Free Request and Order for Free Service of Restraining Orders (FL/E-LP-635) - California

ATTORNEY OF RECORD OR PARTY WITHOUT ATTORNEY (Name and Address)

For Court Use Only

TELEPHONE NO; ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA , COUNTY OF SACRAMENTO STREET ADDRESS: 3341 Power Inn Road CITY AND ZIP CODE: Sacramento, CA 95826 BRANCH NAME: William R. Ridgeway Family Relations Courthouse Case Number: REQUEST AND ORDER FOR FREE SERVICE OF RESTRAINING ORDER

1. Your name (person asking for protection): ____________________________________________ Your address (skip this if you have a lawyer): (If you want your address to be private, give a mailing address instead): Address: ________________________________________________ City: __________________________ State: ______ Zip: ________ Telephone (optional): ___________________ Your lawyer (if you have one): (Name, address, telephone number, and State Bar number): Name:______________________________________________________ Address:____________________________________________________ City: _________________________ State: ______ Zip: _________ Telephone: ___________________________ 2. Name of person you want protection from: _____________________________________________________________ 3. I am entitled to free service of the restraining orders by the sheriff or marshal because (check either item a or b): I asked for Domestic Violence or Elder & Dependent Adult Abuse prevention restraining orders. a. b. I asked for Civil Harassment or Workplace Violence restraining orders and my request was based on my fear of (check at least one box, if applicable): (1) credible threat of violence. (2) stalking. (If you are not entitled to free service under a or b, you may be eligible under a fee waiver or may pay the sheriff or marshal to serve the restraining orders.) 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

4. The sheriff or marshal shall serve the restraining order: Without Cost Domestic Violence Elder/Dependent Adult Abuse Workplace Violence (based on credible threat of violence or stalking) Civil Harassment (based on credible threat of violence or stalking) Date: _____________

With Cost to the person in item #1

Clerk , by ________________________________, Deputy ______________________________________________ Judge of the Superior Court

FL/E-LP-635 (Rev. 1/29/2009) Optional

Request and Order for Free Service of Restraining Order

Page 1 Family Code 6383