—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 will fill out this part.)
Date:
Request for Accommodations
Assistive 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 to the request for orders in writing, file form CH-120, Response to Request for Civil
Harassment Restraining Orders, and have someone age 18 or older—not you or anyone to be protected—mail it to
the person in .
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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 and may order you to
turn in to law enforcement, or sell to or store with a licensed gun dealer, any firearms that you own or possess.
The person who mailed the form must fill out a proof of service form. Form CH-250, Proof of Service of Response by
Mail, may be used. File the completed form with the court before the hearing and bring a copy with you to the court
hearing.
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Clerk’s Certificate
[seal]
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Rev. September 1, 2020
Notice of Court Hearing
(Civil Harassment Prevention)
CH-109, Page 3 of 3
To the Person in :
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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.
Use form CH-115, Request to Continue Court Hearing and to Reissue Temporary Restraining Order.
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For information about service, read form CH-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 CH-200, Proof of Personal Service, may be used.
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To the Person in :
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, Deputy
Clerk, by
For your protection and privacy, please press the Clear
This Form button after you have printed the form.