EA-100 - Request for Elder or Dependent Adult Abuse Restraining Orders

Summary

Request for Elder or Dependent Adult Abuse Restraining Orders

Text

Form ID: EA-100
Title: Request for Elder or Dependent Adult Abuse Restraining Orders
Effective Date: 2026-01-01
Mandatory Form: yes
Languages: 汉语, 한국어, español, Tiếng Việt
Info Page: https://selfhelp.courts.ca.gov/jcc-form/EA-100
Primary Download URL: https://www.courts.ca.gov/documents/ea100.pdf
Alternate Download URLs: https://www.courts.ca.gov/documents/ea100c.pdf, https://www.courts.ca.gov/documents/ea100k.pdf, https://www.courts.ca.gov/documents/ea100s.pdf, https://www.courts.ca.gov/documents/ea100v.pdf
Form Detail Page:
Request for Elder or Dependent Adult Abuse Restraining Orders
(EA-100)
Ask the judicial officer for a restraining order and tell the judicial officer why you need one.
Get form EA-100
汉语
Get form EA-100 in Chinese Simplified
(Chinese Simplified)
한국어
Get form EA-100 in Korean
(Korean)
español
Get form EA-100 in Spanish
(Spanish)
Tiếng Việt
Get form EA-100 in Vietnamese
(Vietnamese)
Effective: January 1, 2026
Go to
How-to instructions for Elder Abuse
Go to
Elder Abuse Form Packets
PDF Text:
Judicial Council of California, courts.ca.gov    
Rev. January 1, 2026, Mandatory Form 
Code Civ. Proc., § 527.9; 
Welf. & Inst. Code, § 15657.03
Request for Elder or Dependent Adult Abuse 
Restraining Orders 
(Elder or Dependent Adult Abuse Prevention)
EA-100 Request for Elder or Dependent 
Adult Abuse Restraining Orders
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of California, County of
Court fills in case number when form is filed.
Case Number:
Read Can a Restraining Order to Prevent Elder or Dependent Adult Abuse 
Help Me? (form EA-100-INFO) before completing this form. Also fill out 
Confidential CLETS Information (form CLETS-001) with as much 
information as you know.
1 Elder or Dependent Adult in Need of Protection
Full Name:
Gender: M F Age:Nonbinary
2 Person From Whom Protection Is Sought
Full Name:
Address (if known):
City: State: Zip:
3 Person Requesting Order
Who is asking the court for protection? (Check a, b, or c):
a. The elder or dependent adult named in   1  .
b. Name:
conservator of the person estate person and estate
of the person named in  1  , appointed by (name of court):
Case No.:
c. Other (name)
(Show this person’s legal authority to make this request on an attached sheet of paper. Write “Attachment 3c—
Information About Person Requesting Protective Order” for a title. You may use form MC-025, Attachment.)
4 Contact Information
Contact information for the person asking the court for protection
a. Your Lawyer (if you have one for this case)
Name:   State Bar No.:
Firm Name:
b. Your Address (If you have a lawyer, give your lawyer’s information. If you do not have a lawyer and want to 
keep your  home address private, you may give a different mailing address instead. The person in   1   does not 
have to give telephone, fax, or email.)
Address:
City: State: Zip:
Telephone: Fax:
Email Address:
This is not a Court Order.
EA-100, Page 1 of 10

Rev. January 1, 2026 Request for Elder or Dependent Adult Abuse 
Restraining Orders 
(Elder or Dependent Adult Abuse Prevention)
Case Number:
5 Description of Protected Person
The person named in       (check a or b):1
a. Is age 65 or older and a resident of California.
b. Is a resident of California and an adult under age 65. This person has physical or mental limitations that 
restrict their ability to carry out normal activities or protect their rights. (Briefly describe limitations on an 
attached sheet of paper or form MC-025. Write “Attachment 5b—Description of  Protected Person” for a 
title.)
6 Additional Protected Persons
a. Are you asking for protection for any other family or household members or for the conservator of the elder or 
dependent adult listed in  1  ? Yes No (If yes, list them):
Full Name Gender Age Relation to person in  1  ?
Lives with person 
in  1  ?
Yes No
Yes No
Yes No
Yes No
Check here if there are more persons. Attach a sheet of paper and write “Attachment 6a—Additional  Protected 
Persons” for a title. You may use form MC-025, Attachment.
b. Why do these people need protection? (Explain below):
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of  
paper or form MC-025 and write “Attachment 6b—Why Others Need Protection” for a title.
7 Relationship of Parties
How does the person in  1  know the person in  2  ? (Explain below): 
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of  
paper or form MC-025 and write “Attachment 7—Relationship of Parties” for a title.
This is not a Court Order.
EA-100, Page 2 of 10

Rev. January 1, 2026 Request for Elder or Dependent Adult Abuse 
Restraining Orders 
(Elder or Dependent Adult Abuse Prevention)
Case Number:
8 Description of Abuse
a. Abuse means either:
(1) Physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment with 
resulting physical harm or pain or mental suffering; or
(2) The withholding by a caretaker of goods or services that are necessary to avoid physical harm or mental 
suffering.
b. Tell the court about the last time the person in   2  abused the person in   1  .
(1) When did it happen? (Provide date or estimated date):
(2) Who else was there?
(3) Describe what happened below.
Check here if there is not enough space for your answer. Put your complete answer on an attached 
sheet of paper or form MC-025 and write “Attachment 8b(3)—Describe Abuse” for a title.
(4) Was the abuse solely financial abuse unaccompanied by force, threat, harassment, intimidation, or any 
other form of abuse?
Yes, only financial abuse. No, the abuse included other forms of abuse described above.
(5) Did the person in   2   use or threaten to use a gun or any other weapon? 
                              (If yes, explain below):Yes No
Check here if there is not enough space for your answer. Put your complete answer on an attached 
sheet of paper or form MC-025 and write “Attachment 8b(5)—Use of Weapons” for a title.
Was the person in   1   harmed or injured as a result of the acts of abuse described above?(6)  
Yes No (If yes, explain below):
Check here if there is not enough space for your answer. Put your complete answer on an attached 
sheet of paper or form MC-025 and write “Attachment 8b(6)—Harm or Injury” for a title.
(7) Did the police come? Yes No
If yes, did they give the person in   1  or the person in   2   an Emergency Protective Order? Yes No
If yes, the order protects (check all that apply):
the person in   1 the person in   2 the persons in   6  .
(Attach a copy of the order if you have one.)
This is not a Court Order.
EA-100, Page 3 of 10

Rev. January 1, 2026 Request for Elder or Dependent Adult Abuse 
Restraining Orders 
(Elder or Dependent Adult Abuse Prevention)
Case Number:
8 c. Is the person in  2   a care custodian who deprived the person in   1  of (kept from the person, did not allow the 
person to have or receive, or did not provide the person with) goods or services that the person needed to avoid 
physical harm or mental suffering?  
(If yes, describe below what the person was deprived of and how that affected the person):
Yes No
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of 
paper or form MC-025 and write “Attachment 8c—Deprivation by Care Custodian” for a title.
d. Has the person in  2  abused the person in   1   at other times?  
                             (If yes, describe prior incidents and provide dates below):Yes No
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of 
paper or form MC-025 and write “Attachment 8d—Previous Abuse” for a title.
9 Venue
Why are you filing in this county? (Check all that apply):
a. The person in   2   lives in this county.
b. The person in   1  was abused by the person in   2   in this county.
c. Other (specify):
10 Other Court Cases
a. Has the person in  1   or any of the persons named in   6  been involved in another court case with the person   
in   2  ?                                (If yes, specify the kind of each case and indicate where and when each was filed):No Yes
Kind of Case Filed in (County/State) Year Filed Case Number (if known)
(1) Elder or Dependent Adult Abuse
(2) Civil Harassment
(3) Domestic Violence
(4) Divorce, Nullity, Legal Separation
(5) Paternity, Parentage, Child Custody
(6) Eviction
(7) Guardianship
(8) Workplace Violence
(9) Small Claims
(10) Criminal
(11) Other (specify):
b. Are there now any protective or restraining orders in effect relating to the person in  1  or any of the persons 
named in   6  and the person in   2   ? No Yes (If yes, attach a copy if you have one.)
This is not a Court Order.
EA-100, Page 4 of 10

Rev. January 1, 2026 Request for Elder or Dependent Adult Abuse 
Restraining Orders 
(Elder or Dependent Adult Abuse Prevention)
Case Number:
Check the orders you want. þ
11 Personal Conduct Orders 
I ask the court to order the person in   2   not to do any of the following things to the person in   1  or to any person 
to be protected listed in  6  :
a. Physically abuse, financially abuse, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or 
otherwise), hit, harass, destroy the personal property of, or disturb the peace of the person.
b. Contact the person, either directly or indirectly, in any way, including, but not limited to, in person, by  
telephone, in writing, by public or private mail, by interoffice mail, by email, by text message, by fax, or by 
other electronic means. 
c. Other (specify):
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of 
paper or form MC-025 and write “Attachment 11c—Other Personal Conduct Orders” for a  title.
The person in   2   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.
12 Stay-Away Orders 
a. I ask the court to order the person in  2   to stay at least               yards away from (check all that apply):
(1) The elder or dependent adult in  1  .
(2) The persons in  6  .
(3) The home of the elder or dependent adult.
(4) The job or workplace of the elder or dependent adult.
(5) The vehicle of the elder or dependent adult.
(6) Other (specify):
b. If the court orders the person in   2   to stay away from all the places listed above, will they still be able to get to 
their home, school, or job?                                   (If no, explain below):Yes No
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of 
paper or form MC-025 and write “Attachment 12b—Stay-Away Orders” for a title.
This is not a Court Order.
EA-100, Page 5 of 10

Rev. January 1, 2026 Request for Elder or Dependent Adult Abuse 
Restraining Orders 
(Elder or Dependent Adult Abuse Prevention)
Case Number:
13 Move-Out Order
I ask the court to order the person in   2  to move out from and not return to the residence at (address):
The person in   1  will suffer physical or emotional harm if the person in  2  does not leave the residence. The person 
in   2  is not named in the title or lease of the residence, either alone or with others beside the person in  1  .
I ask for this move-out order right away to last until the hearing, because:
a. The person in  2   assaulted or threatened the person in   1  ; and
b. The person in  1   has the right to live at the above residence. (Explain below):
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of 
paper or form MC-025 and write “Attachment 13b—My Right to Residence” for a title.
14 Order for Counseling or Anger Management Courses
This item is only available in instances of alleged physical abuse or deprivation of care, not in cases with 
only alleged financial abuse.
a. I request the person in   2   be ordered by the court to attend clinical counseling or anger management courses 
provided by a professional (a counselor, psychologist, psychiatrist, therapist, clinical social worker, or mental or 
behavioral health professional licensed in the State of California to provide counseling or anger management 
courses).
b. Explain why you are requesting an order that the person in   2   attend clinical counseling or anger management 
courses. 
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of 
paper or form MC-025 and write “Attachment 14b— Counseling or Anger Management” for a title.
This is not a Court Order.
EA-100, Page 6 of 10

Rev. January 1, 2026 Request for Elder or Dependent Adult Abuse 
Restraining Orders 
(Elder or Dependent Adult Abuse Prevention)
Case Number:
This is not a Court Order.
EA-100, Page 7 of 10 
16  Temporary Restraining Order
I request that a Temporary Restraining Order (TRO) be issued against the person in   2   to last until the hearing. I 
am presenting form  EA-110, Temporary Restraining Order, for the court’s signature together with this Request.  
Has the person in  2  been told that you were going to go to court to seek a TRO against them?  
                                    (If you answered no, explain why below):Yes No
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of 
paper or form MC-025 and write “Attachment 16—Temporary Restraining Order” for a title.
Unless the abuse is only financial, if the judge grants a protective order, the person in  2   will be prohibited from 
owning, possessing, purchasing, receiving, or attempting to purchase or receive firearms (guns), firearm parts, and 
ammunition while the protective order is in effect. The person in   2   will also be ordered to turn in to law 
enforcement, or sell to or store with a gun dealer, any firearms (guns), firearm parts, and ammunition within the 
respondent's immediate possession or control. If an order is granted, the person in   2   will also be prohibited from 
owning, possessing, or buying body armor and would have to relinquish any they have.
a. I don’t know
b. No
c. Yes (If you have information, complete the section below.)
Describe Firearms (Guns), Firearm Parts, or Ammunition Number or Amount Location, if known
(1)
(2)
(3)
(4)
(5)
(6)
15 Firearms (Guns), Firearm Parts, and Ammunition
Does the person in   2   have firearms (guns), firearm parts, or ammunition? (This includes firearm receivers and 
frames, and any item that may be used as or easily turned into a receiver or frame (see Penal Code section 16531).)

Rev. January 1, 2026 Request for Elder or Dependent Adult Abuse 
Restraining Orders 
(Elder or Dependent Adult Abuse Prevention)
Case Number:
This is not a Court Order.
EA-100, Page 8 of 10 
18 Debts Caused by Financial Abuse
You can ask the judge to decide at the hearing that certain debts or bills you have were caused by the person in 
(2)’s financial abuse. This may help you defend against the debt if you are sued in another case.
Money Owed To For Amount
(1) $
(2) $
(3) $
a. If you want the judge to make this special finding, list the debts or bills you have that were caused by the person 
in (2  ’s financial abuse.
Check here if you want to list additional debts or bills that were caused by financial abuse. You can attach 
form MC-025 and write “Attachment 18a—Additional Debts” for a title.
b. Describe what the person in  2   did to cause the debts and bills that you listed above. Provide as much detail as 
you can about the person in  2  ’s financial abuse.
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of 
paper or form MC-025 and write “Attachment 18b—How Debt Was Incurred” for a title.
17
If you want there to be less than five days between service and the hearing, explain why:
Request to Give Less Than Five Days' Notice of Hearing
You must have your papers personally served on the person in   2   at least five days before the hearing, unless the  
court orders a shorter time for service. (Read form EA-200-INFO, What Is “Proof of Personal Service”?, to learn 
about serving legal papers. Form  EA-200, Proof of Personal Service, may be used to show the court that the 
papers have been served.)
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of  
paper or form MC-025 and write “Attachment 17—Request to Give Less Than Five Days’ Notice” for a title.

Rev. January 1, 2026 Request for Elder or Dependent Adult Abuse 
Restraining Orders 
(Elder or Dependent Adult Abuse Prevention)
Case Number:
19 Lawyer's Fees and Costs
I ask the court to order payment of my lawyer’s fees court costs.
The amounts requested are:
Item Amount Item Amount
$ $
$ $
$ $
Check here if there are more items. Put the items and amounts on an attached sheet of paper or form MC-025 
and write “Attachment 19—Lawyer’s Fees and Costs” for a title.
b. That the person in  2  must stay at least             yards away from, and not take, sell, transfer, encumber, 
conceal, molest, attack, strike, threaten, harm, or otherwise dispose of, the animals listed above.
20 Possession and Protection of Animals
I ask the court to order the following:
a.
I request sole possession of the animals because (specify good cause for granting order):
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of 
paper or form MC-025 and write “Attachment 20a—Possession of Animals” for a title.
That the person in  1   be given the sole possession, care, and control of the animals listed below, which they 
own, possess, lease, keep, or hold, or which reside in their household.
(Identify animals by, e.g., type, breed, name, color, sex.)
21 No Fee to Serve Orders If you want the sheriff or marshal to serve (notify) the person in  2  about the orders 
for free, ask the court clerk what you need to do.
This is not a Court Order.
EA-100, Page 9 of 10

For your protection and privacy, please press the Clear 
button after you have printed the form.
Rev. January 1, 2026 Request for Elder or Dependent Adult Abuse 
Restraining Orders 
(Elder or Dependent Adult Abuse Prevention)
Case Number:
22
I ask the court to make the following additional orders (specify):
Additional Orders Requested
Check here if there is not enough space for your answer. Put your complete answer on an attached sheet of  
paper or form MC-025 and write “Attachment 22—Additional Orders Requested” for a title.
23 Number of pages attached to this form, if any:
Date:
Lawyer’s name (if any)
 Lawyer’s signature
I declare under penalty of perjury under the laws of the State of California that the information above and on all 
attachments is true and correct.
Date:
Type or print your name
 Signature of person making this request
This is not a Court Order.
EA-100, Page 10 of 10

Retrieval chunks

• #1

  Form ID: EA-100 Title: Request for Elder or Dependent Adult Abuse Restraining Orders Effective Date: 2026-01-01 Mandatory Form: yes Languages: 汉语, 한국어, español, Tiếng Việt Info Page: https://selfhelp.courts.ca.gov/jcc-form/EA-100 Primary Download URL: https://www.courts.ca.gov/documents/ea100.pdf Alternate Down…

• #2

  4 Contact Information Contact information for the person asking the court for protection a. Your Lawyer (if you have one for this case) Name: State Bar No.: Firm Name: b. Your Address (If you have a lawyer, give your lawyer’s information. If you do not have a lawyer and want to keep your home address private,…

• #3

  (1) Physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment with resulting physical harm or pain or mental suffering; or (2) The withholding by a caretaker of goods or services that are necessary to avoid physical harm or mental suffering. b. Tell the court about the last ti…

• #4

  paper or form MC-025 and write “Attachment 8c—Deprivation by Care Custodian” for a title. d. Has the person in 2 abused the person in 1 at other times? (If yes, describe prior incidents and provide dates below):Yes No Check here if there is not enough space for your answer. Put your complete answer on an atta…

• #5

  paper or form MC-025 and write “Attachment 11c—Other Personal Conduct Orders” for a title. The person in 2 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. 12 Stay-Away Orders a. I ask the court to order t…

• #6

  behavioral health professional licensed in the State of California to provide counseling or anger management courses). b. Explain why you are requesting an order that the person in 2 attend clinical counseling or anger management courses. Check here if there is not enough space for your answer. Put your comple…

• #7

  Rev. January 1, 2026 Request for Elder or Dependent Adult Abuse Restraining Orders (Elder or Dependent Adult Abuse Prevention) Case Number: This is not a Court Order. EA-100, Page 8 of 10 18 Debts Caused by Financial Abuse You can ask the judge to decide at the hearing that certain debts or bills you have were …

• #8

  b. That the person in 2 must stay at least yards away from, and not take, sell, transfer, encumber, conceal, molest, attack, strike, threaten, harm, or otherwise dispose of, the animals listed above. 20 Possession and Protection of Animals I ask the court to order the following: a. I request sole po…