Answer to Request for Orders to Stop Harassment (United States)
This form is a Stop Harassment Request. The form provided here is simply a sample of what the actual Form CH-110 looks like.
CH-110 Answer to Request for Orders to Stop Harassment
Clerk stamps date here when form is filed.
1. Name of person who asked for the order: _____________________________
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):
_____________________________
_____________________________
_____________________________
Fill in court name and street address:
Superior Court of California, County of _____________________________
_____________________________
_____________________________
Use this form to give the court your answers to CH-100
• Read Form CH-151 to protect your rights.
• Fill out this form and then take it to the court clerk.
• Serve the person in 1. with a copy of this form and any attached pages.
Case Number: _____________________________
3. ____ Personal Conduct Orders
a. ____ I agree to the order requested.
b. ____ I do not agree to the order requested.
c. ____ I agree to the following order (specify):
_____________________________
_____________________________
The court will consider your Answer at the hearing. Write your hearing date and time here:
Hearing 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.
4. ____ Stay Away Orders
a. ____ I agree to the order requested.
b. ____ I do not agree to the order requested.
c. ____ I agree to the following order (specify): _____________________________
5. ____Turn In Guns or Other Firearms
a. ____ I do not own or have any guns or firearms.
b. ____ I agree to the order requested.
c. ____ I do not agree to the order requested.
d. ____ I agree to the following order (specify): _____________________________
6. 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): _____________________________
7. ____ Emotional Distress
a. ____ The person in 1. has not suffered emotional distress. (Explain): _____________________________
_____________________________
b. ____ A reasonable person in the same position as the person in 1. would not have suffered emotional distress. (Explain): _____________________________
_____________________________
c. ____ If the person in 1. has suffered any emotional distress, it is not because of what that person has accused me of doing. (Explain): _____________________________
8. ____ Purpose of Actions
What I did to the person in 1.--if anything--was not done on purpose.
9. ____ Denial
a. I did not do anything described in 8. of Form CH-100. (Skip to 11.)
b. I did some or all of the things described in 8. of Form CH-100. (Explain in - 10. and 11.)
10. Reason or Excuse
I have done some or all of the things the person in 1. has accused me of, but:
a. What I did was legal. (Explain): _____________________________
b. I had a good reason for doing these things. (Explain): _____________________________
I have other reasons to justify what I did. (Explain): _____________________________
11. ____ The court should not make an order against me because: _____________________________
_____________________________
No Fee for Filing
12. ____ I ask the court to waive the filing fee because the person in 1. claims that I have used or threatened to use violence against them or have acted in some other way that would make them reasonably fear violence.
13. ____ Lawyer's Fees and Costs
I ask the court to order payment of my:
a. ____ Lawyer's fees
b. ____ Out-of-pocket expenses
because the temporary restraining order was issued without enough supporting facts.
The amounts requested are:
Item _____________________________ Amount $_____________________________
Item _____________________________ Amount $_____________________________
Item _____________________________ Amount $_____________________________
14. ____ Other Relief
I ask for additional relief as may be proper.
15. ____ Number of pages attached to this form, if any: _____________________________
Date: _____________________________
Attorney's name _____________________________
Attorney's signature _____________________________
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 _____________________________