Fill and Sign the Restraining Order Protection Form

Response to Request for Orders to Stop Elder or Dependent Adult Abuse 1 Name of person who asked for the protective orders: ––––– ––––– 2 Your name: ––––– Your address (skip this if you have a lawyer): (If you want your address to be private, give a mailing address instead): ––––– City: ––––– State: ––––– Zip: ––––– Your telephone (optional): ( ––––– ) ––––– Your lawyer (if you have one): (Name, address, telephone number, and State Bar number): ––––– ––––– ––––– ––––– Use this form to give the court your responses to EA-100. • Read Form EA-151-INFO to protect your rights. • Fill out this form and then take it to the court clerk. • You must have the person in j served with a copy of this form and any attached pages. 3 Personal Conduct Orders a. I agree to the orders requested. b. I do not agree to the orders requested. c. I agree to the following orders (specify): ––––– ––––– 4 Stay-Away Orders a. I agree to the orders requested. b. I do not agree to the orders requested. c. I agree to the following orders (specify): ––––– ––––– 5 Move-Out Order a. I agree to the order requested. b. I do not agree to the order requested. c. I agree to the following order (specify): ––––– ––––– ––––– 6 Turn In Guns or Other Firearms a. I do not own or have any guns or firearms. Superior Court of California, County of ––––– ––––– ––––– ––––– ––––– Case Number : –––––Clerk stamps date here when form is filed EA-110 Court fills in case number when form is filed. The court will consider your Response at the hearing. Write your hearing date and time here: => Date: Time: Dept.: Room You must obey the court’s orders until the hearing. If you do not come to this hearing, the court may make the orders requested against you last for up to 3 years. Hearing Date b. I agree to the order requested. c. I do not agree to the order requested. d. I agree to the following order (specify): ––––– ––––– Judicial Council of California, EA-110, Page 1 of 2 Revised January 1, 2007, Mandatory Form Welfare & Institutions Code, § 15657.03 Your name: ––––– 7 Other Orders a. I agree to the orders requested. b. I do not agree to the orders requested. c. I agree to the following orders (specify): ––––– ––––– 8 The court should not make orders against me because (Give facts or reasons below): ––––– ––––– ––––– ––––– ––––– ––––– ––––– Check here if you need more space. Attach a sheet of paper and write “EA-110, Item 8 Facts and Reasons.” Give specific facts and reasons. 9 Lawyer’s Fees and Costs I ask the court to order payment of my: a. Lawyer’s fees b. Court costs because the temporary restraining order was issued without enough supporting facts. The amounts requested are: Item Amount Item Amount ––––– $ ––––– ––––– $ ––––– ––––– $ ––––– ––––– $ ––––– ––––– $ ––––– ––––– $ ––––– Check here if you need more space. Attach a sheet of paper and write “EA-110, Item 9 Lawyer’s Fees and Costs” at the top. Give specific items and amounts. 10 Other Relief I ask for additional relief as may be proper. 11 Number of pages attached to this form, if any: ––––– Date: ––––– ––––– Lawyer’s name Lawyer’s signature Case Number : ––––– electronic form ã 2007 WWW.LawCA.co m Law PublishersResponse to Request for Orders to Stop Elder or Dependent Adult Abuse (Elder or Dependent Adult Abuse Prevention) I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: ––––– ––––– Name of person filing this request Signature of person filing this request Revised January 1, 2007 EA-110, Page 2 of 2 Response to Request for Orders to Stop Elder or Dependent Adult Abuse (Elder or Dependent Adult Abuse Prevention)