Restraining Order Intake

Person to Be Protected

How did you hear about us?*
Client Name: *


Sex:
Height:
Weight:


Race:
Hair Color:
Age:


Date of Birth:
Phone:*
-


Mailing Address:*


Vehicle (Type, Model, Year):
(License Plate Number and State):

Person to Be Restrained

Opposing Party*


Sex:
Height:
Weight:


Race:
Hair Color:
Age:


Date of Birth:
Phone:
-


Residence Address:
Business/Employer Address:


Name of Employer:
Occupation Title:


Driver's License#
Social Security#


Vehicle (Type, Model, Year):
Any other names used by restrained person:
Describe any marks, scars or tattoos:

Guns or Firearms

Describe any guns or firearms that you believe the restrained person owns or has access to (Number, type, and locations):

Other People to Be Protected

Ex: Name, Date of Birth, Sex, Race, Relationship to you.
Please give instances, date, time, what happened where it happened. Of why you feel like your life is in danger. Please give declaration.*
Have you filed a police report?*
Upload the police report:

Please read the following carefully sign and date by printing your name you are signing this document electronically.

´╗┐I declare under the penalty of perjury under the laws of the state of California that the foregoing is true and correct. I also Understand that Legal Service Centers will prepare all legal documents at my direction. I understand there may be additional fees if the matter becomes contested, as well as additional filing fees, process service fees, or court runner fees. If any amendments , or additional documents are prepared there will be additional fees that will apply. I understand Legal Service Centers DOES NOT ISSUE REFUNDS.


By typing my name bellow I understand that that I am signing this document electronically.*
Today's Date:*