Fill and Sign the Domestic Violence Form

DV-101 Description of Abuse Case Number: ––––– This form is attached to DV- 100, Item 21. Your name: ––––– Name of person you want protection from (restrained person): ––––– Describe the 2nd most recent abuse. a. Date of 2nd most recent abuse: ––––– b. Who was there? ––––– ––––– c. What did the person in  do or say to you that made you afraid? ––––– ––––– d. Describe any use or threatened use of guns or other weapons . ––––– ––––– e. Describe any injuries. ––––– ––––– f. Did the police come? No Yes If yes, did they give you an Emergency Protective Order? Yes No I don't know Attach a copy i f you have one . Judicial Council of California, New January 1, 2003, Optional Form Family Code, § 6200 et seq. Description of Abuse (Domestic Violence Prevention) DV-101, Page 1 of 21 2 3 el ectr onic form ã 2002 WWW.LawCA.co m L a w P u b l i s h e r s Your name: ––––– Case Number: ––––– If you need more space, check the box and attach Form MC-020. Or attach a sheet of paper and write "DV-101- Description of Abuse" at the top. New January 1, 2003 Description of Abuse (Domestic Violence Prevention) DV-101, Page 2 of 2If yes, did they give you an Emergency Protective Order? Yes No I don't know Attach a copy i f you have one .c. What did the person in  do or say to you that made you afraid? ––––– ––––– Describe other recent abuse. a. Date of 2nd most recent abuse: ––––– b. Who was there? ––––– ––––– d. Describe any use or threatened use of guns or other weapons. ––––– ––––– e. Describe any injuries. ––––– ––––– f. Did the police come? No Yes Describe other abuse against you or your children . ––––– ––––– 4 5 el ectr onic form ã 2002 WWW.LawCA.co m L a w P u b l i s h e r s