Free TH-100 PETITION FOR ORDER PROHIBITING ABUSE OR PROGRAM MISCONDUCT (Transitional Housing Misconduct) - California


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Pages: 4
Date: June 24, 2009
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State: California
Category: Court Forms - State
Author: West Group
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URL

http://www.courtinfo.ca.gov/forms/documents/th100.pdf

Download TH-100 PETITION FOR ORDER PROHIBITING ABUSE OR PROGRAM MISCONDUCT (Transitional Housing Misconduct) ( 37.6 kB)


Preview TH-100 PETITION FOR ORDER PROHIBITING ABUSE OR PROGRAM MISCONDUCT (Transitional Housing Misconduct)
COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address):

Index No.
FOR COURT USE ONLY

TELEPHONE NO.:

: Plaintiff(s)
ATTORNEY FOR (Name):

Calendar No.

: : : :

JUDICIAL SUBPOENA

-against-

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

PROGRAM OPERATOR:

Defendant(s) : ......................................................
PARTICIPANT:
CASE NUMBER:

PETITION FOR ORDER PROHIBITING ABUSE THE PEOPLE OFOR PROGRAM MISCONDUCT THE STATE OF NEW YORK

TO

Application for Temporary Restraining Order Modification of Previous Order (date):

(THIS IS NOT AN ORDER)
Read the Instructions for Program Operators before completing this form. You must have a copy served on the participant at least two days before the hearing. GREETINGS: 1. Jurisdiction. This suit is filed in this county because participant resides in this county.

WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ,

2. Program operator (name): the Honorable at the Court operates a "transitional housing program"located at in Health and Safety Code section 50582(g). as defined County of a. b. Governmental agency (specify): of Manager or any recessed in room , on the day , 20 , at o'clock in the noon, and at operator Private nonprofit testify and give evidence as a witness governmental agency or adjourned date, tocorporation receiving program funds from ain this action on the part of the Manager or operator The funding agency is (specify): 3. Program site (specify street address, city, ZIP Code): a. Dwelling unit of participant (address this subpoena is punishable as a contempt of court and will make you liable to Your failure to comply with optional): the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a b. resultOther locations ofto comply. (addresses): of your failure the program

4. Participant to be restrained or excluded is a "homeless person" dwelling at a "program site" as defined in Health and Safety Court in County, day excluded): , 20 Code section 50582 (name all to be restrained orof Age (if under 18) Name
(Attorney must sign above and type name below)

Witness, Honorable

, one of the Justices of the

5. Persons living with participant in participant's dwelling unit who are not to be restrained or excluded (name all below). If none, check this box: Attorney(s) for Age (if under 18) Family relationship Name

Office and P.O. Address
6. Participant has signed a contract with the program operator. The contract includes (attach a copy of the signed contract) a. Program rules and regulations. b. A statement of program operator's right of control over and access to the program unit occupied by participant. Telephone No.: c. A summary of the requirements and procedures of Health and Safety Code sections 50580-50591.

E-Mail (Continued on reverse)
Form Adopted by the Judicial Council of California TH-100 [New July 1, 1992]

PETITION FOR ORDER PROHIBITING ABUSE OR PROGRAM MISCONDUCT
(Transitional Housing Misconduct)

Facsimile No.: Address: Mobile Tel. No.:

Page one of four
Health and Safety Code, 50585

American LegalNet, Inc. www.USCourtForms.com

(THIS IS NOT AN ORDER)
PROGRAM OPERATOR: PARTICIPANT: 7. Participant to be restrained or excluded (names): a. (Program misconduct) has intentionally violated the program rules and regulations. The violation substantially interferes with the orderly operation of the program AND involves (check at least one and cite the rule number): (i) drunkenness on the program site (rule No.): (ii) unlawful use or sale of controlled substances (drugs) (rule No.): (iii) theft (rule No.): (iv) arson (rule No.): (v) destruction of property of the program operator, program employees, other participants, or persons living within 100 feet of the program site (names and relationships to program and rule No.):
CASE NUMBER:

(vi)

violence or threats of violence and harassment of program employees, other participants, or persons living within 100 feet of the program site (names and relationships to program and rule No.):

b.

(Abuse) has intentionally or recklessly (1) caused or attempted bodily injury (2) caused or attempted sexual assault (3) caused fear of serious bodily injury to program employees, other participants, or persons living within 100 feet of the program site (names and relationships to program):

c. FACTS. Describe in detail the most recent incidents of program misconduct or abuse. State what happened, the dates and times, and who did what to whom. Describe any injuries or damage. For alleged program misconduct, cite the rules and regulations violated by each incident of misconduct. If more space is needed, attach additional pages and check this box: (You may use form MC-031 (on the reverse of form MC-030) as an attachment or for the declarations (affidavits) of witnesses.)

(Continued on next page)
TH-100 [New July 1, 1992]

PETITION FOR ORDER PROHIBITING ABUSE OR PROGRAM MISCONDUCT
(Transitional Housing Misconduct)

Page two of four

(THIS IS NOT AN ORDER)
PROGRAM OPERATOR: PARTICIPANT: PROGRAM OPERATOR REQUESTS THE COURT TO MAKE THE ORDERS INDICATED BY THE CHECK MARKS IN THE BOXES BELOW. 8. PROGRAM MISCONDUCT RESTRAINING ORDERS (BREAKING RULES). Participant must not intentionally violate the program rules and regulations so as to interfere substantially with the orderly operation of the program and specifically the rules and regulations on a. drunkenness on the program site (rule No.): b. unlawful use or sale of controlled substances (drugs) (rule No.): c. theft (rule No.): d. arson (rule No.): e. destruction of property (rule No.): f. violence or threats of violence and harassment (rule No.): ABUSE RESTRAINING ORDERS. Participant must not attack, strike, batter, or sexually assault, or threaten to attack, strike, batter, or sexually assault a. program employees b. program participants c. persons living within 100 feet of the program site and specifically the following persons (names):
CASE NUMBER:

9.

10.

PROGRAM SITE EXCLUSION ORDERS. Participant must immediately move from and must not return to the program site and the dwelling unit assigned to participant (address optional): and may take participant's personal property needed until the hearing.

11.

STAY-AWAY ORDERS. Participant must stay at least 200 feet away from the following places: Dwelling unit assigned to participant (address optional): a. b. Other program site locations (addresses):

12.

OTHER ORDERS (specify other orders you request to help carry out the orders requested in items 8-11):

13. I request that copies of orders be given to the following law enforcement agencies (specify all with jurisdiction over the program sites): Law Enforcement Agency Address

14.

PREVIOUS PETITIONS. I have asked for restraining orders against participant before (specify case numbers and dates):

(Continued on reverse)
TH-100 [New July 1, 1992]

PETITION FOR ORDER PROHIBITING ABUSE OR PROGRAM MISCONDUCT
(Transitional Housing Misconduct)

Page three of four

(THIS IS NOT AN ORDER)
PROGRAM OPERATOR: PARTICIPANT:
CASE NUMBER:

REQUEST FOR TEMPORARY RESTRAINING ORDER To Be Effective From Now Until The Hearing 15. 12 be effective 8 9 10 11 I request that the orders requested in items from now until the hearing. (Note: Temporary exclusion orders under items 10-11 require an emergency.) a. Participant (1) has not been under contract with the program for more than six months (date of contract): (2) has been under contract with the program for more than six months, but (i) a restraining order is in effect and subject to further orders (specify in item 14). an action is pending against participant (specify in item 14). (ii) Operator's attorney (attach attorney's affidavit) b. Notice to participant. Program operator (1) informed participant or his or her attorney on (date): at (time): of the date, time, and place this petition would be filed. (2) made the following good-faith efforts to inform participant or his or her attorney of the date, time, and place this petition would be filed (specify efforts):

(3)

should not be required to inform the participant or his or her attorney of the date, time, and place this petition would be filed because (specify reasons):

c. NEED FOR IMMEDIATE ORDER BEFORE THE HEARING. Program operator, program participants, or persons living within 100 feet of the program site will suffer great and irreparable harm before this petition can be heard in court unless the court makes those orders requested above effective now and until the hearing. (Specify the harm and why it will occur before the hearing. For temporary exclusion orders under items 10-11, show emergency and need to prevent imminent serious bodily injury.)

16.

Number of pages attached: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(TYPE OR PRINT NAME) (SIGNATURE OF PROGRAM OPERATOR)

TITLE of person signing:

TH-100 [New July 1, 1992]

PETITION FOR ORDER PROHIBITING ABUSE OR PROGRAM MISCONDUCT
(Transitional Housing Misconduct)

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