DV-101
Description of Abuse
Case Number:
This form is attached to DV-100, Item 21.
1 2 3 Your name:
COURT Name of person you want protection from (restrained person): COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Plaintiff(s) -against: : : : Defendant(s) : ......................................................
Describe the 2nd most recent abuse. a. Date of 2nd most recent abuse: b. Who was there?
Index No. Calendar No.
JUDICIAL SUBPOENA
c. What did the person in do or say to you that made you afraid?
THE PEOPLE OF THE STATE OF NEW YORK TO
GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the
d. Describe any use or threatened use of guns or other weapons.
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable County, , one of the Justices of the day of , 20
e. Describe any
Court in injuries.
(Attorney must sign above and type name below)
f.
Did the police come? No Yes If yes, did they give you an Emergency Protective Order?
Attach a copy if you have one.
Attorney(s) for
Yes
No
I don't know
Office and P.O. Address
Judicial Council of California, www.courtinfo.ca.gov New January 1, 2003, Optional Form Family Code, ยง 6200 et seq.
Description of Abuse
(Domestic Violence Prevention)
Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.:
DV-101, Page 1 of 2
American LegalNet, Inc. www.USCourtForms.com
Case Number:
Your name: 4 Describe other recent abuse. a. Date of other recent abuse: b. Who was there? c. What did the person in do or say to you that made you afraid?
d. Describe any use or threatened use of guns or other weapons.
e. Describe any injuries.
f.
Did the police come? No Yes If yes, did they give you an Emergency Protective Order?
Attach a copy if you have one.
Yes
No
I don't know
5
Describe other abuse against you or your children.
If you need more space, check the box and attach Form MC-020. Or attach a sheet of paper and write "DV-101 -- Description of Abuse" at the top.
New January 1, 2003
Description of Abuse
(Domestic Violence Prevention)
DV-101, Page 2 of 2