Lierk stamps date here when form is filed. DV-109 Notice of Court Hearing 6) Name of Person Asking for Order: Fi LED Superior Com-1 oiCalifcrnia County of! as .11: it? Laura Fleiss Your lawyer in this case (ifyou have one): State Bar JUL 1 5 2019 Name: Samantha Spector/Lisa Meyer No.: 204482/106105 -Sherr1R.CarIer,t 20mm mum Fer} Fn?m Name: Spector Law, Olson, Lowy Meyers, LLP - By? Depot} Address (If you have a lmvyer for this case, give your lawyer?s ?fig-gh- mm information. lfyou do not have a lawyer and want to keep your home address private, give a different mailing address instead. You do not have Fill in own name and street address: to give your telephone, fax, or e-mail.) Superior Court of California, County of Address: 1901 Avenue of the Stars, Suite 1020 . upenor ou City. Los Angeles State. QA le. 90067 111 N. Hill Street Telephone: (424) 313-7500 . Fax: Los Angeles, CA 90012 E-Mail Address: Name of Person to Be Restrained: Court fills in case number when form is filed. Michael L. Fleiss Case Number: 198TFL8172 he court will fill out the rest of this form. Notice of Hearing A court hearing is scheduled on the request for restraining orders against the person in@: Name and address of court if different from above: Date: Time: &1%Q?k?1 Dept: Room: @Temporary Restraining Orders (Any orders granted are attached on form DV-110.) a Temporary Restraining Orders for personal conduct and stay-away orders as requested in form DV-100, Request for omesiic Violence Restraining Order, are (check only one box below): All GRANTED until the court hearing. (2 All DENIED until the court hearing. (Speci?; reasons for denial in b, below.) (3) Partly GRANTED and partly DENIED until the court hearing. (Speci?z reasons for denial in b, below.) b. Reasons for denial of some or all of those personal conduct and stay-away orders as requested in form DV-100, Request for Domestic Violence Restraining Order, are: (1) CI The facts as stated in form 00 do not Show reasonable proof of a past act or acts of abuse. (Family Code, 6320 and 6320.5.) (2) The facts do not describe in suf?cient detail the most recent incidents of abuse, such as what happened, the dates, who did what to whom, or any injuries or history of abuse. (3) Further explanation of reason for denial, or reason not listed above: Notice of Court Hearing DV-109, Page 1 of 3 Fam'wcm 242 (Domestic Violence Prevention) -) Approved by DDJ American LegalNet, Inc. W.FonnsWorkFlow,com Case Number: 198TFL081 72 (9 Confidential Information Regarding Minor 3. A Request to Keep Minor's Information Con?dential (form DV-160) was made and GRANTED (see form Order on Request to Keep Miner?s Information Con?dential, served with this form.) b. If the request was granted, the information described on the order (form DV-165, item must be kept CONFIDENTIAL. The disclosure or misuse of the information is punishable as contempt of court, with a fine of up to $1,000 or possible sanctions. Service of Documents by the Person in (D At least five El days before the hearing, someone age 18 or older?not you or anyone to be protected?must personall give (serve) a court ?le-stamped copy of this form (DY-109, Notice of Court Hearing) to the person incg) along with a copy of all the forms indicated below: Request for Domestic Violence Restraining Order (?le-stamped) . 10, Temporary Restraining Order (?le-stamped) IF GRANTED . V-120, Response to Request for Domestic Violence Restraining Order (blank form) . How Can [Respond to a Request for Domestic Violence Restraining Order? . DV-ZSO, Proof of Service by Mail (blank form) DV-170, Notice of Order Protecting Information of a Minor, and Order on Request to Keep Minor?s Information Confidential IF GRANTED g. Other (specify): Date: JUL 16 2019 af?x/MT (WV Judicial O??icgrl T, SREAR moose: rho Right to Cancel Hearing: Information for the Person in - If item is checked, the judge has denied some or all of the temporary orders you requested until the court hearing. The judge may make the orders you want after the court hearing. You can keep the hearing date, or you can cancel your request for orders so there is no court hearing. - If you want to cancel the hearing, use form 12, Waiver of Hearing on Denied Request for Temporary Restraining Order. Fill it out and ?le it with the court as soon as possible. You may ?le a new request for orders, on the same or different facts, at a later time. - If you cancel the hearing, do not serve the documents listed in item on the other person. - If you want to keep the hearing date, ou must have all of the documents listed in item served on the other person within the time listed in item . 0 At the hearing, the judge will consider Whether denial of any requested orders will jeopardize your safety and the safety of children for whom you are requesting custody or visitation. - You must come to the hearing if you want the judge to make restraining orders or continue any orders already made. If you cancel the hearing or do not come to the hearing, any restraining orders made on form 10 will end on the date of the hearing. Revisedtanuam. 2019 Notice of Court Hearing DV-109, Page 2 of 3 (Domestic Violence Prevention) '9 American LegalNet, Inc. wunv.Fgm?WorkFlow.cgm Case Number: To the Person in The court cannot make the restraining orders after the court hearing unless the person in @has been personally given (served) a copy of your request and any temporary orders. To show that the person in@ has been served, the person who served the forms must ?ll out a proof of service form. form DV-ZOO, Proof of Personal Service, may be used. For information about service, read form What Is ?Proof of Personal Service If you are unable to serve the person in in time, you may ask for more time to serve the documents. Read form How to Ask for a New Hearing Date. To the Person in 0: If you want to reSpond in writing, mail a copy of your completed form DV-120, Response to Request for Domestic Violence Restraining Order; to the person in and ?le it with the court. You cannot mail form DV-IZO yourself. Someone age 18 or older not you must do it. To show that the person in G) has been served by mail, the person who mailed the form must ?ll out a proof of service form. Form Proof of Service by Mail, may be used. File the completed form with the court before the hearing and bring a copy with you to the hearing. For information about responding to a restraining order and ?ling your answer, read form 20-INFO, Ho Can I ReSpond to a Request for Domestic Violence Restraining Order?. Whether or not you respond in writing, go to the hearing if you want the judge to hear from you before making an order. You may tell the judge why you agree or disagree with the orders requested. You may bring witnesses and other evidence. At the hearing, the judge may make restraining orders against you that could last up to ?ve years. The judge may also make other orders about your children, child support, spousal support, money, and property and may order you to turn in or sell any ?rearms that you own or possess. Request for Accommodations Assistive listening systems, computer?assisted real-time captioning, or sign language interpreter services are available if you ask at least ?ve days before the hearing. Contact the clerk?s of?ce or go to courts. ca. gov/forms for Request for Accommodations by Persons with Disabilities and Response (form MC-410). (Civ. Code, 54.8.) (Clerk will fill out this part.) ?Clerk's Certificate? I certify that this Notice of Court Hearing is a true and correct copy of the original on ?le in the court. JUL 16 201.9 Clerk, by 7 Deputy 17% Cindy Kim Revised Januam. 2019 Notice Of Court Hearing Page 3 0f3 (Domestic Violence Prevention) American LegalNet, Inc. .- . Clerk stamps date here when form is filed. DV-110 Temporary Restrammg Order Person in (D must complete items (D, and?only. superior (our: ?fC3iif01?ni'a FILED Name of Protected Person: 9" Laura Fleiss JUL 1 82019 Your lawyer in this case (ifyou have one): 1 ether. :r at in are. Name: SamanthaF. SpectoriLisa H. Meyer State Bar No.: 204482/106105 Sher? 3- Firm Name: ?gect0r Law, Olson, Lewy Meyers, LLP :1 'Di'm? Address (If you have a lawyer for this case, give your lawyer?s information. If you do not have a lawyer and want to keep your home Fit: in court name and street address: address private, give a di?erent mailing address instead. You do not have Superior Court of California, County of to give your telephone, fax, or email): LOS ANGELES Address: 1901 Avenue of the Stars, Suite 1020 111 N. Hill Street City: Los Angeles State: CA Zip: 90067 L03 Angeles, 90012 Telephone: (424) 313?7500 Fax: Central D'smct E-mail Address: Court fills in case number when form is ?ied. Name of Restrained Person: Case Number; Michael L. Fleiss 198TFL08172 Description of restrained person: Sex: Height 6'4" Weight: 220 Hair Color: Black Color: Green Race: Caucasian Age: 55 Date of Birth: 04/14/1964 Address (ifknown): City: State: Zip: Relationship to protected person: Husband Additional Protected Persons In addition to the person named in (D, the following persons are protected by temporary orders as indicated in items and G) Oramily or household members): Full name Relationship to nerson in G) Ag? Benjamin Garcia Fleiss Son Male 4 Check here if there are additional protected persons. List them on an attached sheet of paper and write, V?l I 0, Additional Protected Persons as a title. The court will complete the rest of this form. Court Hearing This order expires at the end of the hearing stated below: Hearing Date: 0 yhb?? #17 Time: K2131. pm. This is a Court Order. Temporary Restraining Order . 6200 . Assassin 6 (Domestic Violence Prevention) American LegaENet. Inc. case Number: 19STFL081 72 (5) Criminal Protective Order a. A criminal protective order on Form Criminal Protective Order?Domestic Violence, is in effect. Case Number: County: Expiration Date: b. information has been provided to the judge about a criminal protective order. To the person in 9 The court has granted the temporary orders checked below. If you do not obey these orders, you can be arrested and charged with a crime. You may be sent to jail for up to one year, pay a fine of up to $1,000, or both. Personal Conduct Orders Not requested El Denied until the hearing RGranted as follows: a. You must not do the following things to the person in G) and I: persons in C3) EHarass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, destroy personal property, disturb the peace, keep under surveillance, impersonate (on the Internet, electronically or otherwise), or block movements Wontact, either directly or indirectly, in any way, including but not limited to, by telephone, mail, e-mail or other electronic means Take any action, directly or through others, to obtain the addresses or locations of the persons i116) and (9 (If this item is not checked, the court has found good cause not to make this order.) b. Peaceful written contact through a lawyer or process server or another person for service of Form DV-120 (Response to Request for Domestic Violence Restraining Order) or other legal papers related to a court case is allowed and does not violate this order. c. Exceptions: Brief and peaceful contact with the person in G), and peaceful contact with children in@, as required for court-ordered visitation of children, is allowed unless a criminal protective order says otherwise. 6) Stay-Away Order Not requested Denied until the hearing ?Granted as follows: a. You must stay at least (speci?z): to yards away from (check all that apply): The person in School of person in (D E?ome of person in (D The persons in The job or workplace of person in? The school or child care Wehicle of person in G) Other (Specy?z): b. Exceptions: Brief and peaceful contact with the person in? and peaceful contact with children in Q3), as required for court-ordered visitation of children, is allowed unless a criminal protective order says otherwise. Move-Out Order Not requested I: Denied until the hearing EGranted as follows: You must take only personal clothing and belongings needed until the hearin and move out immediately from (address): 570% em @1on gmilei, action; cab-7M This is a Court Order. Temporary Restraining Order DV-110,Page2 of6 9 (Domestic Violence Prevention) Revised July 1. 2016 American LegalNet, Inc. case Number: 19STFL081 72 No Guns or Other Firearms or Ammunition a. You cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, other ?rearms, or ammunition. b. You must: Sell to, or store with, a licensed gun dealer, or turn in to a law enforcement agency, any guns or other ?rearms within your immediate possession or control. Do so within 24 hours of being served with this order. Within 48 hours of receiving this order, ?le with the court a receipt that proves guns have been turned in, stored, or sold. (You may use Form Proof of Firearms Turned In, Sold, or Stored, for the receipt.) Bring a court ?led copy to the hearing. c. The court has received information that you own or possess a ?rearm. Record Unlawful Communications Not requested El Denied until the hearing EGranted as follows: The person in G) can record communications made by you that violate the judge?s orders. Care of Animals Not requested Denied until the hearing EGranted as follows: The person in? is given the sole possession, care, and control of the animals listed below. The person in must stay at least yards away from and not take, sell, transfer, encumber, conceal, molest, attack, strike, I"thirie?ten, hann, or otherwise dis ose of the following animals: in {Dem berman Telecaster Child Custody and Visitation El Not requested Denied until the hearing QGranted as follows: Child custody and visitation are ordered on the attached Form 40, Child Custody and Visitation Order or (speci?z other form): . The parent with temporary custody of the child must not remove the child from California unless the court allows it after a noticed hearing (Fam. Code, 3063). Child Support Not ordered now but may be ordered after a noticed hearing. Property Control Mot requested El Denied until the hearing Granted as follows: Until the hearing, only the person in CD can use, control, and possess the following property: 65) Debt Payment Mt requested Denied until the hearing Granted as follows: The person in must make these payments until this order ends: Pay to: For: Amount: Due date: Pay to: For: Amount: Due date: Property Restraint 5 Not requested Denied until the hearing Granted as follows: If the people in %and are married to each other or are registered domestic partners, the person in G) the person in must not transfer, borrow against, sell, hide, or get rid of or destroy any prOperty, including animals, except in the usual course of business or for necessities of life. In addition, each person must notify the other of any new or big expenses and explain them to the court. (The person in? cannot contact the person in G) t'fthe court has made a ?no contact order.) Peaceful written contact through a lawyer or a process server or other person for service of legal papers related to a court case is allowed and does not violate this order. This is a Court Order. Rewsem" 1' 2016 Temporary Restraining Order Page 3 ?f6 9 (Domestic Violence Prevention) American LegalNet, Inc. wuw,FormsWorkFlow.com Uase Number: 72 Spousal Support Not ordered now but may be ordered after a noticed hearing. 6 Revised July 1. 2016 Rights to Mobile Device and Wireless Phone Account a. Property control of mobile device and wireless phone account ENot requested Denied until the hearing El Granted as follows: Until the hearing, only the person in (D can use, control, and possess the following property: Mobile device (describe) and account @hone number): Mobile device (describe) and account (phone number): Mobile device (describe) and account (phone number): El Check here ifyou need more space. Attach a sheet of paper and write I 0 Rights to Mobile Device and Wireless Phone Account as a title. b. Debt Payment Not requested Denied until the hearing Granted as follows: The person in must make these payments until this order ends: Pay to (wireless service provider): Amount: Due date: c. Transfer of Wireless Phone Account Not ordered now but may be ordered after a noticed hearing. Insurance The person in (D El the person in C2) is ordered NOT to cash, borrow against, cancel, transfer, dispose of, or change the bene?ciaries of any insurance or coverage held for the bene?t of the parties, or their child(ren), if any, for whom support may be ordered, or both. Lawyer's Fees and Costs Not ordered now but may be ordered after a noticed hearing. Payments for Costs and Services Not ordered now but may be ordered after a noticed hearing. Batterer Intervention Program Not ordered now but may be ordered after a noticed hearing. Other Orders I: Not requested El Denied until the hearing Granted as follows: El Check here if there are additional orders. List them on an attached sheet of paper and write V-I I 0, Other Orders ?as a title. No Fee to Serve (Notify) Restrained Person If the sheriff serves this order, he or she will do so for free. Date: 16 2919 Mfigem Judge (0r Judicial tiar- t" This is a Court Order. Thm?j Temporary Restraining Order DV-110. Page 4 of 6 -) (Domestic Violence Prevention) erican LegalNet, Inc. Am Case Number: 198TF L081 72 Warnings and Notices to the Restrained Person in 9 If You Do Not Obey This Order, You Can Be Arrested And Charged With a Crime. If you do not obey this order, you can go to jail or prison and/or pay a ?ne. - It is a felony to take or hide a child in violation of this order. - If you travel to another state or to tribal lands or make the protected person do so, with the intention of disobeying this order, you can be charged with a federal crime. You Cannot Have Guns, Firearms, AndIOr Ammunition. You cannot own, have, possess, buy or try to buy, receive or try to receive, or otherwise get guns, other ?rearms, and/or ammunition while the order is in effectjail and pay a $1,000 ?ne. You must sell to or store with a licensed gun dealer or turn in ii to a law enforcement agency any guns or other ?rearms that you have or control. The judge will ask you for proof that you did so. If you do not obey this order, you can be charged -. \z with a crime. Federal law says you cannot .have guns or ammunition while the order is in ff V, ect. Service of Order by Mail If the judge makes a restraining order at the hearing, which has the same orders as in this form, you will get a copy of that order by mail at your last known address, which is written in (2). If this address is incorrect, or to ?nd out if the orders were made permanent, contact the court. Child Custody, Visitation, and Support Child custody and visitationthe hearing, the judge can make custody and visitation orders for your children without hearing from you. Child support: The judge can order child support based on the income of both parents. The judge can also have that support taken directly from a parent's paycheck. Child support can be a lot of money, and usually you have to pay until the child is age 18. File and serve a Financial Statement (Simpli?ed) (form FL-155) or an Income and Expense Declaration (form FL-150) if you want the judge to have information about your finances. Otherwise, the court may make support orders without hearing from you. - Spousal support: File and serve an Income and Expense Declaration (form 50) so the judge will have information about your finances. Otherwise, the court may make support orders without hearing from you. Instructions for Law Enforcement This order is effective when made. It is enforceable by any law enforcement agency that has received the order, is shown a copy of the order, or has verified its existence on the California Law Enforcement Telecommunications System (CLETS). If the law enforcement agency has not received proof of service on the restrained person, and the restrained person was not present at the court hearing, the agency shall advise the restrained person of the terms of the order and then shall enforce it. Violations of this order are subject to criminal penalties. Arrest Required if Order ls Violated If an of?cer has probable cause to believe that the restrained person had notice of the order and has disobeyed the order, the of?cer must arrest the restrained person. (Pen. Code, 836(c)(1), A violation of the order may be a violation of Penal Code section 166 or 273.6. This is a Court Order. Revised July 1. 2015 Temporary Restraining order DV-110, Page 5 of 6 9 (Domestic Violence Prevention) American LegalNet, Inc. \WFEEWorkFlecom Case Number: 198TFL08172 If the Protected Person Contacts the Restrained Person Even if the protected person invites or consents to contact with the restrained person, the orders remain in effect and must be enforced. The protected person cannot be arrested for inviting or consenting to contact with the restrained person. The orders can be changed only by another court order. (Pen. Code, Con?icting Orders?Priorities for Enforcement If more than one restraining order has been issued protecting the protected person from the restrained person, the orders must be enforced according to the following priorities (see Pen. Code, 136.2, and Fam. Code, 6383(h), 6405(b)): 1. EP0: If one of the orders is an Emergency Protective Order (form and it is more restrictive than other restraining or protective orders, it has precedence in enforcement over all other orders. 2. No?Coniaci Order: If there is no EPO, a no?contact order that is included in a restraining or protective order has precedence in enforcement over any other restraining or protective order. 3. Criminal Order: If none of the orders includes a no?contact order, a domestic violence protective order issued in a criminal case takes precedence in enforcement over any con?icting civil court order. Any noncon?icting terms of the civil restraining order remain in effect and enforceable. 4. Family, Juvenile, or Civil Order: If more than one family, juvenile, or other civil restraining or protective order has been issued, the one that was issued last must be enforced. Child Custody and Visitation - The custody and visitation orders are on form items @and G) They are sometimes also written on additional pages or referenced in 40 or other orders that are not part of the restraining order. - Forms DV-100 and are not orders. Do not enforce them. Certi?cate of Compliance With VAWA This temporary protective order meets all ?full faith and credit? requirements of the Violence Against Women Act, 18 U.S.C. 2265 (1994) (VAWA), upon notice of the restrained person. This court has jurisdiction over the parties and the subject matter; the restrained person has been or will be afforded notice and a timely opportunity to be heard as provided by the laws of this jurisdiction. This order is valid and entitled to enforcement in each jurisdiction throughout the 50 states of the United States, the District of Columbia, all tribal lands, and all U.S. territories, commonwealths, and possessions and shall be enforced as if it were an order of that jurisdiction. (Clerk will fill out this part.) ?Clerk's Certificate?? I certify that this emporarv Restraining Order is a true and correct copy of the original on ?le in the court. JUL 16 2019 &Lr Date: Clerk, by Deputy Cindy Kim This is a Court Order. ?Wise" My 1' Temporary Restraining Order Page 5 0?6 (C (Domestic Violence Prevention) American legalNet, Inc. Child Custody and Visitation Case Number: Order This form is attached to (check one): 10 (D Name of Protected Person: Laura Fleiss 1% Mom Dad Other* Other Parent's Name: Michael L. Fleiss El Mom Dad Other* If Other, specijjz relationship to child: The Court Orders: Legal Custody to: (Person Physical Custody to: (9 13 ordered as who makes decisions about (Person the child lives with. health, education. Check at Check at least one.) least one.) Child?s Name Date of Birth Mom Dad Other* Mom Dad Other* 21. Beniamin Garcia Fleiss I 5/4/more children, check here. Attach a sheet of paper and write Child Custody? for a title. IfOther, speci?/ relationship to child and name of person: Child Visitation is ordered as follows: a. visitation to Mom Dad Other (name): b. [1 See the attached page document, dated: c. The parties must go to mediation at: d. Until the next court order, Visitation for El Morn Dad Other (name): will be: (1) Weekends (starting): (The 1st weekend of the month is the 1st weekend with a Saturday.) 2nd 3rd 4th 5th weekend of month from at a.m. pm. to at a.m. I: pm. (day of week) (time) (day of week) (time) (2) El Weekdays (starting): from at I: a.m. pm. to at a.m. El pm. (day of week) (time) (day of week) (time) (3) Other Visitation Check here and attach a sheet of paper if there are other visitation days and times, like holidays. birthdays, sports events. List dates and times. Write 140, Other Visitation for a title. (5) Supervised Visitation or Exchange Visits and/or exchanges of children are supervised as speci?ed on Form DV- 1 50, Supervised Visitation and Exchange Order. This is a Court Order. Child Custody and Visitation Order of 2 Family Code. 3020. 3022. 3040-3043. 3100,5340.7504 (Domestic Violence Prevention) '9 American LegnlNet, inc. vaopnsWorkFlowconl Case Number: 19STFL08172 0 6G) [3 Responsibility for Transportation for Visitation "Responsibility for transportation" means the parent will take or pick up the child or make arrangements for someone else to do so. a. Mom El Dad Other (name): take children to the visits. b. [3 Mom I: Dad Other (name): pick up children from the visits. 0. Drop-off pick-up of children will be at (address): Travel with Children Mom [3 Dad Other (name): must have written permission from the other parent, or a court order, to take the children outside of: a. The State of California b. The United States of America 0. El Other place(s) (list): Child Abduction There is a risk that one of the parents will take the children out of California without the other parent's permission. CI The orders in Form Order: No Travel with Children, are attached and must be obeyed. (Fill out and attach Form DV-145 to this form. El Other Orders Check here and attach any other orders to this form. Write Other Orders as a title. Jurisdiction This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and Enforcement Act (part 3 of the California Family Code starting with 3400). Notice and Opportunity to Be Heard The responding party was given reasonable notice and an opportunity to be heard as provided by the laws of the State of California. Country of Habitual Residence The country of habitual residence of the child or children in this case is CI The United States of America or Other (speci?z): Penalties for Violating This Order If you violate this order, you may be subject to civil or criminal penalties, or both. Duration of Child Custody, Visitation, and Support Orders If this form is attached to Form (Restraining Order After Hearing), the custody and visitation orders in this form remain in effect after the restraining orders on Form DV-130 end. This is a Court Order. Rev Januarvim Child Custody and Visitation Order Page 2 of 2 (Domestic Violence Prevention) American LegalNel, Inc. my; DV-100 Reque. for Domestic Violence Restraining Order You must also complete Form CLET 5-001 Con?dential CLETS Information, and give it to the clerk when you ?le this Request. 6) (9 Name of Person Asking for Protection: Laura Fleiss Age: 31 Your lawyer in this case (ifyou have one): Name: Samantha Specter/Lisa Meyer State Bar No.: 204482/106105 Firm Name: Specter Law, APLC MOLM Address (If you have a lawyer for this case, give your lawyer ?s in ormation. If you do not have a lawyer and want to keep your home address private, give a di?erent mailing address instead. You do not have to give your telephone, fax, or email): Address: 1901 Avenue of the Stars, Suite 1020 City: Los Angeles Telephone: (424) 313-7500 Fax: 'erk stamps date here when form is ?led. FH FD Superior run of California County (if I 1 52015 Sherri R. Carter. resume {glitter/l lerk BLQ Deputy Cindy lite-i Fill in court name and street address: LOS ANGELES 111 N. Hill Street Los Angeles, 90012 State: CA Zip: 90067 Central District E-Mail Address: Superior Court of California, County of Name of Person You Want Protection From: Michael L. Fleiss Description of person you want protection from: Court ?lls in case number when form is ?led. Case Number: 198TFL081 72 Sex: Height: 6'4" Weight: 220 Hair Color: Color: Race: Caucasian Age: 55 Date of Birth: 04/14/1964 Address (if known): City: State: Zip: If yes, list them Do you want an order to protect family or household members? Yes No Full name ?g Age Lives with you? Relationship to you Benjamin Garcia Fleiss Male Check here if you need more space. Attach a sheet of paper and write V-I 00, Protected People for a title. G) What is your relationship to the person in (Check all that apply): We are now married or registered domestic partners. El We used to he married or registered domestic partners. We live together. if you do not have one of these relationships, the court may not be able to consider your request. Read Form (JO-INF 0 for help. We used to live together. ease-pee We are the parents together of a child or children under 18: Child?s Name: Benjamin Garcia leiss Child?s Name: We are related by blood, marriage, or adoption (specify relationship): El We are dating or used to date, or we are or used to he engaged to be married. Child? 5 Name: Date of Birth: May 4, 2015 Date of Birth: Date of Birth: Check here if you need more space. Attach a sheet of paper and write V-I 00, Additional Children ?for a title. h. I: We have signed a Voluntary Declaration of Paternity for our child or children. (Attach a copy if you have 0716 This is not a Court Order. Judicial Council a California. moounmagov Request for Domestic Violence Restraining Order I . . . ?'58 ?y a" my (Domestic Violence Prevention) Family Code. 6200 et seq. Page 1 of6 American LegulNet, Inc. .158 Number: 72 Other Restraining Orders and Court Cases 3. Are there any restraining/protective orders currently in place OR that have expired in the last six months (emergency protective orders, criminal, juvenile, family)? No Yes (date of order): and (expiration date): (Attach a copy if you have one). b. Have you or any other person named in@ been involved in another court case with the person in No El Yes If yes, check each kind of case and indicate where and when each was filed: Kind of Case County or Tribe Where Filed Year Filed Case Number (if known I: Divorce, Nullity, Legal Separation I: Civil Harassment Domestic Violence Criminal El Juvenile, Dependency, Guardianship Child Support Parentage, Paternity Other (specify): [3 Check here ifyon need more space. Attach a sheet of paper and write Other Court Cases for a title. Check the orders you want. El Personal Conduct Orders I ask the court to order the person in not to do the following things to me or anyone listed in@: a. Harass, attack, strike, threaten assault (sexually or otherwise), hit, follow, stalk, molest, destroy personal property, disturb the peace, keep under surveillance, impersonate (on the Internet, electronically or otherwise), or block movements b. Contact, either directly or indirectly, in any way, including but not limited to, by telephone, mail or e-mail or other electronic means The person in C2) will be ordered not to take any action to get the addresses or locations of any protected person unless the court finds good cause not to make the order. 6) Stay-Away Order a. I ask the court to order the person in C2) to stay at least 100 yards away from (check all that apply): Me El My school My home Each person listed in G) My job or workplace IX The school or child care My vehicle Other (specify): b. If the person listed in is ordered to stay away from all the places listed above, will he or she still be able to get to his or her home, school, job, workplace, or vehicle? Yes No (If no, explain): Move-Out Order (If the person in lives with you and you want that person to stay away ?om your home, you must ask for this move-oat order.) I ask the court to order the person in C2) to move out from and not return to (address): 5204 Weke Road, Hanalei, Hawaii, 96714. I have the right to live at the above address because (explain): Ben and I have been living there. This is not a Court Order. Request for Domestic Violence Restraining Order DV-100, Page 2 of6 (Domestic Violence Prevention) 9 American Legalhlet, Inc. wurwfonnsWorkHowxom Revised July 2016 use Number: . 72 Guns or Other Firearms or Ammunition I believe the person in owns or possesses guns, ?rearms, or ammunition. Yes No I don?t know If the judge approves border, the person in (D will be ordered not to own, possess purchase, or receive a ?rearm or ammunition. The person will be ordered to sell to, or store with, a licensed gun dealer, or turn in to law enforcement, any guns or firearms that he or she owns or possesses. Record Unlawful Communications I ask for the right to record communications made to me by the person in that violate the judge?s orders. Care of Animals I ask for the sole possession, care, and control of the animals listed below. I ask the court to order the person in to stay at least 100 yards away from and not take, sell, transfer, encumber, conceal, molest, attack, strike, threaten, harm, or otherwise dispose of the following animals: our dog, Nina I ask for the animals to be with me because: Nina is at the residence with me and Ben Child Custody and Visitation 3. I do not have a child custody or visitation order and I want one. b. I: I have a child custody or visitation order and I want it changed. If you ask for orders, you must/ill out and attach Form Request for Child Custody and Visitation Orders. You and the other parent may tell the court that you want to be legal parents of the children (use Form DV-180, Agreement and Judgment of Parentage). [1 Child Support (Check all that apply): a. I do not have a child support order and I want one. b. [j I have a child support order and I want it changed. c. El I now receive or have applied for TANF, Welfare, or Medi?Cal. If you ask for child support orders, you mast?ll out and attach form FL-I 50, Income and Expense Declaration or Form 5 5, Financial Statement (Simpli?ed). El Property Control I ask the court to give only me temporary use, possession, and control of the property listed here: Debt Payment I ask the court to order the person in 6-) to make these payments while the order is in effect: El Check here if you need more space. Attach a sheet of paper and write V-I 00, Debt Payment ?for a title. Pay to: For: Amount: Due date: Property Restraint I am married to or have a registered domestic partnership with the person in C2) . I ask the judge to order that the person in?not borrow against, sell, hide, or get rid of or destroy any possessions or pro erty, except in the usual course business or for necessities of life. I also ask the judge to order the person i to notify me of any new or big expenses and to explain them to the court. Spousal Support I am married to or have a registered domestic artnership with the person in and no spousal support order exists. I ask the court to order the person in to pay spousal support. (You must complete, file, and serve Form FL-I50, Income and Expense Declaration, be are our hearing . This is not a Court Order. ?"110? Request for Domestic Violence Restraining Order DV-100sPage 3 Dis (Domestic Violence Prevention) 9 American LegaINet, Inc. .FonnsWorkFlow.com ase Number: 198TFL081 72 Rights to Mobile Device and Wireless Phone Account a. El Property control of mobile device and wireless phone account I ask the court to give only me temporary use, possession, and control of the following mobile devices: and the wireless phone account for the following wireless phone numbers because the account currently belongs to the person in (including area code): my number CI number of child in my care (including area code): my number CI number of child in my care (including area code): El my number CI number of child in my care Check here if you need more space. Attach a sheet of paper and write V-l 00, Rights to Mobile Device and Wireless Phone Account for a title. b. Debt Payment I ask the court to order the person in@ to make the payments for the wireless phone accounts listed in 18a because: Name of the wireless service provider is: Amount: Due Date: if you are requesting this order, you must complete, file, and serve Form FL-150, Income and Expense Declaration, before your hearing. c. Transfer of Wireless Phone Account I ask the court to order the wireless service provider to transfer the billing responsibility and rights to the wireless phone numbers listed in 18a to me because the account currently belongs to the person in . If the judge makes this order, you will be financially responsible for these accounts, including service fees and costs of any mobile devices connected to these phone numbers. You may be responsible for other fees. You must contact the wireless service provider to ?nd out what fees you will be responsible for and whether you are eligible for an account. I:l Insurance I ask the court to order the person in to cash, borrow against, cancel, transfer, dispose of, or change the bene?ciaries of any insurance or coverage held for the bene?t of me or the person in@ or our child(ren), for whom support may be ordered, or both. Lawyer?s Fees and Costs I ask that the person in pay some or all of my lawyer?s fees and costs. You must complete, file and serve form FL-150, Income and Expense Declaration, before your hearing. Payments for Costs and Services I ask the court to order the person in to pay the following: You can ask for lost earnings or your costs for services caused directly by the person in (damaged property, medical care, counseling, temporary housing, etc. You must bring proof of these expenses to your hearing. Pay to: For: Amount: 13 Pay to: For: Amount: Batterer Intervention Program I ask the court to order the person listed in to go to a 52-week batterer intervention program and show proof of completion to the court. Other Orders What other orders are you asking for? '3 Check here if you need more space. Attach a sheet 0 (1 er and write 00, Other Orders for a title. This is not a Court Order. 2016 Request for Domestic Violence Restraining Order Page 4 0f 5 (Domestic Violence Prevention) 9 American LegaINet, Inc. ww'wfonnsWorkFlowgom use Number: Time for Service (Notice) The papers must be personally served on the person in C2) at least ?ve days before the hearing, unless the court orders a shorter time for service. if you want ther to be fewer than five days between service and the hearing, explain why below. For help read Form ?What Is Proof of Personal Service?? (29 No Fee to Serve (Notify) Restrained Person lfyou want the sheriff or marshal to serve (noti?z) the restrained person about the orders for free, ask the court clerk what you need to do. Court Hearing The court will schedule a hearing on your request. If the judge does not make the orders effective right away (?temporary restraining orders?), the judge may still make the orders after the hearing. If the judge does not make the orders effective right away, you can ask the court to cancel the hearing. Read form Waiver of Hearing on Denied Request for emporary Restraining Order, for more information. Describe Abuse Describe how the person in ?abused you. Abuse means to intentionally or recklessly cause or attempt to cause bodily injury to you; or to place you or another person in reasonable fear of imminent serious bodily injury; or to harass, attack, strike, threaten, assault (sexually or otherwise), hit, follow, stalk, molest, keep you under surveillance, impersonate (on the Internet, electronically or otherwise), batter, telephone, or contact you; or to disturb your peace; or to destroy your personal property. (For a complete de?nition, see F8111. Code, 6203, 6320.) a. Date of most recent abuse: July 4 - 6 1. Who was there? Myself, Michael, Benjamin 2. Describe how the person in abused you or your child(ren): SEE ATTACHED DECLARATION Check here ifyoa need more space. Attach a sheet of paper and write Recent Abuse for a title. 3. Did the person in? use or threaten to use a gun or any other weapon? No El Yes (If yes, describe): 4, Describe any injuries: bruises; scratched neck 5. Did the police come? No El Yes If yes, did they give you or the person in@ an Emergency Protective Order? I: Yes No I don?t know Attach a copy if you have one. The order protects you or Cl the person in This is not a Court Order. Request for Domestic Violence Restraining Order DV-100- Page 5 0f 5 (Domestic Violence Prevention) 9 American LegalNet, Inc. MW.Fonn5WorkFlow.cgm Case Number: 1 QSTF L081 72 Describe Abuse (continued) Has the person in@ abused you (or your child(ren)) other times? 13. Date of abuse: 1. Who was there? 2. Describe how the person in abused you or your child(ren): SEE ATTACHED DECLARATION Check here ifyou need more Space. Attach a sheet of paper and write 00, Recent Abuse for a title. 3. Did the person in? use or threaten to use a gun or any other weapon? No Yes (Hyes, describe): 4. Describe any injuries: 5. Did the police come? No Yes If yes, did they give you or the person in ('23 an Emergency Protective Order? Yes El No I don?t know Attach a copy z'fyou have one. The order protects you or the person in (23 {fthe person in abused you other times, check here and use Form Description of Abuse or describe any previous abuse on an attached Sheet: of paper and write Previous Abuse? for a. title. Other Persons to Be Protected The persons listed in item@ need an order for protection because (describe): SEE. ATTACHED DECLARATION Number of pages attached to this form, if any: I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: July 15, 2019 Laura 1113135 see electronic signature on the next page Type or print yo ur name Sign your name Date: My 15, 2019 Samantha F. Specter Esq. see electronic signature on the next page Lawyer ?3 name, ifyou have one Low 2er ?s signature This is not a Court 0rde . Revised July 1, 2016 Request for Domestic Violence Restraining Order Page 6 ms (Domestic Violence Prevention) Earn Number . . . . . in Describe Abuse (continued) Has the p??xli?? 131(5)) nhnud gun: {at war chik?renn miner time's? 5 Haiti}! .zlum I Who we . . 2 ikm'sbt Lau- that [mam in ahuscd 3m! In an cluldtm?n) Si} I \k ?it: iml hm N'mu ?ne! muff gum Mm la a shed [mi war Rangun an} (whet ?fawn" M1 \es 5, drunk) - my 13131?:th 5 Did thin mime mumdid the". put 591.1 or tin: mm CE) in {magma}: has No I don't knuw dam-1: a :1 Wu haw an: Dyna pct-warn Q) {Nahum-mu ?Md Hm min-r {Ema (#311 Jun- and mu" f'wm m; ul' Aims: Lint-r15: cim [Wi?mi Mme as an mm; Ina! sin-t n; Mirr and Hui?r 30:0, Firm-mus Abuse? {w a mi:- 0th.: Person: to Be Protoctcd I the lmed in ttcm?) mi an mdc: 1m gmrt?ium became: him-'nfw 253] MHZ um um Rumba: a! vague; mankind is this farm, if my I declare nudist penalty 91? pctjury undc: 2h: (trim: State of (?nlsfumu that mfurmatmn than: is {we and mm: [lau- 1.113132019 [m Laura 1 km . Tm ar pun! min tum: Sign mm namc Due: jg): i5. 21319 31m":- qu SWK W4, . (an .o?r mag. dim: karma: I?mwr ?nmnmun- Tina 3-. rant .1 Com! (mm 0?39 - 5:430. H93 6 (Damn-11c Mimi In: I .J DECLARATION OF LAURA FLEISS DV-100: RECENT ABUSE I, LAURA FLEISS, declare as follows: 1. submit this Declaration in support of my Request for Domestic Violence Restraining Orders If called upon as a witness, I could and would testify competently to the following: MOST RECENT INCIDENT OF ABUSE: JULY 4 THROUGH JULY 6, 2019 2. Petitioner, Michael leiss and met in 2012 when I was a participant in the Miss America pageant, and he was a judge. We were married on April 6, 2014. We have one child together, Benjamin Garcia Fleiss born May 4, 2015. I am also approximately 10 weeks pregnant with our second child. 3. On July 10, 2019, I learned through the media that Mike had filed a Petition for Dissolution of Marriage in Los Angeles Superior Court. The LASC case number is In his Petition for Dissolution, Mike declared that he is a resident of Los Angeles County. 4. Mike works as executive in the entertainment industry. have been a stay- at?home mother since Ben was born four years ago. We have multiple residences together, including three located in Kauai, Hawaii, and one in Malibu, California. Mike goes back and forth between Hawaii and Los Angeles frequently, as his entertainment business is headquartered there. 5. While Mike has frequently been verbally abusive towards me during our marriage, in recent weeks, he has become enraged, due to the fact I am pregnant with our second child. Mike told me many times that he did not want us to have a second child. He also repeatedly told me throughout our marriage, and prior to our marriage, that he knew he would ?have to have? one child with me because I was 26 years-old when we got married, did not yet have any children, and he knew I wanted to have a family. Mike, however, being 55 years?old, did not want to have more than one child together. 6. On Thursday, July 4, 2019, while we were at our house in Kauai, Mike FLEISS: REQUEST FOR DVRO DECLARATION OF LAURA FLEISS demanded that get an abortion. Our son Ben was in the house, seated in another room nearby. Mike told me, "If you have an abortion, then we can just go back to the way we were. Priorto July 4th, Mike threatened me that if I did not have an abortion, he would end the marriage. This was not the first time he had threatened a divorce during our marriage, but now, he was using this threat as leverage to force me to have an abortion. 7. In addition, on July 4th, Mike made the following statements to me: a. am cutting you off ?nancially Monday morning; b. You are paying for everything with your money; 0. ?Next time I see you, I don want to see your stomach;? and d. ?You have a choice, you can choose. Have an abortion or go back to Wisconsin, but you are not taking Ben. 8. He continued to threaten me, demanding to see bank statements showing i paid for an abortion and the flight information to and from Oahu for the medical procedure. 9. On Friday July 5th, Mike was even more angry than he was on July 4th. He continued to berate me. He called me names, including a ?low rent gold-digger,? ?$50,000 whore," ?fucking cunt,? and ?stupid cunt? - all of which he has called me before in the past in order to degrade, demean and humiliate me. 10. I tried to go into another room to call my mother. Mike refused to let me go and made threats that I would lose access to my family and my family?s ability to see Ben. Mike said ?You aren?t going to see your mother for the next two-to-three years. You need to call [your mom] right now and tell her this. was terrified. Then he forced me to call my mother from my cell phone while he was in standing and watching me in the room. When I called my mother, Mike then grabbed the phone and began angrily lecturing my mother. He told her was getting an abortion. Then he said to her, ?You won?t be seeing [Laura] until after August 5 after the abortion.? This statement was especially scary to me, as I had not personally committed to having an abortion but had made an appointment given Mike's insistence and pressure. I had no idea what exactly he meant by it and interpreted it as a threat that he would prevent my family from having contact with 2 FLEISS: REQUEST FOR DVRO DECLARATION OF LAURA FLEISS me or my son. 11. was afraid of Mike because of his threats and verbal abuse. Therefore, on Friday, July 5, 2019, I asked my friend Noelle if she would come to the house in Kauai, where was staying with Ben, and spend the night there with us. Mike had left to stay the night at our house in Haena, Hawaii, but, just in case he returned, fearing for my and my son?s safety, I felt more comfortable having a third?party present in the house with. Noelle was kind enough torgrant my request and, to my great relief, came to stay with us. 12. On Saturday July 6th, Mike returned to our home in Kauai. was in my bedroom in bed with Ben, who was struggling with a bad cold and was trying to comfort him. Mike angrily entered Ben?s bedroom looking for my cellphone. When I got up to leave the room and picked up my cell phone, Mike, who is 6'4" and weighs approximately 220 pounds, forcibly grabbed my phone out of my hands. I immediately became concerned and frightened that Mike would leave the property with my cellphone, stranding me there without it and no access to Ben?s physicians if needed given his bad cold and cough or any way to contact law enforcement if Mike became violent, as his threats indicated he might. I attempted to grab my phone back from Mike, but I was not able to do so. 13. Mike exited the bedroom, and rushed to the top of the stairs. I followed him trying to get my phone back from him, and he yelled that he was going to ?shove me down the stairs.? 14. followed him as he walked down the stairs towards the front door of the house, begging him that I needed my cellphone back. Just before we got outside of the front door, he grabbed my body, forcibly pinned me up against the wall and held me M. After i broke free, he continued to use his arms and hands to aggressively push me away from him as he walked outside the door, still not returning my phone. Then he walked towards his pick-up truck parked outside in our driveway, shouting ?I'm going to punch your face in.? Attached as Exhibit are photos from the outdoor surveillance camera at our home which show Mike pushing me again once we were both outside. 15. When he got to his truck, he opened the front driver-side door and entered. 3 FLEISS: REQUEST FOR DVRO DECLARATION OF LAURA FLEISS was right behind him, pleading with him not to leave me and Ben at the house without access to my phone. With the driver-side door open and before Mike had turned on the car, I stood on the outside running board/footstep directly below the driver-side door, which is approximately 12-18 inches off the ground. While I was standing on there (between Mike and the open door), Mike put the truck in reverse and began to back up, and firmly said, You?re fucked." He then stopped the car suddenly, which nearly made me fall off the running board and caused the swinging doorto almost close on me. At this point, ME forcefully shoved me off of the runnillq board, closed the car door and drove away with my cellphone in his possession. 16. I was extremely traumatized from the incident and started crying hysterically. Our unborn child and I could have been severely injured if I had fallen offthe truck?s running board or run over the wheels of the truck. I began to scream for help. 17. A neighbor across the street heard me and came outside. I ran into his yard and he called the police. After we learned it could take the police an hour or longer to arrive, I asked the neighbor to drive Ben and me to a nearby friend?s house, where i knew we would be safe and away from Mike, if and when he returned home. I went back to the house to get Ben, along with small duffle bag that I kept ready in the closet, packed with clothes and other items, in case ever needed to leave the house on short notice, because of Mike's violent threats and erratic behavior. When I arrived at my friend?s house, she drove me to the police station where I spoke to a police officer to file a police report. The officer asked me if I wanted to file an Emergency Protective Order but I declined as was fearful that I would further incite'Mike and instead told the office was going to seek safety with my parents in a nearby hotel. I am currently in the process of trying to obtain a copy of this officer?s report. 18. On Monday July 8th, I went to my OBGYN to make sure our unborn baby was in good health and to othenivise check the injuries I had suffered. 19. Collectively attached as Exhibit are photographs I took on Saturday, July 6th, and Sunday, July 7th, of bruises on the inside of my arm, a scratch on my neck, and a 4 REQUEST FOR DVRO DECLARATION OF LAURA FLEISS large tear in the dress that was wearing on July 6th, all of which were caused by Mike's violent behavior on July 6th. 20. I am afraid of Mike. I am afraid he will continue to act erratically towards me, verbally and physically, and in the presence of Ben. I have been hiding in a hotel for the past several days with Ben, and want to be able to return home without fear for myself, my son and my unborn child. PRIOR ACTS OF ABUSE EMOTIONAL AND VERBAL 21. Over the past several years of our marriage, Mike has made many emotionally derogatory and demeaning comments designed to demonstrate his financial coercive control over me such as repeatedly insinuating that he would destroy me with his wealth and power. Within that last year, he has verbally abused me many times telling me that I am going to end up ?fat and single in Kenosha, Wisconsin,? with the usual follow- up comment of ?Good luck with that.? He consistently would call me ?fat,? telling me that I need to lose weight, and berate me as being ?lazy? and ?incapable.? He has made these comments in the presence of our son Ben. The name-calling occurred on a regular basis both inside and outside our home, often in front of other people, such as our friends, my mother, and, most importantly, Ben. The continued verbal and emotional abuse have wreaked havoc on my self-esteem. have spent time in therapy discussing the effects upon me of Mike?s demanding and denigrating comments. 22. In April 2018, we were in California the weekend of our wedding anniversary. We went to dinner at Nobu in Malibu, and left Ben at our California residence with my mother. When we were getting ready to leave Nobu, I used Mike's cellphone to order us a ride home using Uber. While I was using Mike's cellphone, I saw some flirtatious text messages between Mike and a female friend. I handed him his phone back with those text messages open on his phone, so he knew that I had seen them. Mike went ballistic. He screamed and cursed at me the entire ride home while we were in the Uber. When we got home, he continued to criticize me and call me names, both that night and that the next day, all in the presence of my mother. The day after our dinner at Nobu, he told me that he 5 FLEISS: REQUEST FOR DVRO DECLARATION OF LAURA FLEISS was calling his attorney to file for divorce, and that I needed to ?go back? to Wisconsin with my mother but without Ben. I was traumatized, both because of the degrading names Mike was calling me, and because of his continuous threats to divorce me and make me go back to Wisconsin. It was also emotionally humiliating that this took place in front my mother. I AM PRIMARY CARETAKER 23. have been Ben's primary caretaker since his birth. All feeding, changing diapers, etc. was done by me or an au pair or night nurse. Ben is not a good sleeper. It is not uncommon for him to been up two to four times a night. It has been this way since he was a baby. I am the parent who gets up with Ben every single time in the middle of the night; Mike sleeps in a different bedroom, or in the cottage, so that he can rest and not be woken at night. I had to arrange childcare for anytime I needed to leave the house, even if Mike was going to be home. if I was ever sick, I would arrange childcare for Ben so that I could rest and get better, and Ben is cared for. I would coordinate childcare if I was going to go workout, go to the grocery store, etc. Eventually, I started bringing Ben with me to those types of activities. 24. Mike usually wakes up and sees Ben in the morning for breakfast, then goes to his cottage to work, does his daily activities, swims, hikes on the beach, goes fishing, plays in his band and then he will join the evening around dinner time. 25. i make breakfast, lunch and dinner for Ben. I grocery shop for his food. I give him his baths, brush his teeth with him, and read books with him before bed. Mike often joins us to read books at night, but i stay with Ben until he falls asleep. 26. When Ben is sick, especially at night, I care for him, administering medicine, taking his temperature and giving him baths to bring his fever down. I make all of Ben?s doctor?s and dentist appointments, transport Ben to them, and attend them with him. CONCLUSION 27. Given the above, this Court should immediately issue a Temporary Domestic 6 FLEISS: REQUEST FOR DVRO DECLARATION OF LAURA FLEISS oo-xloumAmN?towoo-qouanwM?xo Violence Restraining Order so as to prevent Mike from engaging in further physical, verbal and emotional abuse. I am requesting both personal conduct orders and stay away orders to ensure some level of protection against Mike?s conduct and for me and Ben to have exclusive possession of our home. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on July 15, 2019 in Koloa, Kauai. bee electronic signature on the next page] LAURA FLEISS FLEISS: REQUEST FOR DVRO DECLARATION OF LAURA FLEISS ?Violence Restraining Order so as lo pro-vent Mike from engaging in furthor physical. verbal and emollonal abuse I am FEQUQSIIHQ both personal conduct orders and stay away orders to ansure some level of protection against Mike?s oonduct and for me and Ben to haw-2 exclusive possession of our home I declare under penalty of perjury under the laws of the State of Callforma thal the foregoing is true and correct. Executed on July 15, 201911": Koloa. Kauai: FLEISS: REQUEST FOR DECLARATION OF LAURA FLEISS Request for Child Custody and (133:; Mrs-?32 Visitation Orders FL DV-105 This form is attached to 00, Request for Domestic Violence Restraining Order. Check the orders you want l3. Q) Your name: Laura Fleiss Mom Dad Other* Other parent's name: Michael L. Fleiss Mom Dad Other* *If Other, specify relationship to child: IXI Child Custody I ask the court for custody as follows: Legal Custody to: (Person Physical Custody to: who makes decisions about (Person you want the health, education, and welfare) child to live with) Child's Name Date of Birth Mom Dad Other Mom Dad Other a. Benjamin Garcia Fleiss 05/04/Check here if you need more space. Attach a sheet of paper and Change Current Court Order I want to change a current child custody or visitation court order. Case Number (if you have it): County: rite Child ustody for a title. Explain your current order and why you want a change. Check here if you need more space. Attach a sheet of paper and write Change Current Court Order" for a title. Child's Address Where has the child in lived for the last 5 years? Give each city and state the child has lived unless it is unknown to the other parent and you want to keep it con?dential because of domestic Violence or child abuse. Start with where the child lives now and work backwards in time. (If the current address is confidential, check the box below and just provide the current state). Child lived with: Dates lived there: Child (3) addresses (city and state): Mom Dad Other Con?dential El From to present El From to El l:l l:l From to l:l l:l l:l From to Check here if?you need more space. Attach a sheet of paper and write Child ?3 Address for a title. This is not a Court Order. Judicial Council of California. mneurtscagov - - - - 1 f3 Remand-CW1, 2012. Mandamm Request for Child Custody and Visutatlon Orders age Family Code. 3053 (Domestic Violence Prevention) American magni?er, Inc. FonnsWorkFlow .com ej Case Number: Other Children's Addresses Check here if the other child?s (or children's) address information is the same as listed in El If it is different, check here. Attach a sheet of paper and write "Di/1105, Other Children 's?dresses for a title. List other children ?s address information, including dates, and name of person child lived with. Other Custody Case Were you involved in, or do you know of, any other custody case for any child listed in this form? No Yes If yes, fill out below and attach a copy of any custody or visitation orders you have them: a. Name of each child in other custody case: b. Type of case: Parentage (Paternity) Divorce Child Support El Guardianship El Juvenile/Dependency Domestic Violence El Other (speCi?J): c. I was a El Party El Witness Other (specify): d. Court (name): Address: County: State: e. Date of court order: f. Case number (if you have it): Other People With or Claiming to Have Custody or Visitation Rights Do you know of anyone who is not involved in this case who has or claims to have custody or visitation rights with any child listed on this form? No Yes If yes, ?ll out below: Name and address of that person: El Has custody Claims custody rights Claims visitation rights For these children (name of each child): Check here ifyoa need more space. Attach a sheet of paper and write Other People With or Claiming Custody or Visitation for a title. Visitation I ask the court to order that the person in have the following temporary visitation rights: (Check all that apply) a. No visitation until the hearing b. N0 visitation after the hearing c. CI The following visitation [3 until the hearing after the hearing Weekends (starting): (The Ist weekend of the month is the 1 st weekend with a Saturday.) 1st 2nd 3rd El 4th 5th weekend of month from am. p.111. (day of week) (time) (day of week) (time) (2) Weekdays (starting): from at am. El p.111. to at am. El pm. (day of week) (time) (day of week) (time) This is not a Court Order. ReV'memu Request for Child Custody and Visitation Orders 05, Page 2 0? (Domestic Violence Prevention) American LegalNet, Inc. Case Number: I: Other Visitation Attach a sheet of paper with other visitation days and times, like summer vacation, holidays, and birthdays. List dates and times. Write Visitation for a title. I: Responsibility for Transportation The parent will take or pick up the child or make arrangements for someone else to do so. I ask the court to order that: a. Mom El Dad Other (name): take children to the visits. b. Mom Dad I: Other (name): pick up children from the visits. 0. El Drop?off pick?up of children will be at (address): (1. El Check here if other arrangement. Attach a sheet of paper and write 05, Responsibilityfor Transportation for a title. Supervised Visitation a. I ask that the visitation in be supervised by El A professional supervis?> A non?professional supervisor Other Name and telephone number, ifknown: b. I ask that the visitation in be supervised by A professional superv. El A non-professional supervisor Other Name and telephone number, if known: c. I ask that any costs for supervision be paid by: Mom Dad Other (name) Travel With Children I ask the court to order that: [3 Mom Dad Other (name): must have written permission from the other parent, or a court order, to take the children outside of: a. The State of California County of: b. [3 Other place(s) (list): Child Abduction Risk I believe that there is a risk the other parent will take our child out of California and hide the child ?om me. Ifyoa check this box you must fill out and attach Form V-l 08, Request for Order: No Travel with Children. Important Instructions 0 You must tell the court if you find out any other information about a custody case in any court for the children listed on this form. 0 If the court makes a temporary custody order, the parent receiving custody must not take the child out of California Without a noticed hearing. (See Family Code ?3063.) This is not a Court Order. Re??ia??a?y" Request for Child Custody and Visitation Orders ??105! Page 3 0f 3 (Domestic Violence Prevention) American LegalNet, Inc. Jmn715" 1'13!? i 02:14: 3 7 .f?d - . . ?k