Fillable Form 1: DV-110 Temporary Restraining Order (San Mateo County Law Library)

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Form 1: DV-110 Temporary Restraining Order (San Mateo County Law Library)

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This is a Court Order.
Name of Protected Person:
Your lawyer in this case (if you have one):
Zip:
State:City:
Telephone:
Full name
Additional Protected Persons
This order expires at the date and time of the hearing below:
DV-110, Page 1 of 5
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of California, County of
Case Number:
Clerk fills in case number when form is filed.
DV-110
Temporary Restraining Order
1
2
4
Person in must complete items , , and only.
Name:
State Bar No.:
Address:
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.):
Fax:
Firm Name:
E-Mail Address:
Name of Restrained Person:
Description of restrained person:
Sex AgeRelationship to person in
In addition to the person named in , the following persons are protected by temporary orders as indicated in items
3
Expiration Date
1 31 2
1
6
1
and (family or household members):
7
Check here if there are additional protected persons. List them on an attached sheet of paper and write,
“DV-110, Additional Protected Persons” as a title.
The court will complete the rest of this form.
Hearing Date: Time:
a.m. p.m.
M F Height:Sex:
Address (if known):
Race:
Date of Birth:
City:
Age:
Weight: Hair Color: Eye Color:
State: Zip:
Relationship to protected person:
Judicial Council of California, www.courts.ca.gov
Revised January 1, 2012, Mandatory Form
Family Code, § 6200 et seq.
Approved by DOJ
Temporary Restraining Order
(CLETS—TRO)
(Domestic Violence Prevention)
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.
Criminal Protective Order
A criminal protective order on Form CR-160, Criminal Protective Order–Domestic Violence, is in effect.
Case Number:
County: Expiration Date:
a.
The court has granted the temporary orders checked below. If you do not obey these orders,
you can be arrested and charged with a crime. You may be sent to jail for up to one year, pay a
fine of up to $1,000, or both.
You must take only personal clothing and belongings needed until the hearing and move out immediately from
No information has been provided to the judge about a criminal protective order.
b
.
To the person in
2
(address):
This is a Court Order.
DV-110, Page 2 of 5
Case Number:
5
1
6
Personal Conduct Orders
You must not do the following things to the person in and
a.
Not requested
Denied until the hearing
Granted as follows:
persons in :
3
Harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy personal
property, disturb the peace, keep under surveillance, or block movements
3
1
1
7
Stay-Away Order
You must stay at least (specify): yards away from:
a.
The person in
The persons in
Home of person in
The job or workplace of person in
School of person in
The children’s school or child care
Other (specify):
Peaceful written contact through a lawyer or process server or another person as needed to serve Form
DV-120 (Response to Request for Domestic Violence Restraining Order) or other legal papers is allowed
and does not violate this order.
b
.
1
8
Move-Out Order
3
Contact, either directly or indirectly, in any way, including but not limited to, by telephone, mail, e-mail or
other electronic means
Take any action, directly or through others, to obtain the addresses or locations of the persons in
and . (If this item is not checked, the court has found good cause not to make this order.)
Exceptions: Brief and peaceful contact with the person in , and peaceful contact with children in , as
required for court-ordered visitation of children, is allowed unless a criminal protective order says
otherwise.
c.
Not requested
Denied until the hearing
Granted as follows:
3
1
1
1
1
Vehicle of person in
1
3
Exceptions: Brief and peaceful contact with the person in , and peaceful contact with children in , as
required for court-ordered visitation of children, is allowed unless a criminal protective order says
otherwise.
b
.
Not requested Denied until the hearing Granted as follows:
Temporary Restraining Order
(CLETS—TRO)
(Domestic Violence Prevention)
Revised January 1, 2012
You and the person in must follow the orders listed in attached Form DV-140, Child Custody and Visitation
Order. The parent with temporary custody of the child must not remove the child from California until a noticed
hearing (Family Code Section 3063).
You cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, other
firearms, or ammunition.
2
The person in is given the sole possession, care, and control of the animals listed below. The person in
must stay at least ______ yards away from and not take, sell, transfer, encumber, conceal, molest, attack, strike,
threaten, harm, or otherwise dispose of the following animals:
1
Until the hearing, only the person in can use, control, and possess the following property and things:
You must:
Sell to a licensed gun dealer or turn in to a law enforcement agency any guns or other firearms within your
immediate possession or control. This must be done within 24 hours of being served with this order.
•
File a receipt with the court within 48 hours of receiving this order that proves guns have been turned in or
sold. (You may use Form DV-800, Proof of Firearms Turned In or Sold, for the receipt.)
•
1
1
If the people in and are married to each other or are registered domestic partners,
21
must not transfer, borrow against, sell, hide, or get rid of or destroy
Peaceful written contact through a lawyer or a process server or other person for service of legal papers related
to a court case is allowed and does not violate this order.
The court has received information that you own or possess a firearm.
This is a Court Order.
DV-110, Page 3 of 5
Case Number:
Temporary Restraining Order
(CLETS—TRO)
(Domestic Violence Prevention)
Revised January 1, 2012
No Guns or Other Firearms or Ammunition
a.
b
.
c.
9
Not requested Denied until the hearing Granted as follows:
10
Record Unlawful Communications
The person in can record communications made by you that violate the judge’s orders.
1
11
Care of Animals
Not requested Denied until the hearing Granted as follows:
12
Child Custody and Visitation
Not requested Denied until the hearing Granted as follows:
13
Child Support
14 Property Control
Not ordered now but may be ordered after a noticed hearing.
Not requested Denied until the hearing Granted as follows:
2
15
Debt Payment
The person in must make these payments until this order ends:
Pay to:
For: Amount: $ Due date:
Pay to: For: Amount: $ Due date:
Denied until the hearing Granted as follows:
16
Property Restraint
Not requested Denied until the hearing Granted as follows:
Not requested
the person in
1
the person in
2
any property, including animals, except in the usual course of business or for necessities of life. In addition,
each person must notify the other of any new or big expenses and explain them to the court. (The person in
cannot contact the person in if the court has made a “no contact” order.)
2
1
9
You Cannot Have Guns, Other Firearms or Ammunition
You cannot own, have, possess, buy or try to buy, receive or try to receive, or otherwise get guns, other firearms, or
ammunition while this order is in effect. If you do, you can go to jail and pay a $1,000 fine. You must sell to a licensed
gun dealer or turn in to a law enforcement agency any guns or other firearms that you have or control as stated in item
above. The court will require you to prove that you did so.
No Fee to Serve (Notify) Restrained Person
If the sheriff serves this order, he or she will do it for free.
Date:
Judge (or Judicial Officer)
Warnings and Notices to the Restrained Person in
2
If You Do Not Obey This Order, You Can Be Arrested and Charged With a Crime
•
It is a felony to take or hide a child in violation of this order.
•
If you travel to another state or to tribal lands or make the protected person do so, with the intention of disobeying this
order, you can be charged with a federal crime.
•
If you do not obey this order, you can go to jail or prison and/or pay a fine.
This is a Court Order.
DV-110, Page 4 of 5
Case Number:
Temporary Restraining Order
(CLETS—TRO)
(Domestic Violence Prevention)
Revised January 1, 2012
2
If the judge makes a restraining order at the hearing, which has the same orders as in this form, you will get a copy of that
order by mail at your last known address, which is written in . If this address is not correct, or to know if the orders
were made permanent, contact the court.
Service of Order by Mail
18
Lawyer’s Fees and Costs
Not ordered now but may be ordered after a noticed hearing.
19
Payments for Costs and Services
Not ordered now but may be ordered after a noticed hearing.
20
Batterer Intervention Program
Not ordered now but may be ordered after a noticed hearing.
Not requested
Denied until the hearing
Granted as follows:
21
Other Orders
17
Spousal Support
Not ordered now but may be ordered after a noticed hearing.
22
Check here if there are additional orders. List them on an attached sheet of paper and write “DV-110, other
Orders” as a title.
Child Custody, Visitation, and Support
•
Child custody and visitation: If you do not go to the hearing, the judge can make custody and visitation orders for
your children without hearing from you.
•
Child support: The judge can order child support based on the income of both parents. The judge can also have that
support taken directly from your paycheck. Child support can be a lot of money, and usually you have to pay until the
child is age 18. File and serve a Financial Statement (Simplified) (Form FL-155) or an Income and Expense
Declaration (Form FL-150) so the judge will have information about your finances.
•
Spousal support: File and serve an Income and Expense Declaration (Form FL-150) so the judge will have
information about your finances. Otherwise, the court may make support orders without hearing from you.
Instructions for Law Enforcement
This order is effective when made. It is enforceable by any law enforcement agency that has received the order, is shown
a copy of the order, or has verified its existence on the California Law Enforcement Telecommunications System
(CLETS). If the law enforcement agency has not received proof of service on the restrained person, and the restrained
person was not present at the court hearing, the agency shall advise the restrained person of the terms of the order and
then shall enforce it. Violations of this order are subject to criminal penalties.
Arrest Required If Order Is Violated
If an officer has probable cause to believe that the restrained person had notice of the order and has disobeyed the order,
the officer must arrest the restrained person. (Penal Code, §§ 836(c)(1), 13701(b).) A violation of the order may be a
violation of Penal Code section 166 or 273.6.
—Clerk’s Certificate—
I certify that this Temporary Restraining Order is a true and correct copy of the
original on file in the court.
Clerk’s Certificate
[seal]
Clerk, by
, Deputy
(Clerk will fill out this part.)
Date:
This is a Court Order.
DV-110, Page 5 of 5
Case Number:
Temporary Restraining Order
(CLETS—TRO)
(Domestic Violence Prevention)
Revised January 1, 2012
Certificate of Compliance With VAWA
This temporary protective order meets all “full faith and credit” requirements of the Violence Against Women Act,
18 U.S.C. § 2265 (1994) (VAWA) upon notice of the restrained person. This court has jurisdiction over the parties
and the subject matter; the restrained person has been or will be afforded notice and a timely opportunity to be
heard as provided by the laws of this jurisdiction. This order is valid and entitled to enforcement in each
jurisdiction throughout the 50 states of the United States, the District of Columbia, all tribal lands, and
all U.S. territories, commonwealths, and possessions and shall be enforced as if it were an order of that
jurisdiction.
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Form 1: DV-110 Temporary Restraining Order (San Mateo County Law Library)

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Completed 15 December 2020

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