Fill and Sign the Application Order Form

EA-125 Request and Order for Reissuance of Temporary Restraining Order Clerk stamps date here when form is filed. 1 Your name (person asking to reissue order): ––––– Your address (skip this if you have a lawyer): (If you want your address to be private, give a mailing address instead): ––––– City: ––––– StatState: ––––– Zip : ––––– Your telephone (optional): ( ––––– ) ––––– _ Your attorney (if you have one): (Name, address, telephone number, and State Bar number): ––––– Fill in court name and street address: Superior Court of California, County of ––––– ––––– ––––– ––––– 2 Name of person you want protection from: ––––– Description of that person: ––––– ––––– ––––– ––––– ––––– Fill in case number: Case Number: –––––Sex: M F Height: ––––– Weight: ––––– Race: ––––– Hair Color: ––––– Eye Color: ––––– Age: ––––– Date of Birth: ––––– Home Address (if known): ––––– City: ––––– State: ––––– Zip: ––––– Work Address (if known): ––––– City: ––––– State: ––––– Zip: ––––– 3 I ask the Court to reissue the Temporary Restraining Order previously filed in this case on Form EA-120. a. The last Temporary Restraining Order b. The last hearing date was (date): ––––– was issued on (date): ––––– c. The Order has been reissued ––––– times. 4 I ask the court to reissue the Order because (check one): a. I could not get the Order served before the hearing date . b. Other (specify): ––––– I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: ––––– ––––– Type or print your name Sign your name This is a Court OOrder. Judicial Council of California, Revised January 1, 2007, Mandatory Form Welfare & Institutions Code, § 15657.03 Request and Order for Reissuance of Temporary Restraining Order (CLETS–TEA or TEF) (Elder or Dependent Adult Abuse Protection) EA-125, Page 1 of 2 electronic form ã 2007 WWW.LawCA.co m Law Publishers Your Name : ––––– Case Number: ––––– Clerk will fill out section below . 5 The request to reissue the Temporary Restraining Order is: . a Granted b. Denied The Order listed in 3 is reissued and reset for hearing in this court on the date and time below. Unless the court extends the time, the Order will end on the date and at the time below. Name and address of court if different from above: Hearing => Date: ––––– Time: ––––– ––––– Date Dept.: ––––– Room: ––––– ––––– All orders in the Temporary Restraining Order stay in effect unless this order changes them. 6 If this Order is granted, a copy of this Order must be served on the person in 2 the other documents requesting orders to stop elder or dependent adult abuse. before the hearing, along with 7 By the close of business on the date this Order is made, a copy of this Order and any proof of service forms must be delivered to the law enforcement agency listed on Form EA-120, Item 12 : The person in 1 . The attorney of the person in The clerk of the court. 1 . Date: ––––– Judicial Officer Requests for Accommodations Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if you ask at least 5 days before the hearing. Contact the clerk’s office or go to www.courtinfo.ca.gov/forms for Request for Accommodations by Persons with Disabilities and Response (form MC-410 ). (Civil Code, § 54.8) (Clerk will fill out this part.) — Clerk's Certificate — Clerk's Certificate [ seal] I certify that this Request and Order for Reissuance of Temporary Restraining Order is a true and correct copy of the original on file in the court. Date: ––––– Clerk, by , Deputy Revised January 1, 2007 This is a Court Order. Request and Order for Reissuance of Temporary Restraining Order (CLETS–TEA or TEF) (Elder or Dependent Adult Abuse Protection) EA-125, Page 2 of 2