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(Continued from page 1)
FORM DV-100 INSTRUCTIONS
REQUEST FOR ORDER (DV-100)



At the top of page 3, DV-100

Fill out the caption boxes as follows:

Write your name.

Case Number: Write in the case number (the same number as on page 1).


What orders do you want? In this part, numbers 11 through 17, check all of the boxes as to orders that you want the judge to apply to your case.


11.    Record Unlawful Communications:

Check this box if you want to be allowed to record any telephone, voicemail, messages, or other contact by the person to be restrained that violates the Restraining Order.


12.    Property Control:

Check this box if you want the judge to order that you are the only one who can use, possess and control property that you both own or are in the process of buying. This includes personal property, cars, appliances, real property or other things that you shared or bought together.

NOTE: This part of a restraining order is only temporary. It does not guarantee that you can keep the property.


13.    Animals: Possession and Stay-Away Order

Check this box if you want the judge to order that you are the only one who can own, care for, and control the animal(s) you list.

Write the number of yards that you would like the person to be restrained to be ordered to stay away from the animal(s). (Usually people write 100 yards. 100 yards is the length of a football field. This is 91.44 meters.)

You are asking that the person to be restrained cannot take, sell, transfer, encumber, conceal, molest, attack, strike, threaten, harm, or deal in any other way with the animal(s) you list. Write the name of the animal, with a short description. For example: “Tom, pet Persian cat,” or “Suzy, pet poodle.”

If you ask for the animal possession and stay-away order, you must explain to the judge why you should have the animals with you. For example:

  • You have a legal right to the animal(s): you own it (them) and have owned it (them) for a long time.
  • The person to be restrained has abused, or threatened to abuse, the animal(s).
  • You or a person under your care will be emotionally harmed if the person to be restrained takes the animal(s) away.


14.    Debt Payment:

Check this box if you want the judge to order the person to be restrained to pay certain bills while the Restraining Order is in effect. This might include rent, a mortgage, credit card bills or other items.

Check this box if you need to list more than 3 payments you want the restrained person to make. You can either use an Additional Page (Form MC-020) (to be attached to any form) or a separate blank sheet of paper. On either one, at the top write: “DV-100, Item 13 - Debt Payment.”


15.    Property Restraint:

Check this box only if you and the person to be restrained are married to each other, or are registered domestic partners, now. This order stops the person to be restrained from transferring, borrowing against, selling, hiding or getting rid of or destroying any property except to pay for necessary living expenses. This order also requires the person to be restrained to notify you of any new or big expenses and to explain these expenses to the judge.


16.    Attorney’s Fees and Costs:

Check this box if you want the judge to order the person to be restrained to pay some or all of your attorney’s fees and court costs. You can check this box if you do not have an attorney yet, but are planning to get one for the hearing.

To collect attorney’s fees you must show either:

  • The person to be restrained is VERY difficult to work with (for example, he or she is dragging out the court case unnecessarily, or refusing to communicate or settle with you); or
  • The person to be restrained has a lot more money than you, and can afford to pay for your attorney.

If you check this box, you must also fill out and file an Income and Expense Declaration (Form FL-150).


17.    Payments for Costs and Services:

Check this box if you want the person to be restrained to pay you back for money that you lost (such as from missed work) or things you had to pay for (such as damaged property, medical bills, counseling, or temporary housing) because of the person to be restrained’s violence or other scary behavior.

Write whom you have paid, and what you have paid for. (You must bring receipts, bills, written estimates for repairs or letters from an employer to the hearing to prove your payments or days you missed from work.)


18.    Batterer Intervention Program:

Check this box if you want the judge to make the person to be restrained go to a “Batterer Intervention Program” for a year. A batterer’s intervention program is different than an anger management class. There are classes every week for 1 year.


19 .    No Fee to Serve (Notify) Restrained Person:

You may have the sheriff or marshal serve (give a copy of your court papers to the person to be restrained) for you. If you qualify for a fee waiver, the sheriff or marshal will do this for free. To get this service, file a Request for Orders to Stop Harassment (Form CH-100) and an Application for Waiver of Court Fees and Costs (Form FW-001).


At the top of page 4, DV-100

Fill out the caption boxes as follows:

Write your name.

Case Number: Write in the case number (the same number as on page 1).


20.    More Time for Notice:

Check this box if you want to have up to 11 more days to serve this form on the person to be restrained. (Usually you have to serve the court form 21 days before the court hearing.)

NOTE:  To learn how to notify the Restrained Person (called service) and how to let the court know that you have notified the Person (called proof of service), read an information sheet called What is “Proof of Service”? (Form DV-210-INFO).

If there are more facts you want the judge to know about why you need more time to notify the Restrained Person, you can use the added lines.


21.    Other Orders:

Check this box if you want the judge to include extra protections or orders. Write exactly what other things you want included in the court order.

If you need more space to write down all of the orders you are asking for you can use an Additional Page (Form MC-020) (to be attached to any form) or a separate blank sheet of paper. On either one, at the top write: “DV-100, Item 20 - Other Orders.” Then write down what you want the judge to order.


22.    Guns or Other Firearms:

Check this box which is true in your case. Yes – you know that the Restrained Person has or owns any guns. No – you know that the Restrained Person does not have or own any guns. You don’t know.

NOTE: The law says that no one is allowed to own or have any guns or other firearms if he or she is restrained by a court order because of domestic violence. This means that if the judge approves this Request for a Domestic Violence Prevention Order, the Restrained Person will have to sell or turn in any guns or firearms that he or she has, owns or controls.


23.    Describe the Most Recent Abuse:

NOTE: The information you put here is very important. The judge will use this information to decide if he or she will grant the Restraining Order. Answer every question that applies to you.

  1. Write the DATE of the last time you were abused.
  2. List anyone who was there and saw or heard the abuse.
  3. Write what the person to be restrained did or said the last time he or she hurt you or made you afraid. Be sure that you give enough information for the judge to understand what happened.
  4. Write what happened if the person to be restrained used, or said he or she would use, a gun or something else to hurt you (such as a knife or another object).
  5. If you got hurt, tell how you were hurt the last time the person to be restrained abused you. For example, you might tell about bruises, cuts, a broken bone or some other injury.
  6. Check  either the “Yes” or “No” box to tell whether the police came.

If the police did come out, Check either the “Yes”, “No,” or “I don’t know” box to tell the judge if they gave you an Emergency Protective Order (Form EPO-001). If you know that you did get this kind of order, attach a copy of the order to this form.

Check this box if you need more space to describe the most recent abuse. Use an Additional Page (Form MC-020) (to be attached to any form) and write “DV-100, Item 22 – Recent Abuse” by your statement.

Check this box if there have been other times the person to be restrained hurt you or made you afraid. Be sure that you give enough information for the judge to really understand everything that happened. Use a Description of Abuse (Form DV-101), or an Additional Page (Form MC-020) (to be attached to any form) to describe any previous abuse. At the top of either piece of paper write: “DV-100, Item 22 – Recent Abuse”.


Penalty of Perjury:

The last sentence of the form requires that you sign and date the form. Write the date, then print, and sign your name. You are promising under penalty of perjury that everything you have written on this form is true and correct.