Personal Conduct Orders
Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy
personal property of, or disturb the peace of the person.
Contact the person, either directly or indirectly, in any way, including, but not limited to, in person, by
telephone, in writing, by public or private mail, by interoffice mail, by e-mail, by text message, by fax, or by
other electronic means.
Check here if there is not enough space for your answer. Put your complete answer on the attached
sheet of paper or form MC-025 and write “Attachment 8c—Other Personal Conduct Orders,” for a
Yes No I don’t know
If the judge grants a protective order, the person in will be prohibited from owning, possessing, purchasing,
receiving, or attempting to purchase or receive a gun, other firearm, and ammunition while the protective order
is in effect. The person in will also be ordered to turn in to law enforcement, or sell to or store with a
licensed gun dealer, any guns or firearms within his or her immediate possession or control.
Does the person in own or possess any guns or other firearms?
Check the orders you want.
I ask the court to order the person in not to do any of the following things to me or to any person to be
protected listed in :
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.
Guns or Other Firearms and Ammunition
Request for Civil Harassment Restraining Orders
(Civil Harassment Prevention)
CH-100, Page 4 of 6
This is not a Court Order.
I ask the court to order the person in to stay at least yards away from (check all that apply):
The other persons listed in .
My job or workplace.
My children’s school.
My children’s place of child care.
If the court orders the person in to stay away from all the places listed above, will he or she still be able
to get to his or her home, school, or job?
(If no, explain below):
Check here if there is not enough space for your answer. Put your complete answer on the attached sheet of
paper or form MC-025 and write “Attachment 9b—Stay-Away Orders,” for a title.
Revised January 1, 2018