Fillable Form 1: WV-110 Temporary Restraining Order (California)

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Form 1: WV-110 Temporary Restraining Order (California)

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WV-110, Page 1 of 5
Temporary Restraining Order (CLETS—TWH)
(Workplace Violence Prevention)
Judicial Council of California, www.courts.ca.gov
Revised January 1, 2017, Mandatory Form
Code of Civil Procedure, §§ 527.8 and 527.9
Approved by DOJ
In addition to the employee, the following family or household members or other employees are protected by the
temporary orders indicated below:
Date: Time:
Expiration Date
This Order expires at the end of the hearing scheduled for the date and time below:
Full Name
No
Yes
No
Yes
No
Yes
Additional protected persons are listed at the end of this Order on Attachment 4.
Sex Age Household Member? Relation to Employee
p.m.a.m.
Additional Protected Persons
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of California, County of
Court fills in case number when form is filed.
Case Number:
Description:
Respondent (Restrained Person)
Full Name:
Employee (Protected Person)
Full Name:
Petitioner (Employer)
Name:
Name:
Address:
City: State: Zip:
Telephone: Fax:
E-Mail Address:
Your Address (If you have a lawyer, give your lawyer’s information.):
Lawyer for Petitioner (if any, for this case):
a.
b.
State Bar No.:
Firm Name:
1
Sex: FM
Height: Weight:
Race:Hair Color:
Date of Birth:
Eye Color: Age:
Home Address (if known):
State:
City:
Zip:
Relationship to Employee:
WV-110
Temporary Restraining Order
This is a Court Order.
2
3
4
5
WV-110, Page 2 of 5
Revised January 1, 2017
Temporary Restraining Order (CLETS—TWH)
(Workplace Violence Prevention)
4
(6)
(7)
(1)
(4)
and to the other protected persons listed in :
Other (specify):
Harass, molest, strike, assault (sexually or otherwise), batter, 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 e-mail, by fax, or by other electronic means.
Take any action to obtain the person’s address or locations. If this item is not checked, the court has
found good cause not to make this order.
(2)
Commit acts of violence or make threats of violence against the person.
(3)
Follow or stalk the person during work hours or to or from the place of work.
(5)
Enter the workplace of the person.
Personal Conduct Orders
You are ordered not do the following things to the employee
Other personal conduct orders are attached at the end of this Order on Attachment 6a(7).
a.
Not Requested
Denied Until the Hearing
Granted as Follows:
The court has issued the temporary orders checked as granted below. If you do not obey these orders, you can be
arrested and charged with a crime. You may have to go to jail for up to one year, pay a fine of up to $1,000, or
both.
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. However, you may have your papers served by mail
on the petitioner.
Stay-Away Order
a.
You must stay at least yards away from (check all that apply):
4
Each other protected person listed in
(1)
(2)
(3)
(5)
(6)
(7)
The employee’s children’s place of child care
(8)
The employee’s workplace
The employee’s school
The employee’s children’s school
The employee’s vehicle
(9)
Other (specify):
The employee
(4)
The employee’s home
This stay-away order does not prevent you from going to or from your home or place of employment.
b.
b.
Not Requested Denied Until the Hearing Granted as Follows:
This is a Court Order.
To the Respondent:
6
7
Case Number:
WV-110, Page 3 of 5
Revised January 1, 2017
Temporary Restraining Order (CLETS—TWH)
(Workplace Violence Prevention)
Additional law enforcement agencies are listed at the end of this Order on Attachment 10.
No Fee to Serve (Notify) Restrained Person
The sheriff or marshal will serve this Order without charge because:
a.
b.
The petitioner is entitled to a fee waiver.
Ordered
Not Ordered
The Order is based on a credible threat of violence or stalking.
Other Orders
Mandatory Entry of Order Into CARPOS Through CLETS
b.
a.
c.
This Order must be entered into the California Restraining and Protective Order System (CARPOS) through the
California Law Enforcement Telecommunications System (CLETS). (Check one):
The clerk will enter this Order and its proof-of-service form into CARPOS.
The clerk will transmit this Order and its proof-of-service form to a law enforcement agency to be entered
into CARPOS.
By the close of business on the date that this Order is made, the employer or the employer’s lawyer should
deliver a copy of the Order and its proof-of-service form to the law enforcement agencies listed below to
enter into CARPOS:
File a receipt with the court within 48 hours of receiving this Order that proves that your guns or firearms
have been turned in, sold, or stored. (You may use form WV-800, Proof of Firearms Turned In, Sold, or
Stored for the receipt.)
c.
(2)
The court has received information that you own or possess a firearm.
No Guns or Other Firearms and Ammunition
a. 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.
You must:
Sell to or store with a licensed gun dealer or turn in to a law enforcement agency any guns or other firearms
in your immediate possession or control. This must be done within 24 hours of being served with this
Order.
b.
(1)
To the Petitioner:
Not Requested Denied Until the Hearing
Granted as Follows (specify):
Additional orders are attached at the end of this Order on Attachment 9.
Name of Law Enforcement Agency Address (City, State, Zip)
This is a Court Order.
9
10
11
Case Number:
8
WV-110, Page 4 of 5
Revised January 1, 2017
Temporary Restraining Order (CLETS—TWH)
(Workplace Violence Prevention)
In addition to the response, you may file and have declarations served, signed by you and other persons who have
personal knowledge of the facts. You may use form MC-030, Declaration, for this purpose. It is available from the
clerk’s office at the court shown on page 1 of this form or at www.courts.ca.gov/forms. If you do not know how to
prepare a declaration, you should see a lawyer.
•
You must have form WV-120 served on the petitioner or the petitioner’s attorney by mail. You cannot do this yourself.
The person who does the service should complete and sign form WV-250, Proof of Service of Response by Mail. File
the completed proof of service with the court clerk before the hearing date or bring it with you to the hearing.
•
After You Have Been Served With a Restraining Order
Obey all the orders. Any intentional violation of this Order is a misdemeanor punishable by a fine or by
imprisonment in a county jail, or by both fine and imprisonment. (Pen. Code, § 273.6.)
If you want to respond, fill out form WV-120, Response to Petition for Workplace Violence Restraining Orders,
and file it with the court clerk. You do not have to pay any fee to file your response if the petition claims that you
threatened violence against or stalked the employee, or placed the employee in reasonable fear of violence.
•
Read form WV-120-INFO, How Can I Respond to a Petition for Orders to Stop Workplace Violence?, to learn
how to respond to this Order.
•
If you have been personally served with this Temporary Restraining Order and form WV-109, Notice of Court Hearing,
but you do not appear at the hearing either in person or by a lawyer, and a restraining order that is the same as this
Temporary Restraining Order except for the expiration date is issued at the hearing, a copy of the order will be served on
you by mail at the address in item .
Notice Regarding Nonappearance at Hearing and Service of Order
If this address is not correct or you wish to verify that the Temporary Restraining Order was converted into a restraining
order at the hearing without substantive change, or to find out the duration of the order, contact the clerk of the court.
Whether or not you file a response, you should attend the hearing. If you have any witnesses, they must also go to the
hearing.
•
3
•
At the hearing, the judge can make restraining orders against you that last for up to three years. Tell the judge why you
disagree with the orders requested.
•
Warnings and Notices to the Restrained Person in
You Cannot Have Guns or Firearms
2
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 or store with
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.
8
This is a Court Order.
Case Number:
Judicial Officer
Number of pages attached to this Order, if any:
Date:
12
WV-110, Page 5 of 5
Revised January 1, 2017
Temporary Restraining Order (CLETS—TWH)
(Workplace Violence Prevention)
If the Protected Person Contacts the Restrained Person
Even if the protected person invites or consents to contact with the restrained person, this order remains in effect and must
be enforced. The protected person cannot be arrested for inviting or consenting to contact with the restrained person. The
order can be changed only by another court order. (Pen. Code, § 13710(b).)
Start Date and End Date of Orders
This order starts on the date next to the judge’s signature on page 4. The order ends on the expiration date in item 5 on
page 1.
This is a Court Order.
Case Number:
Instructions for Law Enforcement
Enforcing the Restraining Order
This order 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 Restraining and Protective Orders System (CARPOS). Agencies are encouraged to
enter violation messages into CARPOS. If the law enforcement agency has not received proof of service on the restrained
person, the agency must advise the restrained person of the terms of the order and then must enforce it. Violations of this
order are subject to criminal penalties.
If more than one restraining order has been issued, the orders must be enforced according to
the following priorities: (See Pen. Code, § 136.2, Fam. Code, §§ 6383(h)(2), 6405(b).)
1. EPO: If one of the orders is an Emergency Protective Order (form EPO-001) and is more restrictive than other
restraining or protective orders, it has precedence in enforcement over all other orders.
2. No Contact Order: If there is no EPO, a no-contact order that is included in a restraining or protective order has
precedence over any other restraining or protective order.
3. Criminal Order: If none of the orders includes a no contact order, a domestic violence protective order issued in a
criminal case takes precedence in enforcement over any conflicting civil court order. Any nonconflicting terms
of the civil restraining order remain in effect and enforceable.
4. Family, Juvenile, or Civil Order: If more than one family, juvenile, or other civil restraining or protective order
has been issued, the one that was issued last must be enforced.
Conflicting Orders—Priorities for Enforcement
—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:
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Completed 8 February 2021

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