DV-101 Description of Abuse - Domestic Violence Prevention

The person in
If yes, did they give you or the person in an Emergency Protective Order?
DV-101
Description of Abuse
Case Number:
This form is attached to DV-100, Request for Domestic Violence Restraining Order.
Name of person asking for protection:
Name of person you want protection from:
Describe the 2nd most recent abuse.
Date of 2nd most recent abuse:
Who was there?
Describe how the person in
Describe any use or threatened use of guns or other weapons:
Describe any injuries:
YesDid the police or other law enforcement come?
Nof.
Yes I don’t know
No
DV-101, Page 1 of 2
Description of Abuse
Judicial Council of California, www.courts.ca.gov
Rev. January 1, 2012, Optional Form
Family Code, § 6200 et seq.
a.
b.
c.
d.
e.
Attach a copy of the Emergency Protective Order if you have one.
YouThe Emergency Protective Order protects
1
2
3
2
2
2
(Domestic Violence Prevention)
abused you or your children:
To keep other people from seeing what you entered on your form, please press the Clear
This Form button at the end of the form when finished.
Page 1/2
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DV-101 Description of Abuse - Domestic Violence Prevention PDF

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