DV-100 Request for Domestic Violence Restraining Order

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 you
If 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, 2014, Mandatory Form
Family Code, § 6200 et seq.
DV-100, Page 1 of 5
DV-100
Name of Person Asking for Protection:
1
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:
2
M F
Height:
Yes
No
Yes
No
Yes
No
Yes
No
Check here if you need more space. Attach a sheet of paper and write “DV-100, Protected People” for a title.
3
4
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, Protected People” 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.
2
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:
Page 1/5
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DV-100 Request for Domestic Violence Restraining Order PDF

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