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NAME AND ADDRESS OF ATTORNEY FOR PARTY: FOR COURT USE ONLY

TELEPHONE NUMBER: SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL 650 Wake Avenue, El Centro, CA 92243 939 West Main Street, El Centro, CA 92243 2124 Winterhaven Drive, Winterhaven, CA 92283 People of the State of California, vs. Defendant(s):

PETITION TO MODIFY (POST JUDGMENT) PROTECTIVE CASE NUMBER: ORDER IN CRIMINAL PROCEEDING (Penal Code sec. 1203.097, 1203.3) Note: Petitioner must appear in person on the date set for hearing, or the request may not be granted in your absence.

Date: ________________ Time: __________ Department: ___________

1. I, _____________________________, The Petitioner, declare the following:
   2. __ I am the protected person named in the protective order in the above-entitled case. __ I am the parent or guardian of the protected person(s) named on the protective order in the above- entitled case.
   3. I am freely and voluntarily asking the court to modify the Protective Order terms on the above-named defendant.

BACKGROUND INFORMATION
What is your relationship to the defendant? _____________________________
If you have minor children together, please list their names and ages:
__________________________________________________________________________________________
Does the defendant abuse drugs or alcohol? _____________________________
Has there been any contact between you and the defendant in the last 90days? Yes No
If yes, describe:___________________________________________________________________
PRIOR ABUSE. Describe all prior abuse (physical and/or verbal) that has occurred between you and the
defendant._________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
ADVOCACY/COUNSELING: Have you seen a victim advocate to discuss domestic violence? Yes No
Do you have a safety plan if there are future violent domestic incidents? Yes No
WEAPONS: Does the defendant own or have access to firearms? Yes No
OTHER ORDERS: Are there any other Family, Juvenile, or Civil court orders presently in effect in California
courts regarding you and the defendant? Yes No If yes, please provide details, including the court, case
no., and conditions of any order(s):
__________________________________________________________________
__________________________________________________________________________________________
What are you asking this court to do and why? (Note: Per Pen. Code Sec. 1203.097, as long as a
defendant remains on probation, there must be at least a limited Protective Order in place. Protective
orders cannot be deleted by the court.) Attach separate pages if necessary.

_________________________________________________________________________________________

_________________________________________________________________________________________

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:____________ Signature of Petitioner:______________________________________

No. of Attachments:______

Adopted for Optional Use imperial.courts.ca.gov CR-16 (Adopted 01/01/18, Petition to Modify (Post Judgment) Protective Order revised 07/01/19, 01/01/24) in Criminal Proceeding (Penal Code sec.1203.097, 1203.3)