be personally served on the person in at least five days before the hearing, unless the court orders a shorter time for service. If you want there to be fewer than five days between service and the hearing, explain why below. For help, read form DV-200-INFO, “What Is Proof of Personal Service”?

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2

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2

2

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24 Time for Service (Notice)



http://www.courts.ca.gov/documents/dv200info.pdf

I don’t knowYes No


The persons listed in item need an order for protection because (describe):

I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.

DV-100, Page 6 of 6

Case Number:

Other Persons to Be Protected

Number of pages attached to this form, if any:

Date:

Type or print your name Sign your name

Lawyer’s name, if you have one Lawyer’s signature

Date:



Has the person in abused you (or your child(ren)) other times? Describe Abuse (continued)

Date of abuse:Who was there?

Did the person in use or threaten to use a gun or any other weapon?

Describe any injuries:

Did the police come?If yes, did they give you or the person in an Emergency Protective Order?

Attach a copy if you have one.The order protects

b.1.2. Describe how the person in abused you or your child(ren):

Check here if you need more space. Attach a sheet of paper and write “DV-100, Recent Abuse” for a title.

3.

4.

5.

No Yes (If yes, describe):

No Yes

you or the person in If the person in abused you other times, check here and use Form DV-101, Description of Abuse or describe any previous abuse on an attached sheet of paper and write “DV-100, Previous Abuse” for a title.

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2

2

2

2

2


FL/E-LP-613

FL/E-LP-613 (Rev. May 23, 2017) Adopted for Mandatory Use Page 1 of 2 Attachment to Request for

Domestic Violence Restraining Order Page 1 of 2 www.saccourt.ca.gov

Attachment to Request for Domestic Violence Restraining Order

1. Have you participated in another case against the person who is to be restrained which involves child custody and/or visitation? ¨ Yes ¨ No Name of court and case number: __________________________________________________________. The court's order or judgment regarding child custody and/or visitation was: ________________________ ____________________________________________________________________________________.

2. The child (ren) have been living with ¨ Mother ¨ Father ¨ Partner, since: ________________________. (approx. date)

3. Are you currently involved in a dependency case or with Child Protective Services? ____ Yes ____No

4. ¨ I have an ¨ Emergency Protective Order, ¨ Criminal Temporary Restraining Order, or ¨ Criminal Restraining Order against the person who is to be restrained. Name of the Court and case number:_______________________________________________________ ¨ I have had no previous restraining orders against the person who is to be restrained.

5. The most recent incident of abuse by the party to be restrained was ________________________. (approx. date)

Restrained party: ¨ hit me on the: ¨ arms ¨ legs ¨ face ¨ head ¨ stomach ¨ back ¨ eye ¨ kicked me on the ___________________________________________________. ¨ pushed and/or shoved me: ¨ into wall ¨ to the floor ¨ threatened me with a weapon (specify weapon and describe incident): ___________________________________________________________________. ¨ pulled my hair ¨ strangled me ¨ left bruises; describe: _________________________________________________. ¨ sexually abused me, describe: __________________________________________. ¨ City Police/Sheriff was called; ¨ Restrained party was arrested Was a report taken? ¨ Yes ¨ No Report number: _________________________ ¨ Other injuries: _______________________________________________________ _____________________________________________________________________ _____________________________________________________________________

6. The second most recent incident of abuse by the restrained party was: ____________________________. (approx. date)


FL/E-LP-613

FL/E-LP-613 (Rev. May 23, 2017) Adopted for Mandatory Use Page 2 of 2 Attachment to Request for

Domestic Violence Restraining Order Page 2 of 2 www.saccourt.ca.gov

7. The third most recent incident of abuse by the restrained party was:____________________________. (approx. date)


8. Since the last act of abuse, explain the delay, if any, in seeking this restraining order: __________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________

9. The most recent incident of threats to ¨ kill me; ¨ beat me; ¨ take child(ren) was on_________________. (approx. date)

He/She said___________________________________________________________________________ _____________________________________________________________________________________.

10. Restrained party took our child(ren) on ____________________ and will not give them back. (approx. date)

11. Restrained party has ¨ physically abused ¨ sexually molested the child(ren). Children's Protective Services ¨ is ¨ is not involved. Describe the abuse:

_____________________________________________________________________________________ _____________________________________________________________________________________.

12. Other past incidence of abuse:__________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

_____________________________________________________________________________________

13. Restrained party has; does not have a firearms(s) which is registered; unregistered; do not know. The firearm(s) is a (mark all applicable): hand-gun; rifle; other (describe) ___________________ I last saw the firearm(s) on _____________________________.

(approx. date)


Date:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _______________________________________________ (type or print name) (signature of person to be protected)

Full name

This order expires at the end of the hearing stated below:

DV-110, Page 1 of 6

Person in must complete items , , and only.

Description of restrained person:

Sex AgeRelationship to person in

In addition to the person named in , the following persons are protected by temporary orders as indicated in items and (family or household members):

1 31 2

16

1

The court will complete the rest of this form.

Hearing Date: Time:

Relationship to protected person:

Judicial Council of California, www.courts.ca.gov Revised July 1, 2016, Mandatory Form Family Code, § 6200 et seq. Approved by DOJ

Temporary Restraining Order (CLETS—TRO)


Temporary Restraining Order

1 Name of Protected Person:


Firm Name:


Telephone:

Address:

Fax:E-mail Address:

Zip:State:City:

2 Name of Restrained Person:





Case Number:

Sex:

Address (if known):Race: Date of Birth:

City:

Age:Weight: Hair Color: Eye Color:

State: Zip:

M F Height:

3 Additional Protected Persons

Check here if there are additional protected persons. List them on an attached sheet of paper and write, “DV-110, Additional Protected Persons” as a title.

a.m. p.m.

4

This is a Court Order.

DV-110

7

Court Hearing

Case Number: County: Expiration Date: No information has been provided to the judge about a criminal protective order.

A criminal protective order on form CR-160, Criminal Protective Order—Domestic Violence, is in effect. a.

The court has granted the temporary orders checked 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.

You must take only personal clothing and belongings needed until the hearing and move out immediately from

b.

To the person in

DV-110, Page 2 of 6

You must not do the following things to the person in and persons in :

Contact, either directly or indirectly, in any way, including but not limited to, by telephone, mail, e-mail or other electronic meansTake any action, directly or through others, to obtain the addresses or locations of the persons in and . (If this item is not checked, the court has found good cause not to make this order.)

Peaceful written contact through a lawyer or process server or another person for service of Form DV-120 (Response to Request for Domestic Violence Restraining Order) or other legal papers related to a court case is allowed and does not violate this order.

Exceptions: Brief and peaceful contact with the person in , and peaceful contact with children in , as required for court-ordered visitation of children, is allowed unless a criminal protective order says otherwise.

Harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy personal property, disturb the peace, keep under surveillance, impersonate (on the Internet, electronically or otherwise), or block movements

1 3

3

1

1

3

a.

You must stay at least (specify): yards away from (check all that apply):


1 3

a.

c.

b.


Case Number:

Criminal Protective Order

Not requested Denied until the hearing Granted as follows:

b.

(address):

Granted as follows:Denied until the hearingNot requested


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2


Personal Conduct Orders

Stay-Away Order

Move-Out Order



The person in The persons in Home of person in

The job or workplace of person in

School of person in 13

Vehicle of person in 1

11

1

The child(ren)’s school or child careOther (specify):


Child custody and visitation are ordered on the attached form DV-140, Child Custody and Visitation Order or . The parent with temporary custody of the child must not remove the child from California unless the court allows it after a noticed hearing (Fam. Code, § 3063).

You cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, other firearms, or ammunition.You must:

Sell to, or store with, a licensed gun dealer, or turn in to a law enforcement agency, any guns or other firearms within your immediate possession or control. Do so within 24 hours of being served with this order.

•

Within 48 hours of receiving this order, file with the court a receipt that proves guns have been turned in, stored, or sold. (You may use Form DV-800, Proof of Firearms Turned In, Sold, or Stored, for the receipt.) Bring a court filed copy to the hearing.

•

DV-110, Page 3 of 6Revised July 1, 2016

No Guns or Other Firearms or Ammunitiona.

c.

Property Control

Not ordered now but may be ordered after a noticed hearing.

Case Number:

b.

The court has received information that you own or possess a firearm.


The person in is given the sole possession, care, and control of the animals listed below. The person in must stay at least yards away from and not take, sell, transfer, encumber, conceal, molest, attack, strike, threaten, harm, or otherwise dispose of the following animals:

Child Support

Until the hearing, only the person in can use, control, and possess the following property:


Care of Animals

Child Custody and Visitation

Debt PaymentThe person in must make these payments until this order ends:Pay to: For: Amount: $ Due date: Pay to: For: Amount: $ Due date:


(specify other form):





The person in can record communications made by you that violate the judge’s orders.

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1

1

2



If the people in and are married to each other or are registered domestic partners, must not transfer, borrow against, sell, hide, or get rid of or destroy any property, including animals, except in the usual course of business or for necessities of life. In addition, each person must notify the other of any new or big expenses and explain them to the court. (The person in cannot contact the person in if the court has made a “no contact” order.)

21 1the person in 2the person in

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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.

Property Restraint Not requested Denied until the hearing Granted as follows:

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No Fee to Serve (Notify) Restrained PersonIf the sheriff serves this order, he or she will do so for free.

Judge (or Judicial Officer)


Case Number:

Spousal SupportNot ordered now but may be ordered after a noticed hearing.

Insurance is ordered NOT to cash, borrow against, cancel, transfer, dispose of, or change the beneficiaries of any insurance or coverage held for the benefit of the parties, or their child(ren), if any, for whom support may be ordered, or both.

The person in the person in

Lawyer's Fees and CostsNot ordered now but may be ordered after a noticed hearing.Payments for Costs and ServicesNot ordered now but may be ordered after a noticed hearing.Batterer Intervention ProgramNot ordered now but may be ordered after a noticed hearing.Other Orders

Check here if there are additional orders. List them on an attached sheet of paper and write “DV-110, Other Orders” as a title.

Date:




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1 2


17

18 Rights to Mobile Device and Wireless Phone Accounta. Property control of mobile device and wireless phone account

Not requested Denied until the hearing Granted as follows:Until the hearing, only the person in can use, control, and possess the following property:1Mobile device (describe) and account (phone number):Mobile device (describe)

and account (phone number):Mobile device (describe)and account (phone number):

Check here if you need more space. Attach a sheet of paper and write "DV-110 Rights to Mobile Device and Wireless Phone Account" as a title.

b. Debt Payment Not requested Denied until the hearing Granted as follows:The person in must make these payments until this order ends:2Pay to (wireless service provider): Amount: $ Due date:

c. Transfer of Wireless Phone AccountNot ordered now but may be ordered after a noticed hearing.

Instructions for Law EnforcementThis order is effective when made. It is enforceable by any law enforcement agency that has received the order, is shown a copy of the order, or has verified its existence on the California Law Enforcement Telecommunications System (CLETS). If the law enforcement agency has not received proof of service on the restrained person, and the restrained person was not present at the court hearing, the agency shall advise the restrained person of the terms of the order and then shall enforce it. Violations of this order are subject to criminal penalties.


Case Number:

Child custody and visitation: If you do not go to the hearing, the judge can make custody and visitation orders for your children without hearing from you.

•

Child Custody, Visitation, and Support

Child support: The judge can order child support based on the income of both parents. The judge can also have that support taken directly from a parent's paycheck. Child support can be a lot of money, and usually you have to pay until the child is age 18. File and serve a Financial Statement (Simplified) (form FL-155) or an Income and Expense Declaration (form FL-150) if you want the judge to have information about your finances. Otherwise, the court may make support orders without hearing from you.

•

Spousal support: File and serve an Income and Expense Declaration (form FL-150) so the judge will have information about your finances. Otherwise, the court may make support orders without hearing from you.

•


Service of Order by Mail

You Cannot Have Guns, Firearms, And/Or Ammunition.You cannot own, have, possess, buy or try to buy, receive or try to receive, or otherwise get guns, other firearms, and/or ammunition while the order is in effect. If you do, you can go to jail and pay a $1,000 fine. You must sell to or store with a licensed gun dealer or turn in to a law enforcement agency any guns or other firearms that you have or control. The judge will ask you for proof that you did so. If you do not obey this order, you can be charged with a crime. Federal law says you cannot have guns or ammunition while the order is in effect.

If the judge makes a restraining order at the hearing, which has the same orders as in this form, you will get a copy of that order by mail at your last known address, which is written in . If this address is incorrect, or to find out if the orders were made permanent, contact the court.

2

It is a felony to take or hide a child in violation of this order.

If You Do Not Obey This Order, You Can Be Arrested And Charged With a Crime.

•• If you travel to another state or to tribal lands or make the protected person do so, with the intention of disobeying this

order, you can be charged with a federal crime.

If you do not obey this order, you can go to jail or prison and/or pay a fine.•

Warnings and Notices to the Restrained Person in 2



Arrest Required if Order Is ViolatedIf an officer has probable cause to believe that the restrained person had notice of the order and has disobeyed the order, the officer must arrest the restrained person. (Pen. Code, §§ 836(c)(1), 13701(b).) A violation of the order may be a violation of Penal Code section 166 or 273.6.


Case Number:



I certify that this Temporary Restraining Order is a true and correct copy of the original on file in the court.

Clerk’s Certificate [seal]

Clerk, by , Deputy


Date:

Certificate of Compliance With VAWA This temporary protective order meets all “full faith and credit” requirements of the Violence Against Women Act, 18 U.S.C. § 2265 (1994) (VAWA), upon notice of the restrained person. This court has jurisdiction over the parties and the subject matter; the restrained person has been or will be afforded notice and a timely opportunity to be heard as provided by the laws of this jurisdiction. This order is valid and entitled to enforcement in each jurisdiction throughout the 50 states of the United States, the District of Columbia, all tribal lands, and all U.S. territories, commonwealths, and possessions and shall be enforced as if it were an order of that jurisdiction.

3.

4.

Criminal Order: If none of the orders includes a no-contact order, a domestic violence protective order issued in a criminal case takes precedence in enforcement over any conflicting civil court order. Any nonconflicting terms of the civil restraining order remain in effect and enforceable.

Child Custody and Visitation•

•

The custody and visitation orders are on form DV-140, items and . They are sometimes also written on additional pages or referenced in DV-140 or other orders that are not part of the restraining order. Forms DV-100 and DV-105 are not orders. Do not enforce them.

3 4

Conflicting Orders–Priorities for EnforcementIf more than one restraining order has been issued protecting the protected person from the restrained person, the orders must be enforced according to the following priorities (see Pen. Code, § 136.2, and Fam. Code, §§ 6383(h), 6405(b)):1.

2.

EPO: If one of the orders is an Emergency Protective Order (form EPO-001), and it is more restrictive than other restraining or protective orders, it has precedence in enforcement over all other orders.

If the Protected Person Contacts the Restrained PersonEven if the protected person invites or consents to contact with the restrained person, the orders remain in effect and must be enforced. The protected person cannot be arrested for inviting or consenting to contact with the restrained person. The orders can be changed only by another court order. (Pen. Code, §13710(b).)



No-Contact Order: If there is no EPO, a no-contact order that is included in a restraining or protective order has precedence in enforcement over any other restraining or protective order.

Family, Juvenile, or Civil Order: If more than one family, juvenile, or other civil restraining or protective order has been issued, the one that was issued last must be enforced.

This is not a Court Order—Do not place in court file.

CLETS Information

Person to Be Protected (Name):

Eye Color: Date of Birth: Hair Color: Age:

Confidential CLETS InformationJudicial Council of California, www.courts.ca.govNew January 1, 2012, Mandatory FormCal. Rules of Court, rule 1.51

FSex: Height: Weight: Race: M

Person to Be Restrained (Name):

Describe any marks, scars, or tattoos: Other names used by the restrained person:

Describe any guns or firearms that you believe the person in owns or has access to (Number, types, and locations):

1

CLETS-001, Page 1 of 1

Eye Color: Date of Birth: Hair Color: Age: FSex: Height: Weight: Race: M

4 Other People to Be ProtectedSexName Date of Birth

CONFIDENTIALCLETS-001

Additional persons to be protected are listed on Attachment 4.

Guns or Firearms3

2

California Law Enforcement Telecommunications System (CLETS)Information Form

Important: This form MUST NOT become part of the public court file. It is confidential and private.

Case Number (if you know it):

This form is submitted with the initial filing (date):This is an amended form (date):

Fill out as much of this form as you can and give it to the court clerk. If the court issues a restraining order, this form will provide law enforcement with information that will help them enforce it. If any of this information changes, fill out a new (amended) form.

1Race

Driver’s License Number and State: Social Security Number: Vehicle (Type, Model, Year): (License Number and State):

Vehicle (Type, Model, Year): (License Number and State):

Mailing Address (listed on restraining order):Zip:State:City: Telephone (optional):

Employer:Occupation/Title: Work Hours:

Residence Address:Zip:State:City: Telephone:

Business Address:Zip:State:City: Telephone:

Relation to Person in

2

Judicial Council of California, www.courts.ca.gov Revised July 1, 2016, Mandatory Form Family Code, § 6200 et seq. Approved by DOJ

This is a Court Order.Restraining Order After Hearing (CLETS—OAH)

(Order of Protection) (Domestic Violence Prevention)

Full name

The orders, except as noted below, end on

Sex AgeRelationship to person in

In addition to the person named in , the following persons are protected by orders as indicated in items and (family or household members):

Expiration Date

If no date is written, the restraining order ends three years after the date of the hearing in item (a).

(date):

•• If no time is written, the restraining order ends at midnight on the expiration date.

Note: Custody, visitation, child support, and spousal support orders remain in effect after the restraining order ends. Custody, visitation, and child support orders usually end when the child is 18.

•

• The court orders are on pages 2, 3, 4, and 5 and attachment pages (if any).This order complies with VAWA and shall be enforced throughout the United States. See page 5.

DV-130, Page 1 of 7

at (time):

DV-130

Name of Restrained Person:

Description of restrained person:


Fill in court name and street address:Superior Court of California, County of

Clerk fills in case number when form is filed.

Case Number:

Telephone:

Address:


Fax:

Firm Name:

E-Mail Address:

Name of Protected Person:

Zip:State:City:


Sex:

Mailing Address (if known):Race: Date of Birth:

City:

Age:Weight: Hair Color: Eye Color:

State: Zip:

M F Height:

Additional Protected Persons1 6

71

Check here if there are additional protected persons. List them on an attached sheet of paper and write, “DV-130, Additional Protected Persons,” as a title.

a.m. p.m. or midnight

5

1

2

3

4

Relationship to protected person:

Restraining Order After Hearing (Order of Protection)

Amended OrderOriginal Order

The person in must move out immediately from (address):


HearingsThe hearing was on (date): with (name of judicial officer): a.

The court has granted the orders checked below. Item is also an order. 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.

The people in and must return to Dept. (date): at (time):

b.

To the person in :

These people were at the hearing (check all that apply):(name):(name):

c.

The person in must not do the following things to the protected people in and :a.

Peaceful written contact through a lawyer or process server or another person for service of legal papers related to a court case is allowed and does not violate this order.

b.

c.

The person in must stay at least (specify): yards away from (check all that apply):a.

b.

Case Number:

The person in The person in

12

The lawyer for the person in The lawyer for the person in

12

1 2a.m. p.m.

2

9

of the court on

6

7

8

5

2 1 3

Contact, either directly or indirectly, by any means, including, but not limited to, by telephone, mail, e-mail, or other electronic means.Take any action, directly or through others, to obtain the addresses or locations of any protected persons. (If this item is not checked, the court has found good cause not to make this order.)


1 3

Stay-Away Order2

The person in The persons in Home of person in

The job or workplace of person in

School of person in 13

Vehicle of person in 1

11

1

The child(ren)’s school or child care


1 3

Move-Out Order2

Restraining Order After Hearing (CLETS—OAH) (Order of Protection)


DV-130, Page 2 of 7

No Guns or Other Firearms or AmmunitionThe person in cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, other firearms, or ammunition.

a. 9

2

Harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy personal property, disturb the peace, keep under surveillance, impersonate (on the Internet, electronically or otherwise), or block movements.

Personal Conduct Orders

to review (specify issues):


Other (specify):

The court has made the necessary findings and applies the firearm relinquishment exemption under Family Code section 6389(h). Under California law, the person in is not required to relinquish this firearm (specify make, model, and serial number of firearm):

yards away from and not take, sell, transfer, encumber, conceal, molest, attack, strike,

The person in has the right to record communications made by the person in that violate the judge’s orders.21

The person in is given the sole possession, care, and control of the animals listed below. The person in

threaten, harm, or otherwise dispose of the following animals:

Only the person in can use, control, and possess the following property:

b. The person in must: Sell to, or store with, a licensed gun dealer, or turn in to a law enforcement agency, any guns or other firearms within his or her immediate possession or control. Do so within 24 hours of being served with this order.

•

Within 48 hours of receiving this order, file with the court a receipt that proves guns have been turned in, sold, or stored. (Form DV-800, Proof of Firearms Turned In, Sold, or Stored, may be used for the receipt.) Bring a court filed copy to the hearing.

•

c.

The person in must make these payments until this order ends:Pay to: For: Amount: $ Due date:

Pay to: For: Amount: $ Due date: Pay to: For: Amount: $ Due date:

Check here if more payments are ordered. List them on an attached sheet of paper and write “DV-130, Debt Payments” as a title.

Child support is ordered on the attached Form FL-342, Child Support Information and Order Attachment

Child custody and visitation are ordered on the attached Form DV-140, Child Custody and Visitation Order or (specify other form):

Case Number:

9

10

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12

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2

The court has received information that the person in owns or possesses a firearm. 2


Care of Animals

Child Custody and Visitation

Child Support

Property Control

Debt Payment

must stay at least 1 2

or (specify other form):

1

2



DV-130, Page 3 of 7

d. 2

The firearm must be in his or her physical possession only during scheduled work hours and during travel to and from his or her place of employment. Even if exempt under California law, the person in may be subject to federal prosecution for possessing or controlling a firearm.

2

This is a Court Order.Revised July 1, 2016

The must not transfer, borrow against, sell, hide, or get rid of or destroy any property, including animals, except in the usual course of business or for necessities of life. In addition, the person must notify the other of any new or big expenses and explain them to the court. (The person in cannot contact the person in if the court has made a“No-Contact”order.)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.

Property Restraintperson in person in 1 2

21

15

16


Other orders (specify):

The person in must go to and pay for a 52-week batterer intervention program and show written proof of completion to the court. This program must be approved by the probation department under Penal Code § 1203.097. The person in must enroll by (date): or if no date is listed, must enroll within 30 days after the order is made. The person in must complete, file and serve Form 805, Proof of Enrollment for Batterer Intervention Program.

If the sheriff or marshal serves this order, he or she will do it for free.

Attachment or (specify other form):Spousal support is ordered on the attached Form FL-343, Spousal, Partner, or Family Support Order

The person in must pay the following lawyer’s fees and costs:

The person in must pay the following:

No Fee to Serve (Notify) Restrained Person

Case Number:

20

21

22

23

Spousal Support

Lawyer's Fees and Costs

Payments for Costs and Services

Batterer Intervention Program

Other Orders


2

2Pay to: For: Amount: $ Due date:


Check here if more payments are ordered. List them on an attached sheet of paper and write “DV-130, Payments for Costs and Services” as a title.

2

24



DV-130, Page 4 of 7

19 is ordered NOT to cash, borrow against, cancel, transfer, dispose of, or change the beneficiaries of any insurance or coverage held for the benefit of the parties, or their child(ren), if any, for whom support may be ordered, or both.

1 2The person in the person in Insurance


18 Rights to Mobile Device and Wireless Phone AccountProperty Control of Mobile Device and Wireless Phone Account

Only the person in can use, control, and possess the following property:1Mobile device (describe) and account (phone number):Mobile device (describe) and account (phone number):

Check here if you need more space. Attach a sheet of paper and write "DV-130 Rights to Mobile Device and Wireless Phone Account" as a title.

b.The person in must make these payments until this order ends:2Pay to (wireless service provider): Amount: $ Due date:

Debt Payment

a.

The court has made an order transferring one or more wireless service accounts from the person in to the person in . These orders are contained in a separate order (Form DV-900).

c. Transfer of Wireless Phone Account2

1

17

22

••

All of the attached pages are part of this order.Attachments include (check all that apply):

Certificate of Compliance With VAWAThis restraining (protective) order meets all “full faith and credit” requirements of the Violence Against Women Act, 18 U.S.C. § 2265 (1994) (VAWA) upon notice of the restrained person. This court has jurisdiction over the parties and the subject matter; the restrained person has been or will be afforded notice and a timely opportunity to be heard as provided by the laws of this jurisdiction. This order is valid and entitled to enforcement in each jurisdiction throughout the 50 states of the United States, the District of Columbia, all tribal lands, and all U.S. territories, commonwealths, and possessions and shall be enforced as if it were an order of that jurisdiction.

• Number of pages attached to this seven-page form:

Case Number:

Attached pages are orders.27

DV-140Other (specify):

DV-145 DV-150 FL-342 FL-343

Date:Judge (or Judicial Officer)



DV-130, Page 5 of 7


c. No information has been provided to the judge about a criminal protective order.

(List other orders on an attached sheet of paper. Write “DV-130, Other Criminal Protective Orders” as a title.)

a. Case Number: County: Expiration Date:

26 Criminal Protective OrderForm CR-160, Criminal Protective Order—Domestic Violence, is in effect.

b. Case Number: County: Expiration Date:Other Criminal Protective Order in effect (specify):

Proof of service of Form DV-109 and Form DV-110 (if issued) was presented to the court. The judge’s orders in this form are the same as in Form DV-110 except for the end date. The person in must be served. This order can be served by mail. Proof of service of Form DV-109 and Form DV-110 (if issued) was presented to the court. The judge’s orders in this form are different from the orders in Form DV-110, or Form DV-110 was not issued. The person in must be personally “served” (given) a copy of this order.

2

2

Servicea.

b.(1)

(2)

The people in and were at the hearing or agreed in writing to this order. No other proof of service is needed. The person in was at the hearing on the request for original orders. The person in was not present.1 2

1 225

Proof of service of Form FL-300 to modify the orders in Form DV-130 was presented to the court. c. The people in and were at the hearing or agreed in writing to this order. No other proof of1 2(1)

(2) was not at the hearing and must be personally “served” (given) a copy1 2The person in of this amended order.

service is needed.

DV-900

Arrest Required if Order Is ViolatedIf an officer has probable cause to believe that the restrained person had notice of the order and has disobeyed the order, the officer must arrest the restrained person. (Pen. Code, §§ 836(c)(1), 13701(b).) A violation of the order may be a violation of Penal Code section 166 or 273.6.

Case Number:



DV-130, Page 6 of 7


Instructions for Law Enforcement

Start Date and End Date of OrdersThe orders start on the earlier of the following dates:••

The hearing date in item (a) on page 2, orThe date next to the judge’s signature on this page.

The orders end on the expiration date in item on page 1. If no date is listed, they end three years from the hearing date.4

5

You cannot have guns, firearms, and/or ammunition.You cannot own, have, possess, buy or try to buy, receive or try to receive, or otherwise get guns, other firearms, and/or ammunition while the order is in effect. If you do, you can go to jail and pay a $1,000 fine. Unless the court grants an exemption, you must sell to, or store with, a licensed gun dealer, or turn in to a law enforcement agency, any guns or other firearms that you have or control. The judge will ask you for proof that you did so. If you do not obey this order, you can be charged with a crime. Federal law says you cannot have guns or ammunition while the order is in effect. Even if exempt under California law, you may be subject to federal prosecution for possessing or controlling a firearm.

Warnings and Notices to the Restrained Person in 2

It is a felony to take or hide a child in violation of this order.

If you do not obey this order, you can be arrested and charged with a crime.

•• If you travel to another state or to tribal lands or make the protected person do so, with the intention of disobeying this

order, you can be charged with a federal crime.

If you do not obey this order, you can go to jail or prison and/or pay a fine.•

Notice/Proof of ServiceLaw enforcement must first determine if the restrained person had notice of the orders. If notice cannot be verified, the restrained person must be advised of the terms of the orders. If the restrained person then fails to obey the orders, the officer must enforce them. (Fam. Code, § 6383.)Consider the restrained person “served” (notified) if:

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 at the restraining order hearing or was informed of the order by an officer. (Fam. Code, § 6383; Pen. Code, § 836(c)(2).) An officer can obtain information about the contents of the order in the Domestic Violence Restraining Order System (DVROS). (Fam. Code, § 6381(b)-(c).)

••

If the Protected Person Contacts the Restrained PersonEven if the protected person invites or consents to contact with the restrained person, the orders remain in effect and must be enforced. The protected person cannot be arrested for inviting or consenting to contact with the restrained person. The orders can be changed only by another court order. (Pen. Code, § 13710(b).)

—Clerk's Certificate—I certify that this Restraining Order After Hearing (Order of Protection) is a true and correct copy of the original on file in the court.


Conflicting Orders—Priorities for Enforcement

Clerk’s Certificate[seal]

Case Number:



DV-130, Page 7 of 7

Date: Clerk, by , Deputy

If more than one restraining order has been issued protecting the protected person from the restrained person, the orders must be enforced in the following priority (see Pen. Code, § 136.2 and Fam. Code, §§ 6383(h)(2), 6405(b)):1.

2.

3.

4.

EPO: If one of the orders is an Emergency Protective Order (Form EPO-001) and it is more restrictive than other restraining or protective orders, it has precedence in enforcement over all other orders. No-Contact Order: If there is no EPO, a no-contact order that is included in a restraining or protective order has precedence in enforcement over any other restraining or protective order. Criminal Order: If none of the orders includes a no-contact order, a domestic violence protective order issued in a criminal case takes precedence in enforcement over any conflicting civil court order. Any nonconflicting terms of the civil restraining order remain in effect and enforceable. Family, Juvenile, or Civil Order: If more than one family, juvenile, or other civil restraining or protective order has been issued, the one that was issued last must be enforced.


Child Custody and VisitationThe custody and visitation orders are on Form DV-140, items and . They are sometimes also written on additional pages or referenced in DV-140 or other orders that are not part of the restraining order.

Enforcing the Restraining Order in CaliforniaAny law enforcement officer in California who receives, sees, or verifies the orders on a paper copy, in the California Law Enforcement Telecommunications System (CLETS), or in an NCIC Protection Order File must enforce the orders.

3 4


This form is attached to DV-100, Request for Domestic Violence Restraining Order.

Your name: Mom Dad Other*

Mom Dad Other*Other parent’s name:

Change Current Court OrderI want to change a current child custody or visitation court order.

Explain your current order and why you want a change.

Child’s Address

Child (a) lived with: Dad OtherMom

Dates lived there:

to presenttototo

DV-105, Page 1 of 3Judicial Council of California, www.courts.ca.govRev. January 1, 2012, Mandatory FormFamily Code, § 3063

Request for Child Custody and Visitation Orders(Domestic Violence Prevention)

Where has the child in (a) lived for the last 5 years? Give each city and state the child has lived unless it is unknown to the other parent and you want to keep it confidential because of domestic violence or child abuse. Start with where the child lives now and work backwards in time. (If the current address is confidential, check the box below and just provide the current state).

Child (a) addresses (city and state):

Case Number:DV-105 Request for Child Custody and Visitation Orders

11

2

4

5

Check here if you need more space. Attach a sheet of paper and write “DV-105, Child’s Address” for a title.

3

33

Confidential

*If Other, specify relationship to child:

Check here if you need more space. Attach a sheet of paper and write “DV-105, Change Current Court Order” for a title.

Child CustodyPhysical Custody to:(Person you want the child to live with)

I ask the court for custody as follows: Legal Custody to: (Personwho makes decisions about health, education, and welfare)Mom Date of BirthChild’s Name

a.b.c.

Check here if you need more space. Attach a sheet of paper and write “DV-105, Child Custody” for a title.

Dad Other Mom Dad Other

3

d.

Case Number (if you have it): ____________________________________ County:______________________

FromFromFromFrom

Check the orders you want .


Case Number:

Other Custody Case Were you involved in, or do you know of, any other custody case for any child listed in this form?

Yes If yes, fill out below and attach a copy of any custody or visitation orders if you have them:Noa. Name of each child in other custody case:

Domestic Violence Divorce Guardianship

Juvenile/Dependencyb. Type of case:

WitnessPartyc. I was a Other (specify):d. Court (name):

Address: County: State:e. Date of court order:

Other People With or Claiming to Have Custody or Visitation Rights Do you know of anyone who is not involved in this case who has or claims to have custody or visitation

Yes If yes, fill out below:No

Has custody Claims custody rights Claims visitation rightsFor these children (name of each child):

Check here if you need more space. Attach a sheet of paper and write “DV-105, Other People With or Claiming Custody or Visitation” for a title.

DV-105, Page 2 of 3

rights with any child listed on this form? Name and address of that person:

17

8

Request for Child Custody and Visitation Orders(Domestic Violence Prevention)

Other (specify):

Case number (if you have it):

Other Children’s AddressesCheck here if the other child’s (or children’s) address information is the same as listed in .If it is different, check here. Attach a sheet of paper and write “DV-105, Other Children’s Addresses” for a title. List other children’s address information, including dates, and name of person child lived with.

65

Visitation

No visitation until the hearinga. No visitation after the hearingb.

I ask the court to order that the person in have the following temporary visitation rights:(Check all that apply)

92

f.

Rev. January 1, 2012

Parentage (Paternity) Child Support

The following visitation until the hearing after the hearingc.(1) (The 1st weekend of the month is the 1st weekend with a Saturday.)Weekends (starting):

1st 2nd 4th3rd 5th weekend of month

(2) Weekdays (starting):

from at ata.m. a.m.p.m. to p.m.(time) (time)(day of week) (day of week)


Responsibility for TransportationThe parent will take or pick up the child or make arrangements for someone else to do so.

Mom Dad take children to the visits.a. Other (name):Mom Dad pick up children from the visits.b.Drop-off / pick-up of children will be at (address):c.

Travel With Children

Mom Dad must have written permission Other (name):from the other parent, or a court order, to take the children outside of:

The State of Californiaa.b. Other place(s) (list):

Child Abduction RiskI believe that there is a risk the other parent will take our child out of California and hide the child from me.If you check this box you must fill out and attach Form DV-108, Request for Order: No Travel with Children.

You must tell the court if you find out any other information about a custody case in any court for the children listed on this form.If the court makes a temporary custody order, the parent receiving custody must not take the child out of California without a noticed hearing. (See Family Code §3063.)

Other (name):

This is not a Court Order.Rev. January 1, 2012 DV-105, Page 3 of 3Request for Child Custody and Visitation Orders


Case Number:

11

13

14

I ask the court to order that:

I ask the court to order that:

County of: ________________________________________________

Other VisitationAttach a sheet of paper with other visitation days and times, like summer vacation, holidays, and birthdays. List dates and times. Write “DV-105, Visitation” for a title.

Check here if other arrangement. Attach a sheet of paper and write “DV-105, Responsibility for Transportation” for a title.

d.

Supervised Visitationa. I ask that the visitation in be supervised by

c. I ask that any costs for supervision be paid by:Mom Dad% % %Other (name)

12

A professional supervisor Other A non-professional supervisor

10

b. I ask that the visitation in be supervised by

9

10

•

•

Name and telephone number, if known: ______________________________________________________

Name and telephone number, if known: ______________________________________________________A professional supervisor Other A non-professional supervisor

Important Instructions

1


Case Number:

This form is attached to DV-105, Request for Child Custody and Visitation Orders.

Other*Your name: Mom Dad

Other*Mom DadOther parent’s name:

*If “Other,” specify relationship with

Do you think the other parent may take the children without your permission to:

YesAnother county in California? If “yes,” what county?Noa.

Another state? Yes If “yes,” what state?Nob.

Yes If “yes,” what country ?A foreign country? Noc.YesIf “Yes,” is the other parent a citizen of that country? No

YesIf “Yes,” does the other parent have family or emotional ties to that country? NoExplain:

Why do you think the other parent may take the children without your permission? The other parent: (Check all that apply)

Has violated — or threatened to violate — a custody or visitation order in the past.a.Does not have strong ties to California.b.

c.

Sold his or her homeQuit his or her jobEnded a leaseClosed a bank accountHidden or destroyed documentsSold or gotten rid of assets

Applied for a passport, birth certificate, or school or medical recordsHas a history of: (Check all that apply)d.

Domestic violenceChild abuseNot cooperating with me in parentingChild abduction

Has a criminal recorde.Please explain your answers to a–e:f.

DV-108, Page 1 of 2

2

Has done things recently that make it easy for him or her to take the children away without permission. He or she has: (Check all that apply)

Judicial Council of California, www.courts.ca.govRevised January 1, 2012, Mandatory FormFamily Code, § 3048

DV-108 Request for Order:No Travel with Children

11

12

13

14

Request for Order: No Travel with Children(Domestic Violence Prevention)

children:

Case Number:

What orders do you want? Check the boxes that apply to your case. Post a Bond

. If the other parent takes the I ask the court to order the other parent to post a bond for $children without my permission, I can use this money to bring the children back.

Do Not Move Without My Permission or Court OrderI ask the court to order the other parent not to move with the children without my written permission or a court order.

No Travel Without My PermissionI ask the court to order the other parent not to travel with the children outside: (Check all thatapply)

The United StatesThis county California Other (specify):

Notify Other State of Travel RestrictionsI ask the court to order the other parent to register this order in the state of before the children can travel to that state for visits.

Turn In and Do Not Apply for Passports or Other Vital DocumentsI ask the court to order the other parent to turn in and not apply for passports or other documents (such as visas or birth certificates) that can be used for travel.

Provide Itinerary and Other Travel DocumentsIf the other parent is allowed to travel with the children, I ask the court to order the other parent to give me before leaving:

The children’s travel itineraryCopies of round-trip airline ticketsAddresses and telephone numbers where the children can be reachedAn open airline ticket for me in case the children are not returnedOther (specify):

Notify Foreign Embassy or Consulate of Passport RestrictionsI ask the court to order the other parent to notify the embassy or consulate ofof this order and to provide the court with proof of that notification within calendar days.

Foreign Custody and Visitation OrderI ask the court to order the other parent to get a custody and visitation order equal to the most recent U.S. order before the child can travel to that country for visits. I understand that foreign orders may be changed or enforced depending on the laws of the country.

I declare under penalty of perjury under the laws of the State of California that the information on this form is true and correct.

Date:

Type or print your name Sign your name

This is not a Court Order.DV- 108, Page 2 of 2Revised January 1, 2012 Request for Order: No Travel with Children


1

Person child lived with (name and complete current address)








Additional children are listed on form FL-105(A)/GC-120(A). (Provide all requested information for additional children.)

FL-105/GC-120FOR COURT USE ONLY

SUPERIOR COURT OF CALIFORNIA, COUNTY OFSTREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CASE NUMBER:

DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

1. I am a party to this proceeding to determine custody of a child.2.My present address and the present address of each child residing with me is confidential under Family Code section 3429 as

I have indicated in item 3.3. There are (specify number):

(Insert the information requested below. The residence information must be given for the last FIVE years.)a. Child’s name Place of birth Date of birth Sex

Period of residence Address Relationship

Confidentialto present

to

to

tob. Child’s name Place of birth Date of birth Sex

Residence information is the same as given above for child a. (If NOT the same, provide the information below.)

Period of residence Address Relationship

Confidentialto present

to

to

to

Additional residence information for a child listed in item a or b is continued on attachment 3c.c.

Page 1 of 2Family Code, § 3400 et seq.; Form Adopted for Mandatory Use

Judicial Council of California FL-105/GC-120 [Rev. January 1, 2009]

DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA) Probate Code, §§ 1510(f), 1512

minor children who are subject to this proceeding, as follows:

www.courtinfo.ca.gov

TELEPHONE NO.: FAX NO. (Optional):E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

PETITIONER:RESPONDENT:

GUARDIANSHIP OF (Name): Minor

OTHER PARTY:

Child's residence (City, State)



d.




(This section applies only to family law cases.)

(This section apples only to guardianship cases.)

Confidential

Confidential

Juvenile Delinquency/ Juvenile Dependency

and provide the following information):5. One or more domestic violence restraining/protective orders are now in effect. (Attach a copy of the orders if you have one

a. Criminal

b. Family

d. Other

Court State Case number (if known) County Orders expire (date)

Court (name, state, location)

Court order or judgment

(date)Case status

b. Guardianship

c. Other

Name of each child

a. Family

Case number

Court (name, state, location)

e. Adoption

Juvenile Delinquency/ Juvenile Dependency

Case Number

Your connection to

the case

CASE NUMBER:SHORT TITLE:

Do you have information about, or have you participated as a party or as a witness or in some other capacity in, another court case or custody or visitation proceeding, in California or elsewhere, concerning a child subject to this proceeding?

Yes (If yes, attach a copy of the orders (if you have one) and provide the following information):

Do you know of any person who is not a party to this proceeding who has physical custody or claims to have custody of or visitation rights with any child in this case? (If yes, provide the following information):Yes

a. Name and address of person b. Name and address of person c. Name and address of person

Has physical custody Has physical custodyHas physical custodyClaims custody rightsClaims custody rightsClaims custody rights

Claims visitation rights Claims visitation rights Claims visitation rights

Name of each child Name of each child Name of each child

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

7. Number of pages attached:NOTICE TO DECLARANT: You have a continuing duty to inform this court if you obtain any information about a custody

FL-105/GC-120 [Rev. January 1, 2009] Page 2 of 2DECLARATION UNDER UNIFORM CHILD CUSTODY JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

4.

6.No

proceeding in a California court or any other court concerning a child subject to this proceeding.

No

FL-105/GC-120

Proceeding

Proceeding

c.

d.

FL/E-LP-616

Page 1 FL/E-LP-616 (Revised 09/2015) Parent-Child Relationship Declaration MANDATORY Family Code 6323

www.saccourt.ca.gov

Parent-Child Relationship Declaration (Family Code Section 6323)

Case Name ___________________________________ Case Number________________

I, ___________________________________, declare: (print name of declarant)

I am the □ father □ mother and the other party is the □ father □ mother of the following child(ren):

______________________________________ Date of Birth_________________

______________________________________ Date of Birth_________________

______________________________________ Date of Birth_________________

CHECK THE STATEMENT(S) THAT APPLY TO YOU:

1. _____ I gave birth to (all of) the child(ren).

2. _____ The child(ren) was/were born during marriage/domestic partnership or within 300 days after separation.

3. _____ I/we adopted the child(ren) or are in process of adoption the child(ren).

4. _____ I have/the other party has signed a declaration of paternity.

5. _____ The Juvenile Dependency Court has made a determination that there is a parent-child relationship between the father and the child(ren)/mother and the child(ren).

6. _____ A court has determined paternity in a child support agency case where custody and/or visitation was an issue.

7. _____ I have been determined to be the parent of the child(ren) through a Uniform Parentage Act court order.

8. _____ Current child custody and visitation orders as follows: __________________________________________________________________ __________________________________________________________________

__________________________________________________________________ __________________________________________________________________


Date:_______________________ ______________________________________________ Signature of Declarant

DV-140


Case Number:Child Custody and Visitation Order

DV-130DV-110This form is attached to (check one):

Mom Dad Other*Name of Protected Person:

Mom Dad Other*Other Parent’s Name:

The Court Orders:Physical Custody to:(Person the child lives with. Check at least one.)

Legal Custody to: (Person who makes decisions about health, education. Check at least one.)

Child Custody is ordered as follows:

Mom Dad Other* Mom Dad Other*Date of BirthChild’s Name

a.b.c.

If more children, check here. Attach a sheet of paper and write “DV-140, Child Custody” for a title.* If Other, specify relationship to child and name of person:

Child Visitation is ordered as follows:Mom DadNo visitation toa. Other (name):

See the attachedb. - page document, dated:The parties must go to mediation at:c.

Mom Dad Other (name):Until the next court order, visitation for will be:d.

(1) (The 1st weekend of the month is the 1st weekend with a Saturday.)Weekends (starting):

1st 2nd 4th3rd 5th weekend of monthfrom at ata.m. a.m.p.m. to p.m.

(time) (time)(day of week) (day of week)



Other Visitation(3)

Check here and attach a sheet of paper if there are other visitation days and times, like holidays, birthdays, sports events. List dates and times. Write “DV- 140, Other Visitation” for a title.

Supervised Visitation or Exchange

Judicial Council of California, www.courts.ca.govRev. January 1, 2012, Mandatory FormFamily Code, §§ 3020, 3022, 3040–3043, 3100, 6340,7604

DV-140, Page 1 of 2Child Custody and Visitation Order

5

* If Other, specify relationship to child:

1

2

3

4

5


Visits and/or exchanges of children are supervised as specified on Form DV-150, Supervised Visitation and Exchange Order.


Case Number:

Travel with ChildrenMom Dad must have written permission from the Other (name):

other parent, or a court order, to take the children outside of:The State of Californiaa.

Other place(s) (list):

Child AbductionThere is a risk that one of the parents will take the children out of California without the other parent’s permission. The orders in Form DV-145, Order: No Travel with Children, are attached and must be obeyed. (Fill out and attach Form DV-145 to this form.)

Other OrdersCheck here and attach any other orders to this form. Write “DV-140, Other Orders” as a title.

Jurisdiction This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and Enforcement Act (part 3 of the California Family Code starting with § 3400).

Notice and Opportunity to Be Heard The responding party was given reasonable notice and an opportunity to be heard as provided by the laws of the State of California.

Country of Habitual Residence The country of habitual residence of the child or children in this case is The United States of Americaor Other (specify):

Penalties for Violating This Order If you violate this order, you may be subject to civil or criminal penalties, or both.

Rev. January 1, 2012 DV-140, Page 2 of 2

.

Duration of Child Custody, Visitation, and Support OrdersIf this form is attached to Form DV-130 (Restraining Order After Hearing), the custody and visitation orders in this form remain in effect after the restraining orders on Form DV-130 end.

657

658

c.

Child Custody and Visitation Order (Domestic Violence Prevention)

The United States of Americab.

Responsibility for Transportation for Visitation“Responsibility for transportation” means the parent will take or pick up the child or make arrangements forsomeone else to do so.

Drop-off / pick-up of children will be at (address):c.

6

Mom Dad take children to the visits.a. Other (name):Mom Dad pick up children from the visits.b. Other (name):

56

DV-140


Case Number:Child Custody and Visitation Order

DV-130DV-110This form is attached to (check one):

Mom Dad Other*Name of Protected Person:

Mom Dad Other*Other Parent’s Name:

The Court Orders:Physical Custody to:(Person the child lives with. Check at least one.)

Legal Custody to: (Person who makes decisions about health, education. Check at least one.)

Child Custody is ordered as follows:

Mom Dad Other* Mom Dad Other*Date of BirthChild’s Name

a.b.c.

If more children, check here. Attach a sheet of paper and write “DV-140, Child Custody” for a title.* If Other, specify relationship to child and name of person:

Child Visitation is ordered as follows:Mom DadNo visitation toa. Other (name):

See the attachedb. - page document, dated:The parties must go to mediation at:c.

Mom Dad Other (name):Until the next court order, visitation for will be:d.

(1) (The 1st weekend of the month is the 1st weekend with a Saturday.)Weekends (starting):

1st 2nd 4th3rd 5th weekend of monthfrom at ata.m. a.m.p.m. to p.m.

(time) (time)(day of week) (day of week)



Other Visitation(3)

Check here and attach a sheet of paper if there are other visitation days and times, like holidays, birthdays, sports events. List dates and times. Write “DV- 140, Other Visitation” for a title.

Supervised Visitation or Exchange

Judicial Council of California, www.courts.ca.govRev. January 1, 2012, Mandatory FormFamily Code, §§ 3020, 3022, 3040–3043, 3100, 6340,7604

DV-140, Page 1 of 2Child Custody and Visitation Order

5

* If Other, specify relationship to child:

1

2

3

4

5


Visits and/or exchanges of children are supervised as specified on Form DV-150, Supervised Visitation and Exchange Order.


Case Number:

Travel with ChildrenMom Dad must have written permission from the Other (name):

other parent, or a court order, to take the children outside of:The State of Californiaa.

Other place(s) (list):

Child AbductionThere is a risk that one of the parents will take the children out of California without the other parent’s permission. The orders in Form DV-145, Order: No Travel with Children, are attached and must be obeyed. (Fill out and attach Form DV-145 to this form.)

Other OrdersCheck here and attach any other orders to this form. Write “DV-140, Other Orders” as a title.

Jurisdiction This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and Enforcement Act (part 3 of the California Family Code starting with § 3400).

Notice and Opportunity to Be Heard The responding party was given reasonable notice and an opportunity to be heard as provided by the laws of the State of California.

Country of Habitual Residence The country of habitual residence of the child or children in this case is The United States of Americaor Other (specify):

Penalties for Violating This Order If you violate this order, you may be subject to civil or criminal penalties, or both.

Rev. January 1, 2012 DV-140, Page 2 of 2

.

Duration of Child Custody, Visitation, and Support OrdersIf this form is attached to Form DV-130 (Restraining Order After Hearing), the custody and visitation orders in this form remain in effect after the restraining orders on Form DV-130 end.

657

658

c.

Child Custody and Visitation Order (Domestic Violence Prevention)

The United States of Americab.

Responsibility for Transportation for Visitation“Responsibility for transportation” means the parent will take or pick up the child or make arrangements forsomeone else to do so.

Drop-off / pick-up of children will be at (address):c.

6

Mom Dad take children to the visits.a. Other (name):Mom Dad pick up children from the visits.b. Other (name):

56

DV-145


Case Number:Order: No Travel With Children

This form is attached to DV-140, Child Custody and Visitation Order.

Other*Name of Protected Person: Mom Dad

Other*Mom DadOther Parent’s Name:*If Other, specify relationship to child:

There is a risk that (name of parent): might take the children without permissionbecause that parent (check all that apply):

Has violated—or threatened to violate—a custody or visitation order in the pasta.Does not have strong ties to Californiab.Has done things that make it easy for him or her to take the child without permission. c.He or she has (check all that apply):


Applied for a passport, birth certificate, or school or medical recordsHas a history of (check all that apply):d.

Domestic violenceChild abuseNot cooperating with the other parent in parentingTaking the children without permission

Has a criminal recorde.Has family or emotional ties to another county, state or foreign countryf.

The Court makes the orders, checked below, to prevent the parent in from taking the children without permission. These orders are valid in other states and any country that has signed The Hague Convention on the Civil Aspects of International Child Abduction.

Post a BondThe parent in must post a bond for $

Do Not Move Without Written Permission of the Other Parent or Court OrderThe parent in must not move with the children outside

Do Not Travel Without Permission of the Other Person or Court OrderThe parent in must not travel with the children outside (check all that apply):

This county California The United States Other (specify):

DV-145, Page 1 of 2Order: No Travel With Children(Domestic Violence Prevention)

Note: If (f ) is checked, at least one other item in items (a)–(e) must be checked also.

.

Judicial Council of California, www.courts.ca.govRev. January 1, 2012, Mandatory FormFamily Code, § 3048, 42 USC § 11601 et seq.

1

2

3The Court Finds:

4

5

6

The Court Orders:3

3

3

3

without written permission of the other parent or a court order.

This county California

Other (specify): ___________________________________________________________________________without written permission from the other parent or a court order.

The United States


Case Number:

Turn In and Do Not Apply for Passports or Other Vital DocumentsThe parent in must not apply for passports or other documents (such as visas or birth certificates) that can be used for travel, and must turn in the following documents:

Provide Itinerary and Other Travel DocumentsThe parent in must give the other parent the following before traveling with the children:

The children’s travel itineraryCopies of round-trip airline ticketsAddresses and telephone numbers where the children can be reachedAn open airline ticket for the other parent in case the children are not returnedOther (specify):

Notify Foreign Embassy or Consulate of Passport RestrictionsThe parent in must notify the embassy or consulate of of this order and provide the court with proof of that notification within calendar days.

Foreign Custody and Visitation OrderThe parent in must get a foreign custody and visitation order equal to the most recent U.S. order before the children can travel to that country for visits. The court recognizes that foreign orders may be changed or enforced depending on the laws of that country.

Enforcing the OrderThe court authorizes any law enforcement officer to enforce this order. In this county, contact the Child Abduction Unit of the Office of the District Attorney at:

Other

Notice to Authorities in Other States and CountriesThis court has jurisdiction to make child custody orders under California’s Uniform Child CustodyJurisdiction and Enforcement Act (California Family Code, part 3, § 3400 et seq.) and The HagueConvention on the Civil Aspects of International Child Abduction (42 U.S.C. § 11601 et seq.). If jurisdiction is based on other factors, they will be listed in paragraph 13 above.

Order: No Travel With Children (Domestic Violence Prevention)

DV-145, Page 2 of 2Rev. January 1, 2012

8

9

10

11

12

13

3

3

3

3

Notify Other State of Travel RestrictionsThe parent in must register this order in the state of before the children can travel to that state for visits.

73

DV-145


Case Number:Order: No Travel With Children

This form is attached to DV-140, Child Custody and Visitation Order.

Other*Name of Protected Person: Mom Dad

Other*Mom DadOther Parent’s Name:*If Other, specify relationship to child:

There is a risk that (name of parent): might take the children without permissionbecause that parent (check all that apply):

Has violated—or threatened to violate—a custody or visitation order in the pasta.Does not have strong ties to Californiab.Has done things that make it easy for him or her to take the child without permission. c.He or she has (check all that apply):


Applied for a passport, birth certificate, or school or medical recordsHas a history of (check all that apply):d.

Domestic violenceChild abuseNot cooperating with the other parent in parentingTaking the children without permission

Has a criminal recorde.Has family or emotional ties to another county, state or foreign countryf.

The Court makes the orders, checked below, to prevent the parent in from taking the children without permission. These orders are valid in other states and any country that has signed The Hague Convention on the Civil Aspects of International Child Abduction.

Post a BondThe parent in must post a bond for $

Do Not Move Without Written Permission of the Other Parent or Court OrderThe parent in must not move with the children outside

Do Not Travel Without Permission of the Other Person or Court OrderThe parent in must not travel with the children outside (check all that apply):

This county California The United States Other (specify):

DV-145, Page 1 of 2Order: No Travel With Children(Domestic Violence Prevention)

Note: If (f ) is checked, at least one other item in items (a)–(e) must be checked also.

.

Judicial Council of California, www.courts.ca.govRev. January 1, 2012, Mandatory FormFamily Code, § 3048, 42 USC § 11601 et seq.

1

2

3The Court Finds:

4

5

6

The Court Orders:3

3

3

3

without written permission of the other parent or a court order.

This county California

Other (specify): ___________________________________________________________________________without written permission from the other parent or a court order.

The United States


Case Number:

Turn In and Do Not Apply for Passports or Other Vital DocumentsThe parent in must not apply for passports or other documents (such as visas or birth certificates) that can be used for travel, and must turn in the following documents:

Provide Itinerary and Other Travel DocumentsThe parent in must give the other parent the following before traveling with the children:

The children’s travel itineraryCopies of round-trip airline ticketsAddresses and telephone numbers where the children can be reachedAn open airline ticket for the other parent in case the children are not returnedOther (specify):

Notify Foreign Embassy or Consulate of Passport RestrictionsThe parent in must notify the embassy or consulate of of this order and provide the court with proof of that notification within calendar days.

Foreign Custody and Visitation OrderThe parent in must get a foreign custody and visitation order equal to the most recent U.S. order before the children can travel to that country for visits. The court recognizes that foreign orders may be changed or enforced depending on the laws of that country.

Enforcing the OrderThe court authorizes any law enforcement officer to enforce this order. In this county, contact the Child Abduction Unit of the Office of the District Attorney at:

Other

Notice to Authorities in Other States and CountriesThis court has jurisdiction to make child custody orders under California’s Uniform Child CustodyJurisdiction and Enforcement Act (California Family Code, part 3, § 3400 et seq.) and The HagueConvention on the Civil Aspects of International Child Abduction (42 U.S.C. § 11601 et seq.). If jurisdiction is based on other factors, they will be listed in paragraph 13 above.

Order: No Travel With Children (Domestic Violence Prevention)

DV-145, Page 2 of 2Rev. January 1, 2012

8

9

10

11

12

13

3

3

3

3

Notify Other State of Travel RestrictionsThe parent in must register this order in the state of before the children can travel to that state for visits.

73

Supervised visits shall be visit(s) per week of hours(s) each, to be arranged with the provider.

This form is attached to

Name of Protected Person:

Other Parent’s Name:

The Court Orders:

Parent to be supervised is:

Schedule of Supervised Visits

Type of Provider

Provider’s InformationName:

Telephone number:

Costs Will Be Paid As Follows:

Contact With Provider

Judicial Council of California, www.courts.ca.gov Rev. January 1, 2016, Mandatory Form Family Code, § 3100, 3031

DV-150, Page 1 of 1

a.b.

*If Other, specify relationship to child:

Address:

Supervised Visitation and Exchange Order (Domestic Violence Prevention)

c.

Mediation, Visitation and Exchangea.b.

c.

Supervised Visitation and Exchange OrderDV-150 Case Number:

Parties must go to mediation at:Visitation of children is supervised.

Exchanges of children are supervised.

DV-110, Temporary Restraining Order DV-130, Restraining Order After HearingDV-140, Child Custody and Visitation Order

Mom Dad Other*

Mom Dad Other*

Mom Dad Other (name):

All visits as provided in the schedule on Form DV-140, item (d) are to be supervised.

Other schedule of supervised visits is attached. (Check here and attach a sheet of paper with “DV-150, Other Schedule” for a title.)

a. Professional (individual or supervised visitation center)b. Nonprofessional

Mom to pay: %Dad to pay: %Other:

8

Mom to contact provider before (date):Dad to contact provider before Other:

4

1

4

2

3

5

6

7

9 The court also orders (specify):


(date):

FL-342

CHILD SUPPORT INFORMATION AND ORDER ATTACHMENTTO

THE COURT USED THE FOLLOWING INFORMATION IN DETERMINING THE AMOUNT OF CHILD SUPPORT:1.

2. Gross monthly income

Net monthly income

Receiving TANF/CaIWORKSEach parent’s monthly income is as follows:

Imputation of income. The court finds that the

and has based the support order upon this imputed income.3.

%%

4.Hardships for the following have been allowed in calculating child support:

Petitioner/ plaintiff

Respondent/ defendant

Approximate ending time for the hardship

a.b.c.

THE COURT ORDERS5.

6.a. Base child support

(date): and continuing until further order of the court, or until the child marries, dies, is emancipated, reaches age 19, or reaches age 18 and is not a full-time high school student, whichever occurs first, as follows:

Payable to (name):Date of birth Monthly amount

one-half on the 1st and one-half on the 15th of the monthPayable

THIS IS A COURT ORDER. Page 1 of 3

CHILD SUPPORT INFORMATION AND ORDER ATTACHMENTForm Adopted for Mandatory Use Judicial Council of California FL-342 [Rev. January 1, 2017]

Family Code, §§ 4055–4069 www.courts.ca.gov

Child’s name

%

must pay child support beginning

has the capacity to earn:

a.b.

Other parent/ party

PETITIONER/PLAINTIFF:RESPONDENT/DEFENDANT:

OTHER PARENT/PARTY:

CASE NUMBER:

a.

b.

Petitioner/plaintiff: $Respondent/defendant: $

Other parent/party: $

$$$

$$$

$$$

$$$

Number of children who are the subjects of the support order (specify):

Approximate percentage of time spent with petitioner/plaintiff: Respondent/defendant:

Other parent/party:

The low-income adjustment applies.

Other minor children:Extraordinary medical expenses:Catastrophic losses:

Child support

Petitioner/plaintiff Respondent/defendant Other parent/party

Petitioner/plaintiff Respondent/defendantOther parent/party

Hardships

Children of this relationship

Income

Low-income adjustment

Findings and Order After Hearing (form FL-340)Restraining Order After Hearing (CLETS-OAH) (form DV-130)

Judgment (form FL-180)

$ per

(specify):

on the 1st of the month

Other

a.

b.

other (specify):

The low-income adjustment does not apply because (specify reasons):

A printout of a computer calculation and findings is attached and incorporated in this order for all required items not filled out below.

This order does not meet the child support guideline set forth in Family Code section 4055. Non-Guideline Child Support Findings Attachment (form FL-342(A)) is attached.

(1)

(2)

their respective places of employment or self-employment. Both parties are ordered to cooperate in the presentation, collection, and reimbursement of any health-care claims. The parent ordered to provide health insurance must seek continuation of coverage for the child after the child attains the age when the child is no longer considered eligible for coverage as a dependent under the insurance contract, if the child is incapable of self-sustaining employment because of a physically or mentally disabling injury, illness, or condition and is chiefly dependent upon the parent providing health insurance for support and maintenance.

THIS IS A COURT ORDER.Page 2 of 3CHILD SUPPORT INFORMATION AND ORDER ATTACHMENTFL-342 [Rev. January 1, 2017]

d.

7. Health-care expenses Health insurance coverage for the minor children of the parties must be maintained by thea.

per month.per month.per month.

per month.per month.per month.

if available at no or reasonable cost through

FL-342

(2) Reasonable uninsured health-care costs for the childrenper month.per month.per month.

c. Mandatory additional child support

THE COURT FURTHER ORDERS

per month child-care costs.(d)(c)

6. b.

(1) Child-care costs related to employment or reasonably necessary job trainingper monthper month

child-care costs.child-care costs.

(a)(b)

e.

Child Support Order Suspension f.When a person who has been ordered to pay child support is in jail or prison or is involuntarily institutionalized for any period of more than 90 days in a row, the child support order is temporarily stopped. However, the child support order will not be stopped if the person who owes support has the financial ability to pay that support while in jail, prison, or an institution. It will also not be stopped if the reason the person is in jail, prison, or an institution is because the person didn't pay court ordered child support or committed domestic violence against the supported person or child. The child support order starts again on the first day of the month after the person is released from jail, prison, or an institution.

Total child support per month: $

$$$

$$$

$$$

$$$

Mandatory additional child support

Additional child support

Non-Guideline Order

Petitioner/plaintiff must pay:Respondent/defendant must pay:Other parent/party must pay:Costs to be paid as follows (specify):

(d)(c)

(a)(b)


(d)(c)

(a)(b)


(d)(c)

(a)(b)


Costs related to the educational or other special needs of the children

Travel expenses for visitation

petitioner/plaintiff respondent/defendant other parent/party


OTHER PARENT/PARTY:

CASE NUMBER:

% of total or

% of total or % of total or

% of total or


% of total or


% of total or


Noticesa. Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on Changing

a Child Support Order (form FL-192) must be attached and is incorporated into this order.

Child Support Case Registry FormBoth parties must complete and file with the court a Child Support Case Registry Form (form FL-191) within 10 days of the date of this order. Thereafter, the parties must notify the court of any change in the information submitted within 10 days of the change by filing an updated form.

NOTICE: Any party required to pay child support must pay interest on overdue amounts at the legal rate, which is currently 10 percent per year.

THIS IS A COURT ORDER.Page 3 of 3CHILD SUPPORT INFORMATION AND ORDER ATTACHMENTFL-342 [Rev. January 1, 2017]

FL-342

11.

12.

13.

If this form is attached to Restraining Order After Hearing (form DV-130), the support orders issued on this form (form FL-342) remain in effect after the restraining orders issued on form DV-130 end.

b.

9. In the event that there is a contract between a party receiving support and a private child support collector, the party ordered to pay support must pay the fee charged by the private child support collector. This fee must not exceed 33 1/3 percent of the total amount of past due support nor may it exceed 50 percent of any fee charged by the private child support collector. The money judgment created by this provision is in favor of the private child support collector and the party receiving support, jointly.

is ordered to seek employment with the 10.

8. Earnings assignmentAn earnings assignment order is issued. Note: The payor of child support is responsible for the payment of support directly to the recipient until support payments are deducted from the payor’s wages and for payment of any support not paid by the assignment.

b.

c.at a reasonable cost at this time.

7.

following terms and conditions:

petitioner/plaintiff respondent/defendant other parent/party

The party providing coverage must assign the right of reimbursement to the other party.

Health insurance is not available to the

Petitioner/plaintiff Respondent/defendant Other parent/partyEmployment search order (Family Code § 4505)

Other orders (specify):


OTHER PARENT/PARTY:

CASE NUMBER:

FL-343

SPOUSAL, PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENTTO Findings and Order After Hearing (form FL-340) Judgment (form FL-180)

above (for temporary support only).

1. Net income. The parties’ monthly income and deductions are as follows (complete a, b, or both ):Total Total Total Net monthly

gross monthly monthly hardship disposableincome incomedeductions deductions

receiving TANF/CaIWORKS a. Petitioner:b. Respondent:

3. Judgment for spousal or partner support

months.The parties were married for (specify numbers): yearsb.

See Attachment 3d.

THE COURT ORDERS

petitioner petitioner 6. respondent must pay to the respondentspousal support family supporta

s$ per month, beginning (date): , payable through (specify end date):

day of each month.payable on the (specify):

Support must be paid by check, money order, or cash. The support payor’s obligation to pay support will terminate on the death of either party, remarriage, or registration of a new domestic partnership of the support payee.

An earnings assignment for the foregoing support will issue. (Note: The payor of spousal, family, or partner support is responsible for the payment of support directly to the recipient until support payments are deducted from the payor’s earnings, and for any support not paid by the assignment.)

Service of the earnings assignment is stayed provided the payor is not more than (specify number): days late in the payment of spousal, family, or partner support.

d.

Page 1 of 2Form Approved for Optional Use

Judicial Council of California FL-343 [Rev. July 1, 2012]

Family Code, §§ 150, 299, 3651,SPOUSAL, PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT (Family Law)

3653, 3654, 4320, 4330, 4337www.courts.ca.gov

The marital standard of living was (describe):

receiving TANF/CaIWORKS

Other (specify):

The parties were registered as domestic partners or the equivalent for (specify numbers): c.

partner support

c.

b.

The


OTHER PARENT:

CASE NUMBER:

temporary

THE COURT FINDS

2. A printout of a computer calculation of the parties’ financial circumstances is attached for all required items not filled out

Modifies a judgment or order entered on (date):

The parties are both self-supporting, as shown on the Declaration for Default or Uncontested Dissolution or Legal d.Separation (form FL-170).

e.

The issue of spousal or partner support for the petitioner respondent is reserved for a later determination. 4.

The court terminates jurisdiction over the issue of spousal or partner support for the petitioner respondent. 5.

Restraining Order After Hearing (CLETS-OAH) (form DV-130) Other (specify):

a.

a.

$$

$$

$$

$$

THIS IS A COURT ORDER.

Stipulation of Parties

months.years

PETITIONER/PLAINTIFF: CASE NUMBER:

RESPONDENT/DEFENDANT:

OTHER PARENT:

The parties must promptly inform each other of any change of employment, including the employer’s name, address, and telephone number.

8.

This order is for family support. Both parties must complete and file with the court a Child Support Case Registry Form (form FL-191) within 10 days of the date of this order. The parents must notify the court of any change of information submitted within 10 days of the change by filing an updated form. A Notice of Rights and Responsibilities (Health-Care Costs and Reimbursement Procedures) and Information Sheet on Changing a Child Support Order (form FL-192) is attached.

9.

NOTICE: Any party required to pay support must pay interest on overdue amounts at the “legal” rate, which is currently 10 percent.

THIS IS A COURT ORDER.Page 2 of 2SPOUSAL, PARTNER, OR FAMILY SUPPORT ORDER ATTACHMENT

(Family Law)FL-343 [Rev. July 1, 2012]

Other orders (specify):11.

Notice: If this form is attached to Restraining Order After Hearing (CLETS-OAH) (Order of Protection) (form DV-130), the orders issued on this form (FL-343) do not expire upon termination of the restraining orders issued on form DV-130.

10.

The petitioner7. respondent should make reasonable efforts to assist in providing for his or her support needs.

(If you need more space to answer any questions on this form, attach an 8 1/2-by-11-inch sheet of paper and write the question number before your answer.)

1. Employment (Give information on your current job or, if you're unemployed, your most recent job.)

Form Adopted for Mandatory Use Judicial Council of California FL-150 [Rev. January 1, 2019]

INCOME AND EXPENSE DECLARATION Family Code, §§ 2030–2032, 2100–2113, 3552, 3620–3634, 4050–4076, 4300–4339

www.courts.ca.gov

Page 1 of 4

Employer:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

BRANCH NAME:

CITY AND ZIP CODE:

STREET ADDRESS:

MAILING ADDRESS:

PETITIONER:

RESPONDENT:

OTHER PARTY/PARENT/CLAIMANT:

FOR COURT USE ONLY

CASE NUMBER:INCOME AND EXPENSE DECLARATION

PARTY WITHOUT ATTORNEY OR ATTORNEY

STATE: ZIP CODE:CITY:

STREET ADDRESS:

FIRM NAME:

NAME:

TELEPHONE NO.: FAX NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (name):

STATE BAR NUMBER:

FL-150

Attach copies of your pay stubs for last two months (black out SocialSecuritynumbers).

a.Employer's address:b.Employer's phone number:c.Occupation:d.Date job started:e.If unemployed, date job ended:f.

g. I work about hours per week.h. I get paid $ gross (before taxes)

(If you have more than one job, attach an 8 1/2-by-11-inch sheet of paper and list the same information as above for your other jobs. Write "Question 1—Other Jobs" at the top.)

2. Age and educationMy age is (specify):a.

b. I have completed high school or the equivalent: Yes No If no, highest grade completed (specify):Number of years of college completed (specify):c. Degree(s) obtained (specify):Number of years of graduate school completed (specify):d. Degree(s) obtained (specify):

e. I have: professional/occupational license(s) (specify):vocational training (specify):

3. Tax informationa. I last filed taxes for tax year (specify year):b. My tax filing status is single head of household married, filing separately

married, filing jointly with (specify name):c. I file state tax returns in California other (specify state):

I claim the following number of exemptions (including myself) on my taxes (specify):d.

Other party's income. I estimate the gross monthly income (before taxes) of the other party in this case at (specify): $4.This estimate is based on (explain):

Number of pages attached:

I declare under penalty of perjury under the laws of the State of California that the information contained on all pages of this form and any attachments is true and correct.

(SIGNATURE OF DECLARANT)

Date:

(TYPE OR PRINT NAME)

per month per week per hour.

Sacramento

William R. Ridgeway Family Relations CourthouseSacramento, CA 95814

3341 Power Inn Road3341 Power Inn Road

Spousal support

Spousal support that I pay by court order from a different marriage ..........................

Attach copies of your pay stubs for the last two months and proof of any other income. Take a copy of your latest federal tax return to the court hearing. (Black out your Social Security number on the pay stub and tax return.)

Income (For average monthly, add up all the income you received in each category in the last 12 monthsand divide the total by 12.)

FL-150 [Rev. January 1, 2019] Page 2 of 4INCOME AND EXPENSE DECLARATION

All other property, (estimate fair market value minus the debts you owe).....c. real and personal

* Check the box if the spousal support order or judgment was executed by the parties and the court before January 1, 2019, or if a court-ordered change maintains the spousal support payments as taxable income to the recipient and tax deductible to the payor.

$

FL-150CASE NUMBER:PETITIONER:

RESPONDENT:


5.

Salary or wages (gross, before taxes).....................................................................................................a.Overtime (gross, before taxes)................................................................................................................b.Commissions or bonuses.........................................................................................................................c.Public assistance (for example: TANF, SSI, GA/GR) ..................................d.

e.Partner supportf.

currently receivingfrom this marriage from a different marriagefrom this domestic partnership from a different domestic partnership

Pension/retirement fund payments..........................................................................................................g.Social Security retirement (not SSI).........................................................................................................h.Disability:i. Social Security (not SSI) State disability (SDI) Private insuranceUnemployment compensation.................................................................................................................j.Workers' compensation............................................................................................................................k.

l. Other (military allowances, royalty payments) (specify):

Investment income (Attach a schedule showing gross receipts less cash expenses for each piece of property.)6.Dividends/interest....................................................................................................................................a.Rental property income...........................................................................................................................b.Trust income............................................................................................................................................c.

d. Other (specify):

Income from self-employment, after business expenses for all businesses.........................................7.I am the owner/sole proprietor business partner other (specify):Number of years in this business (specify):Name of business (specify):Type of business (specify):

Attach a profit and loss statement for the last two years or a Schedule C from your last federal tax return. Black out your Social Security number. If you have more than one business, provide the information above for each of your businesses.

Additional income. I received one-time money (lottery winnings, inheritance, etc.) in the last 12 months (specify source and amount):

8.

Change in income. My financial situation has changed significantly over the last 12 months because (specify):9.

10. DeductionsRequired union dues....................................................................................................................................................a.Required retirement payments (not Social Security, FICA, 401(k), or IRA)..................................................................b.Medical, hospital, dental, and other health insurance premiums (total monthly amount).............................................c.Child support that I pay for children from other relationships.......................................................................................d.

e.Partner support that I pay by court order from a different domestic partnership..........................................................f.Necessary job-related expenses not reimbursed by my employer (attach explanation labeled "Question 10g").........g.

11. AssetsCash and checking accounts, savings, credit union, money market, and other deposit accounts...............................a.Stocks, bonds, and other assets I could easily sell.......................................................................................................b.

$

$$$$$$$$$$$

Last monthAveragemonthly

$

$

$

$$

Last month

Total

federally taxable*

federally tax deductible*

$

$

$$

$$

$

$$

The following people live with me:



RESPONDENT:


12.

Attorney fees (This information is required if either party is requesting attorney fees):15.a.b.c.d. My attorney's hourly rate is (specify):

I confirm this fee arrangement.

Average monthly expenses13. Estimated expenses Actual expenses Proposed needs

Installment payments and debts not listed above14.

To date, I have paid my attorney this amount for fees and costs (specify): $The source of this money was (specify):I still owe the following fees and costs to my attorney (specify total owed): $

(SIGNATURE OF DECLARANT)

Date:

(TYPE OR PRINT NAME)

Name AgeHow the person is related to me (ex: son)

That person's gross monthly income

Pays some of thehousehold expenses?

a.b.c.d.e.

Yes NoYes NoYes NoYes NoYes No

a. Home:(1) Rent or mortgage.......... $

$

$$

$

$

If mortgage:(a) average principal: $(b) average interest: $

(2) Real property taxes..................................(3) Homeowner's or renter's insurance

(if not included above)..............................(4) Maintenance and repair...........................

b. Health-care costs not paid by insurance........c. Child care.......................................................

$d. Groceries and household supplies.................$e. Eating out.......................................................$f. Utilities (gas, electric, water, trash)................$g. Telephone, cell phone, and e-mail.................

$

$h. Laundry and cleaning.....................................i. Clothes...........................................................

$j. Education.......................................................$k. Entertainment, gifts, and vacation..................

$l. Auto expenses and transportation

(insurance, gas, repairs, bus, etc.).................

$m. Insurance (life, accident, etc.; do not include

auto, home, or health insurance)...................$$

$

$

$

n. Savings and investments...............................o. Charitable contributions..................................p. Monthly payments listed in item 14

(itemize below in 14 and insert total here).....q. Other (specify):

r. TOTAL EXPENSES (a–q) (do not add inthe amounts in a(1)(a) and (b)) $

s. Amount of expenses paid by others

Paid to For Amount Balance Date of last payment

$

$

$

$

$

$

$

$

$

$

$

$

CHILD SUPPORT INFORMATION (NOTE: Fill out this page only if your case involves child support.)



RESPONDENT:


a.b.

d.(Do not include the amount your employer pays.)

Number of children16.

I do I do not

I have (specify number): children under the age of 18 with the other parent in this case.a.

Name of insurance company:

The monthly cost for the children's health insurance is or would be (specify): $

The children spend percent of their time with me and percent of their time with the other parent.b.

Children's health-care expenses17.have health insurance available to me for the children through my job.

c.

Additional expense for the children in this case18.Childcare so I can work or get job training....................................................................a.Children's health care not covered by insurance...........................................................b.Travel expenses for visitation........................................................................................c.

Special hardships. I ask the court to consider the following special financial circumstances19.

Extraordinary health expenses not included in 18b...................................a.Major losses not covered by insurance (examples: fire, theft, other insured loss)...............................................................................................

b.

Expenses for my minor children who are from other relationships and are living with me..................................................................................

c.

d. Children's educational or other special needs (specify below):.....................................

(attach documentation of any item listed here, including court orders):

(1)

Names and ages of those children (specify):(2)

Child support I receive for those children...............................................(3)

20.

(If you're not sure about percentage or it has not been agreed on, please describe your parenting schedule here.)

Address of insurance company:

Amount per month

Other information I want the court to know concerning support in my case (specify):

The expenses listed in a, b, and c create an extreme financial hardship because (explain):

Amount per month For how many months?

$

$

$$

$

$

$

$

Wireless service provider (name):




Fills in case number:Case Number:

1

2


All rights and responsibilities for the accounts listed in , including all financial responsibility for the telephone numbers, monthly service costs, and costs for any mobile device associated with the telephone numbers, must be immediately transferred to the new account holder (person in ).

TO THE WIRELESS SERVICE PROVIDER: This order is made under California Family Code section 6347.

Order Transferring Wireless Phone AccountDV-900

The person in will be financially responsible for the accounts listed in starting:

4

Order Transferring Wireless Phone Account (Domestic Violence Prevention)

DV-900, Page 1 of 2Judicial Council of California, www.courts.ca.gov New July 1, 2016, Mandatory Form Family Code, § 6347

THE ORDER APPLIES TO:

TRANSFER OF RIGHTS AND RESPONSIBILITIES

Date:Judicial Officer

Transfer of the following wireless phone number(s):Telephone number (include area code):

Telephone number (include area code):Telephone number (include area code):Telephone number (include area code):Telephone number (include area code):

Check box to include attachment with additional telephone number(s).

5

the date the account is transferred by the wireless service provider(specify date)

6 The person in must send this order and a completed copy of form DV-901 to the wireless service provider listed in . For information on where to send this form and Form DV-901, go to the following website: http://www.sos.ca.gov/registries/safe-home/domestic-violence-wireless-plans. Form DV-901 is a confidential form and must NOT be filed with the court.

1

ATTENTION WIRELESS SERVICE PROVIDERThe new account holder’s (person in ) contact information, including information on form DV-901, must NOT be disclosed to the current account holder (person in ).

3

Current account holder (name):

New account holder (name):

Billing telephone number:

4

33 4

3

32

This order is made under California’s Domestic Violence Prevention Act.


http://www.sos.ca.gov/registries/safe-home/domestic-violence-wireless-plans

When the current account holder has already terminated the account

When differences in network technology prevent the functionality of a device on the network

When there are geographic or other limitations on network or service availability

If the provider determines that transfer CANNOT occur, then the provider MUST notify the person in within 72 hours of receipt of this order (California Family Code section 6347).


DV-900, Page 2 of 2 New July 1, 2016

Case Number:

•

•

•

3

Order Transferring Wireless Phone Account (Domestic Violence Prevention)

INSTRUCTIONS FOR WIRELESS SERVICE PROVIDERThe orders contained on page 1 of this form must be followed unless the wireless service provider cannot operationally or technically effectuate the order due to certain circumstances, including, but not limited to, any of the following:


I certify that this order is a true and correct copy of the original on file in the court.

Clerk’s Certificate [seal]

Clerk, by , Deputy


Date:

Domestic Violence and Child Custody If you are involved in a family law case involving children and there has been domestic

What is ‘domestic violence’? It means to hit, kick, scare, throw things, pull hair, push, follow, harass, sexually assault or threaten to do any of these things. It also includes other actions that make someone afraid of being hurt. Domestic violence can be spoken, written or physical.

What is ‘child custody’? There are two types:

Physical custody: The person that the child lives with primarily. Legal custody: The person who makes important decisions about the child’s health care, education and well-being.

When does domestic violence affect who gets custody of child? Whenever there has been a finding by a judge that, within the past 5 years, a parent in this case committed domestic violence against any of the people listed below:

The other parent in the custody case; Your child or your child’s siblings; A current spouse or someone they are currently engaged to, living with or dating; or,

Their parent.

An example of a finding is when a judge grants a restraining order for 1 year or more.

How does a finding of domestic violence affect my case? If a court decides that there is domestic violence, the judge must follow special rules to decide custody of the child. These rules are set in a special law known as “3044” (see page 2). Usually, the judge cannot give custody to the person who committed domestic violence. However, the judge can give that person visitation.

Are there exceptions? Yes. There are situations when the judge can give custody to the person who committed the domestic violence. To do that, the judge must be convinced that it would not be harmful to the child. The judge must look at what is going to be best for the child and must consider specific things, like has the person: Had any other incidents of domestic

violence? Followed all of the terms of any

restraining order? Completed a batterer’s treatment

program? Finished an alcohol/drug program, if

ordered? Finished a parenting class, if

ordered? If on probation or parole, did the

person followed all of the terms?

This law applies to any person seeking custody, not only a parent. To read the law, see California Family Code Section 3044. Other laws also apply.

California Courts Online Self-Help Center: www.courtinfo.ca.gov/selfhelp/[REVISED JANUARY 2019]


Family Code 3044

(a) Upon a finding by the court that a party seeking custody of a child has perpetrated domestic violence within the previous five years against the other party seeking custody of the child, or against the child or the child’s siblings, or against any person in subparagraph (C) of paragraph (1) of subdivision (b) of Section 3011 with whom the party has a relationship, there is a rebuttable presumption that an award of sole or joint physical or legal custody of a child to a person who has perpetrated domestic violence is detrimental to the best interests of the child, pursuant to Sections 3011 and 3020. This presumption may only be rebutted by a preponderance of the evidence.

(b) To overcome the presumption set forth in subdivision (a), the court shall find that paragraph (1) is satisfied and shall find that the factors in paragraph (2), on balance, support the legislative findings in Section 3020.

(1) The perpetrator of domestic violence has demonstrated that giving sole or joint physical or legal custody of a child to the perpetrator is in the bestinterests of the child pursuant to Sections 3011 and 3020. In determining the best interests of the child, the preference for frequent and continuing contact with both parents, as set forth in subdivision (b) of Section 3020, or with the noncustodial parent, as set forth in paragraph (1) of subdivision (a) of Section 3040, may not be used to rebut the presumption, in whole or in part.(2) Additional factors:

(A) The perpetrator has successfully completed a batterer’s treatment program that meets the criteria outlined in subdivision (c) of Section 1203.097 of the Penal Code.(B) The perpetrator has successfully completed a program of alcohol or drug abuse counseling, if the court determines that counseling is appropriate.(C) The perpetrator has successfully completed a parenting class, if the court determines the class to be appropriate.(D) The perpetrator is on probation or parole, and he or she has or has not complied with the terms and conditions of probation or parole.(E) The perpetrator is restrained by a protective order or restraining order, and he or she has or has not complied with its terms and conditions.(F) The perpetrator of domestic violence has committed any further acts of domestic violence.

(c) For purposes of this section, a person has “perpetrated domestic violence” when he or she is found by the court to have intentionally or recklessly caused or attempted to cause bodily injury, or sexual assault, or to have placed a person in reasonable apprehension of imminent serious bodily injury to that person or to another, or to have engaged in behavior involving, but not limited to, threatening, striking, harassing, destroying personal property, or disturbing the peace of another, for which a

court may issue an ex parte order pursuant to Section 6320 to protect the other party seeking custody of the child or to protect the child and the child’s siblings.

(d) (1) For purposes of this section, the requirement of a finding by the court shall be satisfied by, among other things, and not limited to, evidence that a party seeking custody has been convicted within the previous five years, after a trial or a plea of guilty or no contest, of a crime against the other party that comes within the definition of domestic violence contained in Section 6211 and of abuse contained in Section 6203, including, but not limited to, a crime described in subdivision (e) of Section 243 of, or Section 261, 262, 273.5, 422, or 646.9 of, the Penal Code.

(2) The requirement of a finding by the court shall also be satisfied if a court, whether that court hears or has heard the child custody proceedings or not, has made a finding pursuant to subdivision (a) based on conduct occurring within the previous five years.

(e) When a court makes a finding that a party has perpetrated domestic violence, the court may not base its findings solely on conclusions reached by a child custody evaluator or on the recommendation of the Family Court Services staff, but shall consider any relevant, admissible evidence submitted by the parties.

(f) (1) It is the intent of the Legislature that this subdivision be interpreted consistently with the decision in Jaime G. v. H.L. (2018) 25 Cal.App.5th 794, which requires that the court, in determining that the presumption in subdivision (a) has been overcome, make specific findings on each of the factors in subdivision (b).

(2) If the court determines that the presumption in subdivision (a) has been overcome, the court shall state its reasons in writing or on the record as to why paragraph (1) of subdivision (b) is satisfied and why the factors in paragraph (2) of subdivision (b), on balance, support the legislative findings in Section 3020.

(g) In an evidentiary hearing or trial in which custody orders are sought and where there has been an allegation of domestic violence, the court shall make a determination as to whether this section applies prior to issuing a custody order, unless the court finds that a continuance is necessary to determine whether this section applies, in which case the court may issue a temporary custody order for a reasonable period of time, provided the order complies with Section 3011, including, but not limited to, subdivision (e), and Section 3020.

(h) In a custody or restraining order proceeding in which a party has alleged that the other party has perpetrated domestic violence in accordance with the terms of this section, the court shall inform the parties of the existence of this section and shall give them a copy of this section prior to any custody mediation in the case.

Superior Court of California County of Sacramento

William R. Ridgeway Family Relations Courthouse 3341 Power Inn Road

Sacramento, CA 95826

Family Law and Probate Division Resource Sheet

Filing Options

Drop Box Drop for Family Law, Probate & Juvenile Dependency filings ONLY in the Drop Box located in the Court lobby, Mon – Fri: 7:30 am – 5:00 pm. To ensure your documents are returned to you, include a self-addressed, stamped envelope.

Filing by Mail In lieu of filing papers at the courthouse, they may be filed by mailing them to the William R. Ridgeway Family Relations Courthouse. To ensure your documents are returned to you, include a self-addressed, stamped envelope.

File Ordering Options

Request a Court File Online If you have an older file, you can now order it on the court’s web site. To order your file, go to: http://www.saccourt.ca.gov/family/records-request.aspx

Child Support Options

Department of Child Support Services www.childsup.ca.govEstablishes, modifies and enforces child support and health insurance orders for custodial parents and for AFDC reimbursement; enforces existing spousal support orders together with child support orders, child support calculator. www.cse.ca.gov/ChildSupport/cse/guidelineCalculatorSacramento County Dept. of Child Support Services 3701 Power Inn Road, Sacramento, CA Hours: 8:00 am – 5:00 pm. (866) 901-3212

- Continued next column -

DissoMaster Support Calculations Child/spousal/partner support calculations are Prepared at no charge by the Temporary Judges Every Tues from 9:00 to 11:00 in Room 215 (second floor). No appointment required.

Self Help Options

e-Correspondence Assistance for self-represented parties with Family Law and Probate Guardianship cases in the Sacramento County Superior Court via the web. Assistance is provided by staff of the Family Law Facilitator’s Office. Please sign up for an e-Correspondence account at the address below: https://services.saccourt.ca.gov/FLFOeCorrespondence/

Web Site for Sacramento Superior Court www.saccourt.ca.govProvides information about the Court, local rules, forms and instructions. For Family Law court process information and Self Help Resources, follow the link for “Family and Children.” For Probate court process information, follow the link for “Probate.”

California Courts Online Self Help Center www.courts.ca.govProvides information on the legal system, resources for finding legal help, alternatives to going to court, as well as specific information about Family Law, Probate, Domestic Violence, and much more.

Family Law Facilitator’s Office Assists self-represented litigants with Family Law and Probate guardianship cases, including child support and paternity in cases involving DCSS. Hours: Mon – Thurs: 8:30 am – 4:00 pm Family Relations Courthouse, Room 113 Walk In Service Only (with service ticket)

Superior Court of California County of Sacramento

William R. Ridgeway Family Relations Courthouse 3341 Power Inn Road

Sacramento, CA 95826

Family Law and Probate Division Resource Sheet

Domestic Violence & Elder Abuse ResourcesCrisis Hotlines/Shelters

A Community for Peace (Citrus Heights) 916-728-7210

My Sister’s House (Asian/Pan Pacific Services) 916-428-3271

PEACE for Families (Roseville) 800-575-5352

WEAVE 916-920-2952 – main crisis line

Saint.John’s Program for Real Change 916-453-1482

24/7 Sexual Assault hotline 800-656-HOPE

24/7 Domestic Violence hotline 800-799-SAFE

Children’s Emergency Services

National Parent Helpline 1-855-427-2736 (toll free) Trained advocates provide emotional support and resources to parents and caregivers. www.nationalparenthelpline.org

Children’s Crisis Nursery 916-394-2000 Emergency Childcare and shelter services.

Reporting Abuse

Adult Protective Services (Elderly / Adult Victims) 916-874-9377

Children’s Protective Services (CPS)916-875-5437

Victim Assistance

Victim/Witness Center 916-874-5701 Trained and experienced victim advocates provide crisis counseling, direct assistance, and information about the criminal justice system and community referrals.

Victim Notification of Abuser’s Release from Jail. 800-491-3064

Victims can register to be notified upon release of abuser from jail.

Help Getting a Temporary Restraining Order

Temporary Restraining Order Workshop Family Relations Courthouse Self Help Computer Room, Room 114 Mondays, Wednesdays and Fridays at 8:45 am (Spanish interpreter available)

This workshop will help you complete the forms to apply for a Domestic Violence Restraining Order.

Other Legal Services

1-800-VICTIMS Legal assistance in family law matters for victims of domestic violence.

Victim Counseling & Batterer’s Treatment Programs

The Sacramento Superior Court maintains lists of local providers of counseling, supervised visitation and other services commonly required in cases involving domestic violence. All provider lists are posted on the Sacramento Superior Court’s website at:

http://www.saccourt.com/family/self_help_center/ResourceReferralProgram.asp

Batterer’s Treatment Programs are for the abuser, male or female, and are focused on stopping the cycle of violence through anger management and personal techniques to reduce conflict and common triggers of abuse. Batterer’s Treatment Programs are certified by the Sacramento County Department of Probation

Family Law & Probate - Superior Court of California · 2019-06-26 · Family Law & Probate DVRO...

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