Free FL-412* - California

COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. PETITIONER/PLAINTIFF: :
RESPONDENT/DEFENDANT: OTHER PARENT:

FL-412

Index No.

CASE NUMBER:

: :

Calendar No.

Plaintiff(s) AFFIDAVIT OF FACTS CONSTITUTING CONTEMPT Domestic Violence/Custody and :Visitation -againstAttachment to Order to Show Cause and Affidavit for Contempt (form FL-410)
1.

JUDICIAL SUBPOENA

......................................................

: The Citee has violated the restraining order issued on (date): by contacting, molesting, harassing, attacking, striking, threatening, sexually assaulting, battering, telephoning, sending any messages to, following, : stalking, destroying the personal property of, disturbing the peace of, keeping under surveillance, or blocking movements in public places and thoroughfares of me or any other person protected by the restraining order. (Specify which order was Defendant(s) violated, how the order was violated, and when the violation occurred): :

2.

Continued on Attachment 1. The Citee has violated the restraining order issued on (date): by not moving from and THE PEOPLE OF THE STATE OF NEW YORK staying away from the residence as ordered by the court. (Specify how the order was violated and when the violation occurred):

TO
3.

Continued on Attachment 2. The Citee has violated the restraining order issued on (date): by not staying (specify): yards away from me, the other protected persons, my residence, my place of work, the children's GREETINGS: of child care, my vehicle, or other (specify): school or place (Specify which order was violated, how the order was violated, and when the violation occurred):

4.

WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Continued on Attachment 3. located at County of by not relinquishing his inThe Citee has violated the restraining order issued on (date): , at room , on the day of , 20 o'clock in the noon, and at any recessed or her firearm(s) asto testify and give evidence which order was violated, how the order was the ordered by the court. (Specify as a witness in this action on the part of violated, and when the or adjourned date,
violation occurred):

5.

Your failure to comply with this subpoena is punishable as a contempt of Continued on Attachment 4. liable to court and will make you The Citee has violated the restraining order issued on (date): a maximum penalty of $50 and allby failure to sustained as a the party on whose behalf this subpoena was issued for damages complete court-ordered failure to treatment/anger management class (specify how the order was violated): batterer's comply. result of your Witness, Honorable The in order issued on day of (date): CourtCitee has violated County, , one of the Justices of the 5. Continued on Attachment

6.

by violating the following custody or , 20 visitation order (specify which order was violated, how the order was violated, and when the violation occurred):

(Attorney must sign above and type on Attachment 6. Continued name below)

7.

The Citee has violated the order issued on (date): order was violated and how the order was violated):

by violating other orders (specify which

Attorney(s) for
Continued on Attachment 7.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Office and P.O. Address Date:

(TYPE OR PRINT NAME)

Form Adopted for Mandatory Use Judicial Council of California FL-412 [Rev. January 1, 2003]

Telephone No.: (SIGNATURE) Facsimile No.: E-Mail Address: AFFIDAVIT OF FACTS CONSTITUTING CONTEMPT Domestic Violence/Custody and Visitation Mobile Tel. No.:

Page 1 of 1 Family Code, § 292; Code of Civil Procedure, §§ 1211.5, 2015.5 www.courtinfo.ca.gov

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