Fillable Form 1: DV-101 Description of Abuse This form (California)

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Form 1: DV-101 Description of Abuse This form (California)

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DV-101, Page 1 of 2
Judicial Council of California, www.courts.ca.gov
Rev. January 1, 2017, Optional Form
Family Code, § 6200 et seq.
3
1
2
Describe abuse to you or your children.
Name of person asking for protection:
Name of person you want protection from:
Case Number:
DV-101
Description of Abuse
a. Date of abuse:
d.
This form is attached to DV-100, Request for Domestic Violence Restraining Order .
b.
Who was there?
2
Describe how the person in abused you or your children:
Description of Abuse
(Domestic Violence Prevention)
Describe any use or threatened use of guns or other weapons:
e.
Did the police or other law enforcement come?
If yes, did they give you or the person in an Emergency Protective Order?
2
The Emergency Protective Order protects
Attach a copy of the Emergency Protective Order if you have one.
f.
YesNo
Yes No
I don’t know
2
You
The person in
Describe any injuries:
Case Number:
4
5
Describe abuse to you or your children.
a.
Date of abuse:
d.
b.
c.
e.
Did the police or other law enforcement come?
If yes, did they give you or the person in an Emergency Protective Order?
2
The Emergency Protective Order protects
Attach a copy of the Emergency Protective Order if you have one.
f.
YesNo
Yes No
I don’t know
2
You
The person in
Has the person in abused you (or your children) other times?
2
Describe abuse to you or your children.
Check here if you need more space. Attach a sheet of paper and write “DV-101—Description of Abuse” for a
title.
DV-101, Page 2 of 2
Rev. January 1, 2017
Description of Abuse
(Domestic Violence Prevention)
Who was there?
2
Describe how the person in abused you or your children:
Describe any use or threatened use of guns or other weapons:
Describe any injuries:
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Form 1: DV-101 Description of Abuse This form (California)

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Completed 20 November 2020

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