Kern — KERN-0029

Source: https://www.kern.courts.ca.gov/system/files/general/kern-0029-civil-harassment-law-enforcement-information-rev-82223.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address) FOR COURT USE ONLY

TELEPHONE NO: FAX NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR(Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF KERN STREET/MAILING ADDRESS: 1215 Truxtun Avenue CITY AND ZIP CODE: Bakersfield, CA 93301 BRANCH NAME: Metropolitan Division-Civil Department

PLAINTIFF: CASE NUMBER:

DEFENDANT:

CIVIL HARASSMENT (LAW ENFORCEMENT INFORMATION)

If you are filing at the Bakersfield-Metro location, you must complete this form, and submit it with your Request for Orders to Stop Harassment (CH-100), Notice of Hearing (CH-109), and Temporary Restraining Order (CH-100).

Please check the appropriate box so the court may direct it to the appropriate law enforcement agency.

☐ I live in the City of Bakersfield

☐ I live in the County of Kern

Date: __________________

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(Signature)

KERN-0029 (Revised 8/22/23) CIVIL HARASSMENT LAW ENFORCEMENT INFORMATION (Optional Form)