cm.o10
PaTORNEY OF PART HEC ATTORNEY Si Bir aT
lorrice OF THe COUNTY COUNSEL
Ikatharine L. Eliott (136283)/Trevor Koski (250230)
[950 Madu Ave,, Sute 240, Nevada Cty, CA 95960
TELEMOVEND (530) 265-1919
sare Petitoner, County of Nevada
[SUPERIOR COURT OF CALIFORNIA, COUNTY OF NEVADA
STREET A0DRESS. 201 Church Street
sine Aconess: 204 Church Street
[-rv avo 2ncooe: Nevada Ciy, CA 95959
[case NAME
‘County of Nevada vt Tene Rebane Kenney
JAN i
CIVIL CASE COVER SHEET
[=] Untimited [De] Limites
(Amount (amount
demanded Semanded is
exceeds $25,000) $25,000)
Filed with frst appearance by defendant
(Cal, Rules of Court, ule 3.402)
San ereeGU2e - 08619
2
fi. Cheak one box bow forthe caso type tat bal deserbs his cave
ate Tor onvact
ito [_) Breen of conrectarany (0)
[ Uneures motor 48) [Ea] Rue a0 cotetors (09)
‘iar PuPOIWO (Peron nunyPropery [=] ower alston (oy
DamageWrongful Death) Tort [insurance coverage (18)
a Aavosts (8) one caneact 7)
[Pret abit 4) eee
Meseat maactc 4) trina drains
Other PuPDAD (23) ‘condemnation (14)
onPiroiwo (othe Tor [2 Wiongs eveton (9)
[_) business ont business pracin (7) =} Oter el groper 25)
[J comegnis 06) Uatewtt Desir
oetamation 19) Commerc (3)
(Fem (16 (Resse 02)
[ iretectua prov (19) bags 26
“dill Rovew
[J Protessiona neaigence 20)
[J Other non-PUPDAND ton (25)
Employment
5 Wienattterination 6)
[=] ter employment ($5)
2 Thiscase (J is __ [x Jisnot
factors requiring exceptional judicial management
4, (Large numberof separatey represented partes
b. [] Extensive motion practice raising eiffeut or novel
issues thet wil be time-consuming to resolve
©. [=] Substantial amount of documentary evidence
[Asset freure (05)
Petton te atiration award (11)
(ww of mandate (02)
TS otter usa roviow (9)
‘court
‘ems 1-6 Below must be completed (eee instructions on page 2)
Pet rage reguaton 0)
TS conanston cee 10)
Dm
[secu gabon 2
Enforcement of Judgment
[5 Eemercement of adgment (20)
Miscellaneous Civ Complaint
TC acoen
ores complain (not species above 42)
[ Pavinrahin and corporate governance (21)
[1 other patton (not spect above) (48)
ly Complex CW Ligation
OF Cour, rulos 3.400-2403)
ort 40)
EnvronmentaTox tot (20)
Ingurence coverage dal ang rm he
‘ove sed prowstonaly complex case
‘ypes a1)
‘complex under rule 3400 of the California Rules of Court, the case ls complex, mark the
4. [Large number of witnesses
2. [=] Coordination wth reated actions pending in ene or mace
‘cours in other counties, states, o countries, or ina federal
£._[] Substantial postiudgmentjuicial supervision
Remedies sought (check al that epply):a. (—] monetary . [ic
3
4, Number of causes of action (speciy): Temparary Workplace Violence Restraining Order, Workplace Violence Rest
5
Triscase (_] is []isnot aciass action sut.
8. If tere are any known related cases, fi
Date: January 31, 2022
‘Trevor Koski
Tinea,
NOTICE
in sanctions
File this cover sheet in adition to any cover sheet required by local cour rule.
cther partes tothe action oF
collections at
ing
| Ithis case is complex under rule 3.400 et seq, ofthe California Rules of Court, you must
Under rule 3.740 ora complex case, ths cover sheet will be used for statistical purpost
Tionmonetary, declaratory or injunctive relief c, (—) punitive
ining Order
nd serve 8 notice of related case, (You may y cm.015)
rf +
(Aa OF PRE GR AT OEE FR PT
v
+ Plantit must fe this cover sheet with the frst paper fied in the action or proceeding (except small claims cases or cases fled
Lnder the Probate Code, Family Code, or Welfare and Insitutons Code). (Cal. Rules of Cour, re 3.220.) Falureto fie may result)
v8 copy of is cover sheet on at |
“Shon
CIVIL CASE COVER SHEETINSTRUCTIONS ON HOW TO COMPLETE THE COVER SHEET cm.o10
‘To Plaintiffs and Others Filing First Papers. Ifyou ae fing a frst paper (for example, a complaint) in a civil case, you must
‘complete and fle, along with your frst paper, the Civil Case Cover Sheet containes on page 1. This information wil be used to compile
Statistics about the types and numbers of cases fled. You must complete items 1 through & onthe sheet. In tem t, you must creck
both a general and a more specitc type of case isted in tem 1,
one. Ifthe casa fas multple causes of action, chack the box that best indicates the primary cause of action
‘To assist you in completing the sheet, examples of the cases that belong under each case type in item 1 are provided below. A cover
sheet must be fled only with your intial paper. Failure to fle @ cover sheet wit the fist paper fied in 8 cv case may subject a party,
its counsel, or both to sanctions under rules 20 and 3.220 of the CalMfornia Rules of Coun.
‘To Parties In Rule 3.740 Collections Cases. A "calecuons casa" under rule 3.740 is defined as an action for recovery of money owed
Ina sum state tobe certain that isnot more than $25,000, exclusive of interest and attorneys fees, arising from a transaction in which
property, services, or money was acquired on credit A collections case does not include an action seeking the following: (1) tor
‘damages, (2) punitive damages, (3) recovery of real property, (4) recovery of personal property, of (6) a prejudgment wit of
attachment. The identfication of a case as ¢ rule 3.740 collections case on tis form means that it willbe exempt from the general
time-for-servce requirements and case management rues, unless a defendant fies a responsive pleading. A rule 3.740 collections
‘case wil be subject tothe requirements for service and obtaining a judgment in rue 3.740
‘To Parties in Complex Cases. in complex cases only, parties must also use the Civil Case Cover Sheet to designate whether the
case Is comple. If plant believes tne case is compiex under rule 3.400 ofthe California Rules of Court, this must be indicated by
completing tne appropriate boxes in tems 1 and 2. Ifa paintif designates a case 3s complex, the cover shoot must be served withthe
Complaint on all parties tothe action. A defendant may file and serve no later than the time ofits frst appearence a joinder inthe
Plaintiffs designation, @ counter-designation tha the case is not complex, o, iT ine plaintiff has made no designation, a designation that
the case is complex. vcontrag@ ASE TYPES AND EXAMPLES
‘Auto Tor ona Compl Civil Litigation (Cal.
‘al @2)-Peaorl iuyProaty ‘rae af Cartan (8) ‘of court Rules 3400-2400)
Oamagerorgiul Death =. Antilrust/Trade Regulation (03)
‘Uninsured Motorist (46) (the (Corkiact rot uninwtt deteiner Construction Defect (10)
case noes on united or wong eto ‘aiming tans To 40)
‘oto seco onuaearaty Bao Seter Secu tiga 2),
arbitration, check this item Plain (not rou or negigence) Environmental Toxic Tost (30)
instead of Auta) (eoohgent oe Insurance Coverage Claims
Other PHIPOIWO (Personal Injur = (arising from provisionally complex
ochre one bahay Sens
noe Cotecora e; maray one, open ames
inci ook aco) Enemmert of agnent 2)
Asbestos Property Damage Eee ‘Abstract of Judgment (Out of
‘2aoesos Pacer tot ‘ner Promissory NosCatectons ‘cou
‘irong Dea se Contes of user (nn
Proc Lay (a sb or Insranes Gowran (nt rovisonaly omen ters)
‘ovetonuaroartal 4). comptes) (1) Si State sggmert
esea Mipacice 9) ‘to Sutogaton Admnitatve agony var
‘Medical Malpractae Grier Coverage (not unpei taxes)
Prylsars& Surgeons comer Cont 7) PelboCanet of kof
Other Protesscnal Health Care Contractual Fraud “Joggment on Unpais Taxes,
‘Malpractice ter Corral Diet ‘Onna Envorcement of Judgment
ter PHP 23) oat Property ‘cae
Promeses Liaily (eg. sip Esvinene Oomainanverse Imiscolaneous Civil Complaint
ee \wongft ton (9) om
tention Bay ig oat Eton ‘ine Comp (a speci
‘eg, ssa, valor) (mer Rea: Property (eet ie) 20) soon et
Intentions nticion of ‘Wil of Possession of Rea! Property Dectaratory Ratt Only
‘motor Dass NotanocFoonre Inne Ret Oy (hone
grt ict rte se
“erator Daves ‘irr Rea Prony at eminent wechanes lar
‘other PUPDIWD dome, lndorteran, or tre: Commercid Complaint
‘Non-PI/PDIWD (Other) Tort forectosure) ‘Case (non-torvinan-complex),
Business Tor/Untair Business: Wednatit Cant ‘Other Civil Complaint
Practice (07) Gomme 38, (non-tortinon-complex)
i igs 9. discimnaion, essen (32) Niecotanaous Givi Pettion
nse aes rato Drs 8) ie cose inves eget ara and Corporate
harassment) (08) a ‘Governance (21)
‘Defamation (e.g, slander, tibet) ape 2s Commentiel cr Resitontinl, Other Petition (not specifies
cial Review
13) now ‘nove 3)
Fraud 10) atl Fete (8) Cw Horaseect
ito Propaty 10) Potton Re: Artin Avert (11) Wirspiae ance
Presson Nephgnce 25) Wot ard 2) SesaOopensen Act
peretoe ‘Wi-admiatatve Wandomes sete
(er Professional Maracioe ‘Wit Mandanusen Lied Gout econ Cortes
(not medical or legal) me Pettion for Name Change
Caner Non. PUP Tr 8) vt Oper ios Court Case Fetton br Rete Frome
Employment bere) Claim
‘Wrangil Termination (36) (Otrwt dutta Review 0) Other Civil Petition
Won vera a ‘eve ot Hain eer rer
Noteg of Repeat Labor
setae!
‘ar say 207 CIVIL CASE COVER SHEETTVET Petition for Workplace Violence _
Restraining Orders
Read How Do 1 Get an Order to Prohibit Workplace Violence (om 3
Woo Into tere contin NOTE: Fetner mast saver hp ah EO ont
be an employer with standing to bring this action under Code of COURT SHAG
Civil Procedure section 27.8. Also fil out Confidential CLETS JAN 3 202
Information (form CLETS-001) with as much information as you know. ve
JASON B. GALKIN
(A) Petitioner (Employer) EXECUTIVE OFFICER & CLERI
a. Name: County of Nevada _ | By:M, MORGAN, Deputy Cier
isa Cl corporation [sole proprietorship Fin cou ame on aol areas
specif): County Superior Court of Calfona, Coury of
andi ling this sult on behalf ofthe employee identified in tem @). | yeyanq cQUNTY SUPERIOR COURT
b. Lawyer for Petitioner ifany for this case) 1201 CHURGH STREET, SUITE
Name: Trevor Koski State Bar No.: 250230 _|NEVADAGITY GA 95950
Firm Name: Office of the County Counsel
reeciieonnenwmenonemminn GU22 -08 6192
©. Address: Rood Administrative Center 950 Maidu Ave,
City: Nevada City
Telephone: 530-265-1319
E-Mail Address:
[email protected]
2) Employee in Need of Protection
Full Name: Netalie Adona
sox: OM OF Age:
@) Respondent (Person From Whom Protection Is Sought)
Full Name: Teine Rebane Kenney Age:
Adres (non) as
City:
@) Additional Protected Persons
a. Are you asking for protection for any family or household members of the employee or for any other
employees at the employee's workplace or at other workplaces of the petitioner?
Bq Yes C1 No (Ufyes, list them)
EullName Sex Age Houschold Member? Relationship to Employee
‘Suzanne Hardin _E ___ 0 Yes ( No Co-Worker
— Cl Yes [J No
~_ Oy Yes (No
CJ Adéitional protected persons are listed in Attachment 4a
eienee keke cs
‘SenitsySieamett@™" Petition for Workplace Violence Restraining Orders WV-100, Page sof
Cnechndan aoarse 9 (Workplace Violence Prevention) =|
ick Poole, filed concurrently herewith.
@ & Why do these people need protection? (Explain)
@ Response is stated in Attachment 4b.
See Declarations of Natalie Adona, Suzanne Hardin, and
@) Relationship of Employee and Respondent
a. How does the employee know the respondent? (Describe): Response is stated in Attachment Sa,
See Declarations of Natalie Adona, Suzanne Hardin, and Nick Poole, filed concurrently herewith
'. Respondent [] is [&] isnot current employee of patitioner. (Explain any decision to retan, terminate,
or otherwise discipline the respondend 7 Response is stated in Attachment 5b
(© Venue
~~ Why are you filing inthis county? (Check all that apply.
a, The respondent lives inthis county.
b. &] The respondent has caused physical or emotional injury to the petitioner's employee inthis county.
©, Bl Other (specif): Respondents have itimidat 3 caused Plaintiffs to fear for ther safety
bara
Other Court Cases
Has the employee or any ofthe persons named in @been involved in another court case withthe respondent?
No (1 Yes yes, check each kind of case and indicate where and when each was filed:
Kind of Case Filed in (Coump/State) Year Filed Case Number (ifknnown)
(1) Workplace Violence __
2) © Civil Harassment
G) 1 Domestic Violence —
(4) © Divorce, Nullity, Legal Separation _
(5) Bi Paternity, Parentage, Child Support _
©) CO Bvietion —
@)_ O Guardianship Z
(8) Oi Smalt Claims eo
() C1 Postsecondary School Violence
(10) © Criminal
(1) Ty Other epee): _
b, Are any restraining orders or criminal protective orders now in effect relating to the employee or any of the
persons in@) and the respondent? — CJ No] Yes (ifyes, atach a copy if you have one,)
(siaewemoncs
Petition for Workplace Violence Restraining Orders W400, Page 20s
(Workplace Violence Prevention) >Description of Respondent's Conduct
‘a. Respondent has (check one or more):
(1) BB Assaulted, battered, or stalked the employee
2) Gi Made a credible threat of violence against the employee by meking knowing or willful statements or
engaging in a course of conduct that would place a reasonable person in fear for his or her safety or the
safety of his or her immediate family
'. One or more of these acts (check either or both):
(1) Took place at the employee's workplace
(2) Can reasonably be construed to be cartied out in the future atthe employee’s workplace
‘Address of workplace: 950 Maidu Ave., Nevada City, CA 95959 _
©. Describe what happened. (Provide detaits; include the dates ofall incidents beginning with the most recent; tell
who did what to whom; identify any witnesses):
BH Response is stated in Attachment Bc.
See Declarations of Natalie Adona, Suzanne Hardin, and Nick Poole
led concurrently herewith
4. Was the employee harmed or injured? ——_] Yes [No (ifyes, describe harm or injuries):
[§] Response is stated in Attachment 84.
Declarations of Natalie Adona, Suzanne Hardin, and Nick Poole, filed concurrently herewith.
«. Did the respondent use or threaten to use a gun or any other weapon? [] Yes [8] No (Ufyes, describe):
Ci Response is stated in Attachment 8e,
WV-100, Page 3 016
oceans tt Petition for Workplace Violence Restraining Orders zt
(Workplace Violence Prevention)[Case Number:
(® & Forany ofthe incidents desribed above, dd the police come?) Yes C) No [don't know
If yes, did the employee or the respondent receive an Emergency Protective Order?
C Yes (No [) I don't know
Iyes, the order protects (check all shat apply)
( theemployee the respondent Zone or more of the persons in @).
(Attach a copy of the order if you have one.)
Check the orders you want [7
® & Personal Conduct Orders
ask the court to order the respondent not to do any of te following things to the employee or to any person to
be protected listed in@)
1, & Harass, intimidate, molest, attack, strike, stalk, threaten, assault (sexually or otherwise), hit, abuse, destroy
personal property of, or disturb the peace of the person.
b. [x] Commit acts of unlawful violence on or make threats of violence to the person.
¢. (&] Follow or stalk the person during work hours or o or from the place of work.
4. 0) Contact the person, either directly or indirectly, by any means, including, but not limited to, in person, by
telephone, in writing, by public or private mail, by interoffice mail, by e-mail, by text message, by fax, or by
other electronic means.
©. & Enter the person's workplace,
© (&) Other (specifi).
7 As stated in Attachment 9f,
Respondent may contact the Clerk-Recorder's Office at any time via remote means (e.g. email or phone) to__
‘conduct Respondent's lawful business (e.g. Respondent's recall petition).
The respondent will be ordered not to take any action o get the addresses or locations of any protected person
unless the court finds good cause not to make the order
Stay-Away Order
‘a. [ask the court to order the respondent to stay at least__50. yards away from (check all that apply):
(1) & The employee, (8) BH] The employee's vehicle,
@) B The other persons listed in @ () Bl Other spech: ne ood Cone
= ar arena spondent may come to the Rood Center to
(©) & The employee's workplace wful business but must not come tothe
) BH The employee's home, second floor within 50 yards of the Clerk
(5) C The employee's school, Recorders Office.
(©) B The school of the employee's
children.
() C The place of child care ofthe employee's
children,
—_________ i EEE
Reon ina a8 Petition for Workplace Violence Restraining Orders eae Pron enie
(Workplace Violence Prevention) =>Number |
he or she still be able to get
b Ifthe court orders the respondent to stay away from al the places iste above,
tohisorher home, school, orjob? Yes L] No. (ifno, explain):
7 Response is stated on Attachment 10b,
i) Guns or Other Firearms and Ammunition
Does the respondent own or possess any guns or other firearms? [] Yes [] No [&] I don’tknow
{ie judge grants a protective order, the respondent willbe prohibited from owning, possessing purchasing
receiving or attempting fo purchase or receive a gun, other firearm, and ammunition while the protective order is
ineffect. The respondent will also be ordered to turn in ta law enforcement, or sell to or store with a licensed gun
dealer, any guns or frearms within his or her immediate possession or control
3] Temporary Restraining Order
{request that a Temporary Restraining Order (TRO) be issued against the Respondent to last until the hearing. Iam
presenting form WV-I10, Temporary Restraining Order, for the court’s signature together with this Petition,
Hs the Respondent been told that you were going to go to court to seek a TRO against him/her?
Bd Yes C]No (Ifyou answered no, explain why below):
CD Reasons are stated in Attachment 12,
(43) D Request for Less Than Five Days’ Notice of He:
You must have your papers personally served on the respondent at least five days before the hearing, unless the
court orders a shorter time for service. (Form WV-200-INFO explains what is proof of personal service. Form
WV-200, Proof of Personal Service, may be used to show the court that the papers have been served.)
Ifyou want there to be fewer than five days between service and the hearing, explain why:
i Reasons are stated in Attachment 13.
(@) & No Fee for Filing
ask that there be no filing fee because the respondent has threatened violence against the employee, or stalked
the employee, or acted or spoken in a manner that has placed the employee in reasonable fear of violence.
(ieee eos
Sorcetionaay 08 Petition for Workplace Violence Restraining Orders WV-100, Page 5 of ©
(Workplace Violence Prevention) >‘Case Number:
&) No Fee to Serve Orders
Task the court to order the sheriff or marshal to serve the respondent with the others for free because this request
for orders is based on a credible threat of violence or stalking,
@ G Court Costs
1 ask the cour to order the respondent to pay my court costs,
@ CO Additional Orders Requested
1 ask the court to make the following additional orders (specify:
1 Adeitional orders requested are stated in Attachment 17.
‘Number of pages attached to this form, if any: 10
Date: Jan 31,2022
revor Koski
Lawyer's name (if any) Ss signatare
{ 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: Jan 31, 2022
Name ofppetitioner ‘Signature
it Clerk
Tite
Peeks
Petition for Workplace Violence Restraining Orders W400, Page 8 of 8
(Workplace Violence Prevention)Cera eon
TILED
ML OF CALIFORNIA
SUPERIOR COURT OF CALIF
Sun
OFFICE OF THE COUNTY COUNSEL FEB 01 Na
Katharine L. Elliott, County Counsel (135253) anson ef bitin 7
Trevor Koski, Assistant County Counsel (250230) ESSGUTVE QECER 8 Guen
1950 Maidu Avenue, Suite 240
Nevada City, CA 95959
Tel: (530) 265-1319 Fax: (530) 265-9840
|Attomeys for Petitioner County of Nevada
SUPERIOR COURT OF THE STATE OF CALIFORNIA
COUNTY OF NEVADA
JCOUNTY OF NEVADA, ‘Case No.: CU22-086192
Petitioner [AMENDED] DECLARATION OF
vs. SUZANNE HARDIN IN SUPPORT
OF PETITION FOR TEMPORARY
TEINE REBANE KENNEY, AND PERMANENT WORKPLACE
VIOLENCE RESTRAINING ORDER
Respondent.
1, Suzanne Hardin, do hereby declare:
1, Tam an Administrative Assistant II in the Clerk Recorder's Office (“Office”) for
the County of Nevada. I have personal knowledge of the facts as contained herein and I submit
this declaration in support of the County's Petition for a Temporary and Permanent Workplace
Restraining Order against Teine Rebane Kenney, Chip Mattoon, and Jacquelyn Mattoon
(collectively “Respondents”), in which I am one of the named protected employees. If called as
{2 witness, I could and would competently testify as to the facts alleged herein.
Te
DECLARATION OF SUZANNE HARDIN IN SUPPORT OF PETITION FOR TEMPORARY AND
PERMANENT WORKPLACE VIOLENCE RESTRAINING ORDER2. My primary duties as an Administrative Assistant II in the Office are to support
the Clerk-Recorder and Election departments, As part of my duties, | sometimes interact with
the public to assist them with administrative and customer service support.
3. Tam aware that a group of Nevada County citizens (“Recall Proponents”) are
currently seeking to recall members of the Board of Supervisors, and that Respondents are part
of that larger group. Prior to the week of January 16, 2022, | had not interacted with the Recall
Proponents or Respondents.
4, was working in the Office on January 19, 2022. On that date, { had heard that
the Recall Proponents may come to the Office and I noticed that a security guard had been
stationed in front of the Office’s door. Later that day, Recall Proponents came to the Office.
Despite having a security guard at the door, they came into the Office without masks. I heard
numerous people, including the Assistant Clerk-Recorder instruct them that masks were required
inside the Office. They refused to put on masks or to leave the Office until their questions were
Janswered. ‘The Assistant Clerk-Recorder eventually answered their questions and they left.
5. Iwas working in the Office on January 20, 2022, On that date, I was informed
that the Office would be locking its door and only admitting one or two members of the public at
jatime. My understanding was that this protocol was put into place to protect the Office staff
from an incident like yesterday, where numerous members of the public entered the Office
making demands and refusing to wear masks.
6. Inthe afternoon on January 20, 2022, Respondents entered the Rood Center and
Jcame up to the Office. They knocked on the door. They were not wearing masks. I went to the
{door and opened it a small amount and informed Ms. Kenney that the Office was not allowing
People in the lobby area without a mask, She yelled, “I am coming in!” She then pushed against
the door, which knocked hard into me, Fearful for my own safety and the safety of my co-
}workers, | tried to close the door. Ms. Kenney then put her foot and arm through the door,
2:
DECLARATION OF SUZANNE HARDIN IN SUPPORT OF PETITION FOR TEMPORARY AND
PERMANENT WORKPLACE VIOLEN TRAINING ORDER10
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13
4
15
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20
2
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[preventing it from being closed. When I realized | could not close the door, | stopped pushing on
the door, and the three Respondents pushed their way into the Office.
7. Once in the Office, Ms. Kenney told me that I injured her and demanded to know
my name. I gave her my name and told her that I felt unsafe and threatened by her actions.
8, The Assistant Clerk-Recorder immediately came to speak with the Respondents,
Jand I went back to my office to collect myself because I felt very shaken by the interaction,
9. Lwas in the Office on January 21, 2022. On that day, I learned that the Office had
[suspended in-person services and locked its door. Later that aftemoon, Recall Proponents
‘marched around the building multiple times blowing a horn. After approximately one hour, they
Jentered the Rood Center and came up to the Office. They knocked loudly on the door and I
could hear them yelling. ‘They sounded angry. | felt trapped. I was worried that they would not
leave. I was scared that if | or any of my co-workers did have to leave, the Respondents would
use physical violence to force their way into the Office. Respondents were outside the locked
Office door for approximately 45 minutes before they left.
10. Respondents’ threatening and escalating behavior, which has already resulted in
{them slamming a door into me and forcing their way into a locked office, has caused me to fear
that they
again act out violently against me or my co-workers,
| declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct based on my information and belief, Executed this thirty-first day
of January, 2022, in Nevada City, California,
DECLARATION OF SUZANNE HARDIN IN SUPPORT OF PETITION FOR TEMPORARY AND.
PERMANENT WORKPLACE VIOLENCE RESTRAINING ORDER‘SUPERIOR COURT OF CALIFORNIA
\SOURTY OF NEVADA
OFPICE OF THE COUNTY COUNSEL B01 2022
Katharine L. Elliott, County Counsel (135253) FEB 0}, an
Trevor Koski, Assistant County Counsel (250230) EXECUNVE DERGRR GS ERK
}950 Maidu Avenue, Suite 240 By: M. MORGAN, Deputy Clerk
Nevada City, CA 95959
Tel: (530) 265-1319 Fax: (530) 265-9840
‘Attorneys for Petitioner County of Nevada
SUPERIOR COURT OF THE STATE OF CALIFORNIA
COUNTY OF NEVADA
COUNTY OF NEVADA, Case No.: CU22-086192
Petitioner [AMENDED] DECLARATION OF
vs. NATALIE ADONA IN SUPPORT OF
PETITION FOR TEMPORARY AND
‘TEINE REBANE KENNEY, PERMANENT WORKPLACE
VIOLENCE RESTRAINING ORDER
Respondent
1, Natalie Adona, do hereby declare:
1, Lam the Assistant Clerk-Recorder for the County of Nevada, I have personal
knowledge of the facts as contained herein and I submit this declaration in support of the
County's Petition for a Temporary and Permanent Workplace Restraining Order against Teine
Rebane Kenney, Chip Mattoon, and Jacquelyn Mattoon (collectively “Respondents”), in which I
am one of the named protected employees. If called as a witness, I could and would competently
testify as to the facts alleged herein,
_
DECLARATION OF NATALIE ADONA IN SUPPORT OF PETITION FOR TEMPORARY AND PERMANENT
WORKPLACE VIOLENCE RESTRAINING ORDER10
12
13
“4
16
7
18
19
20
21
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28
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2. In late 2021, a group of Nevada County voters (“Recall Proponents”) served each
member of the Nevada County Board of Supervisors with a petition to recall. Respondents are
part of the Recall Proponent group,
3. ‘The Clerk Recorder's Office (“Office”) is located in the Rood Center, which is a
]County building, The County currently has a Local Health Officer Order that requires people to
}wear masks indoors when in public, regardless of their vaccination status. California also
indoor public spaces such as the Rood Center
‘currently has an indoor mask mandate that covers
Jand the Office. The Rood Center has security guards that inform members of the public who
Jcome into the building that masks are required.
4. Over the past few weeks, the number of Covid-19 cases in the County has
skyrocketed, Last week was the highest weekly total of recorded Covid-19 cases within the
[County since the pandemic began. The current surge of Covid-19 cases has caused the County
in the Office, which
to encourage many of its employees to work remotely. Most employe
Provides services directly to the public, do not have the option of remote work. ‘To provide a
safe workplace to our employees, particularly during the current surge in Covid-19 cases, the
Office strictly enforces the State and local health orders requiring that employees and members
of the public who enter the Office wear masks.
5. Over the past month, I have been in repeated contact with the Recall Proponents
concerning their recall petitions. These contacts include phone calls, emails, and Recall
Proponents coming into the Clerk-Recorder's Office.
6. On January 19, 2022, a group of approximately six Recall Proponents came to the
Office. ‘The Recall Proponents were not wearing masks. A security guard was stationed in the
lobby of the Rood Center and at the door to the Office, My understanding is that the security
guards informed the Recall Proponents that they could not enter the Rood Center, and then the
(Office, without a mask. ‘The Recall Proponents did not pul on masks or leave. They pushed past
the security guard stationed at the Office's door and came inside.
=
DECLARATION OF NATALIE ADONA IN SUPPORT OF PETITION FOR TEMPORARY AND PERMANENT
WORKPLACE VIOLENCE RESTRAINING ORDER7. Once the Recall Proponents were in the Office, I came and informed them that
‘masks were required and I repeatedly asked that they put on masks. | also offered alternative
‘means to obtain Clerk-Recorder services outside the Office, as I had in the past, where masks
would not be required. They refused to put on masks and refused to leave, insisting that they
| would first discuss their recall petitions in person. At that point, { decided that for the safety of
myself and my staff, | would assist them as quickly as possible, hoping they would then go on
their way without further incident, which is what occurred.
8. After the Recall Proponents left, the Clerk-Recorder made the decision to lock the
Office's door and let customers in one or two at a time, depending on whether marriage services
were requested. This decision was made to protect staff from harassment, intimidation, the
threat of violence, and to provide them a safe and healthy workplace.
9. (On January 20, 2022, Respondents came back to the Rood Center. They again
refused to wear masks and came inside the Rood Center and up to the Office. They knocked on
the locked door of the Office. ‘They did not have an appointment. An employee in the Office
‘cracked the door open to tell them that they would have to put on masks to enter the Office. My
‘understanding is that Teine Rebane Kenney said, “I am coming in,” and began pushing the door
into the employee. ‘The employee, being pushed backward, instinctually attempted to push the
door closed, but Ms. Rebane had inserted her arm and foot through the door and was continuing
to push. Respondents then pushed open the door and came inside. Ms. Rebane allegedly stated
that she was injured and threatened the employee with legal action
10, Once Respondents had pushed open the door and entered the Office, | came over
to speak with them. Most of my staff present at that time retreated to the back of the Office,
where there is a door that can be locked to the lobby area. For the safety of myself and my staff,
| again did my best to assist them so that they would leave without further incident.
11, Following this incident, on January 20, 2022, the Clerk-Recorder closed all in-
person services, This decision was made to protect Clerk-Recorder staff from harassment,
s
DECLARATION OF NATALIE ADONA IN SUPPORT OF PETITION FOR TEMPORARY AND PERMANENT
WORKPLACE VIOLENCE RESTRAINING ORDER20
21
2
23
4
25
26
2
intimidation, the threat of violence, and to provide them a safe and healthy workplace. To notify
the public of this, a sign was placed on the door, stating that the Office was closed for in-person.
services. Alternatives to in-person services, such as phone service and drop-box service, are
offered to all people seeking assistance on any service
12, Thenext day, on January 21, 2022, a large group of Recall Proponents came to
the Rood Center. { believe that Respondents were part ofthis group. ‘The Recall Proponents
marched around the building multiple times blowing a horn, After approximately one hout, a
group of them came inside the Rood Center and up to the Office. They were not wearing masks,
Theard them knocking loudly on the locked door. could also hear them shouting, complaining
that the Office was closed to in-person services, and complaining about other doors in the Rood
Center being locked.
13. For approximately 45 minutes, the Recall Proponents remained outside the locked
doors of the Office apparently attempting to gain entrance. In addition to our door, the Recall
Proponents also knocked on various other County department offices near the Office demanding
information. | instructed my staff to not open the door. I did this because I was fearful that if the
door was opened, the Recall Proponents would again physically force their way into the Office
Jand potentially become violent. | had a genuine fear for my safety, and the safety of my
jemployees, from the Recall Proponents, and in particular, the Respondents, who continue to
cscalate situations whenever they are required to follow the rules of the Office.
14, Over the past week, multiple employees in the Office have reported to me that
they feel intimidated, harassed, and have a genuine fear for their own safety from the
Respondents and from the Recall Proponents more generally. Employees reported feeling
trapped when the Respondents and other Recall Proponents are outside the Office door.
Employees have reported that they are scared to leave to go the bathroom, to conduct personal
‘errands on their breaks, or leave the Office for any reason. ‘They fear for their own safaty and,
specifically, that the Respondents will again physically force their way into the Office. Multiple
aa
DECLARATION OF NATALIE ADONA IN SUPPORT OF PETITION FOR TEMPORARY AND PERMANENT
WORKPLACE VIOLENCE RESTRAINING ORDER22
23
24
25
26
27
‘employees also expressed concem for themselves and family members who are at increased risk
of complications due to COVID-19.
15. Respondents’ threatening and escalating behavior, which hes already turned
physically violent once, have caused me to fear that they will act out violently against me or my
employees.
16. If Respondents are restrained by the Court from coming near me and the Office,
the Office will ensure that Respondents will be able to conduct any business they have with the
Office, including the recall, through remote means such as the teléphone, email, and physical
drop boxes. This Office does not want to interfere with Respondents’ legitimate activities. It
only seeks to protect its employees from intimidation and the threat of physical violence they
currently feel.
I declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct based on my information and belief. Executed this thirty-first day
of January, 2022, in Nevada City, California.
= —
‘Natalie Adona
=
DECLARATION OF NATALIE ADONA IN SUPPORT OF PETITION FOR TEMPORARY AND PERMANENT
WORKPLACE VIOLENCE RESTRAINING ORDERSUPERIOR CouRT OF
‘COUNTY OF NEVADA Ot
Fi
OFFICE OF THE COUNTY COUNSEL 6B on 2
Katharine L. Elliott, County Counsel (135253) execd AGN 2: SALKINY |
Trevor Koski, Assistant County Counsel (250230)
}950 Maidu Avenue, Suite 240
Nevada City, CA 95959
Tel: (530) 265-1319 Fax: (530) 265-9840
‘Attorneys for Petitioner County of Nevada
SUPERIOR COURT OF THE STATE OF CALIFORNIA
COUNTY OF NEVADA
COUNTY OF NEVADA, Case No.: CU22-086192
Petitioner [AMENDED] DECLARATION OF
vs. NICK POOLE IN SUPPORT OF
PETITION FOR TEMPORARY AND
'TEINE REBANE KENNEY, PERMANENT WORKPLACE
VIOLENCE RESTRAINING ORDER
Respondent.
I, Nick Poole, do hereby declare:
1. Tam the Risk Manager for the County of Nevada. I have personal knowledge of
the facts as contained herein and I submit this declaration in support of the County's Petition for
a Temporary and Permanent Workplace Restraining Order against Teine Rebane Kenney, Chip
Mattoon, and Jacquelyn Mattoon (collectively “Respondents”). If called as a witness, I could
and would competently testify as to the facts alleged herein,
DECLARATION OF NICK POOLE IN SUPPORT OF PETITION FOR TEMPORARY AND PERMANENT
WORKPLACE VIOLENCE RESTRAINING ORDER
By: M. MORGAN, Deputy Clotk
a2, Part of my role as the Risk Manager is serving as the County Safety Officer. As
Safety Officer, | am responsible to ensure a safe, secure and healthful work environment to
|County employees in compliance with State and Federal regulations.
3. Tam aware that a group of Nevada County citizens (“Recall Proponents") are
currently secking to recall members of the Board of Supervisors, and that Respondents are part
of that larger group. | am familiar Respondents and can identify them by sight,
4, [have reviewed security footage from the Rood Center for January 19, 20, and
21, 2022.
5. Respondents were the only Recall Proponents who forced their way through
locked door and into the Clerk-Recorder’s Office on January 20, 2022.
6, Respondents were part ofa larger group of Recall Proponents who came to the
Rood Center, and then up to the Clerk-Recorder’s Office, on January 21, 2022. Respondents and
other Recall Supporters were in the hallway near the Clerk Recorder's Office, knocking on the
(Clerk Recorder's Office door and other nearby doors, for approximately 30 to 45 minutes.
| declare under penalty of perjury under the laws of the State of California that the
foregoing is true and correct based on my information and belief. Executed this thirty-first day
of January, 2022, in Nevada City, California,
NICK POOLE
a
DECLARATION OF NICK POOLE IN SUPPORT OF PETITION FOR TEMPORARY AND PERMANENT
WORKPLACE VIOLENCE RESTRAINING ORDERNVAEUME Temporary Restraining Order pomsees ee hae ran frm
@ Petitioner (Employer) ark td Broun
&. Name: County of Nevada
Layer ethos fan or isc) FEB 01 202,
Name: ‘Trevor Kos State Bar No:250230 wagon e SN
‘irm Name: i 1¢ County Cot (ECUTIVE OFFICER
Fim Name: Oreos Coun Comssi______| exenlvg ort5 8 Cogn
b. Your Address (7you have a lawyer, give your lawyer's information,):
Address: Rood Administrative Center 950 Maid A\
Flin cour name and seat eases
City: Nevada City State: CA [Superior Court of Gaiforla, County of
‘Telephone: 530-265-1319 Fax:
E-Mail Address:
[email protected] NEVADA COUNTY SUPERIOR COURT
201 CHURCH STREET, SUITE 5
Employee (Protected Person) NEVADA CITY CA 95969
Full Name: Natalie Adona ‘Santis ave ninbSTaRON ESE
@ Respondent (Restrained Person) C jc Drm 0 8 6 9 2
Full Name: eine Rebane Kenney _&
Description:
sex: MG F Height: Weight: Date of Birth:
Hair Color: Red Eye Color: Age: $6 Rave: _
Home Address (finowy):
City: State: CA Zip: 95949
Relationship to Employee:
& Additional Protected Persons
In addition to the employee, the following family or household members or other employees are protected by the
temporary orders indicated below:
EulLName Sex Age Household Member? Relation to Employee
Suzanne Hardin F C1 Yes No Co_Worker
_ 1 Yes C] No -
- - 1 Yes [ No __
1 Additional protected persons are listed atthe end ofthis Order on Attachment 4.
Expiration Date
This Order expires at the end of the hearing scheduled for the date and time below:
pa: 2IZLJ2aLL Time:
Bierce
his
10, Page tof
ceases ceirmicazeree™" Temporary Restraining Order (CLETS—TWH)
Seecetedesen guracaite (Workplace Violence Prevention)[Case Number: |
‘The court has issued the temporary orders checked as granted below. If you do not obey these orders, you can be
arrested and charged with a crime, You may have to go to jail for up to one year, pay a fine of up to $1,000, or
both.
@) Personal Conduct Orders
OC Not Requested () Denied Until the Hearing gq Granted as Follows:
8. Youare ordered not do the following things tothe employee
AL and tothe other protected persons listed
(1) Harass, motes, strike, assault (sexually or otherwise, batter, abuse, destroy personal property of, ot
disturb the peace ofthe person,
@) R) Commit acts of violence or make threats of violence against the person.
@) BRL Follow or stalk the person during work hours o to or from the place of work
(4) C 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 e-mail, by fax, o by other electronic means
(5) Ba Enter the workplace ofthe person.
(6) & Take any action to obtain the person’s address or locations. If this item is not checked, the court has
found good cause not to make this order.
(1) & other (specify)
(Other personal conduct orders are attached atthe end of this Order on Attachment 63(7).
Respondent may contaet the Clerk-Recorder’s Office at any time via remote means (e.2. email or
Phone) to conduct Respondent's lawful business (e.g. Respondent's recall petition).
b. 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. However, you may have your papers served by mail
oon the petitioner.
@ Stay-Away Order
(Not Requested |) Denied Until the Hearing Xl Granted as Follows:
@ You must stay at least___50_yards away from (check all that apply)
(1) BQ The employee (1) D The employees children’s place of child care
(2) & Each other protected person listed in@) (8) AR, The employee's vehicle
@) 58 The employee's workplace (9) $f Other (specif)
4) fal the employee Spondent may come to the Rood Center to
(0) fine enpioye's home cond evil busnes ut ust not come Be
(8) O The employee's schoo! building's second floor within 50 yards of the Clerk.
(©) G The employee's children’s schoo! Recorder's Office.
b. This stay-away order does not prevent you from going to or from your home or place of employment.
his is a Court Order
Temporary Restraining Order (CLETS—TWH) WV10, Page 2015
(Workplace Violence Prevention) >‘Case Number
@) No Guns or Other Firearms and Ammunition
1. You cannot own, possess, have, buy or try to buy, receive or try to receive, or in any other way get guns, other
firearms, or ammunition,
b. You must:
(1) Sell to or store with a licensed gun dealer or turn in toa law enforcement agency any guns or other firearms,
in your immediate possession or control, This must be done within 24 hours of being served with this
Order,
(2) File a receipt with the court within 48 hours of receiving this Order that proves that your guns or firearms
have been turned in, sold, or stored. (You may use form WV-800, Proof of Firearms Tumed In, Sold, ot
Stored for the receipt.)
©. [The court has received information that you own or possess a firearm.
@) Other Orders
[Not Requested [] Denied Until the Hearing (Granted as Follows (specify
(1) Additional orders are attached at the end of this Order on Attachment 9.
Mandatory Entry of Order Into CARPOS Through CLETS
‘This Order must be entered into the California Restraining and Protective Order System (CARPOS) through the
California Law Enforcement Telecommunications System (CLETS). (Check one):
a. (The clerk will enter this Order and its proof-of-service form into CARPOS,
'b. Cl The clerk will transmit this Order and its proof-of-service form to a law enforcement agency to be entered
into CARPOS.
©. [1 By the close of business on the date that this Order is made, the employer or the employer's lawyer should
deliver a copy of the Order and its proof-of-service form to the law enforcement agencies listed below to
enter into CARPOS:
‘Name of Law Enforcement Agency ‘Addvess (Cp, State, Zip)
Additional taw enforcement agencies are listed a the end ofthis Order on Attachment 10.
@) No Fee to Serve (Notify) Restrained Person | Ordered} Not Ordered
The sheriffor marshal will serve this Order without charge because:
a. P& The Order is based on a credibie threat of violence or stlking,
b. J The petitioner is entitled to a fee waiver
eee kosakoncn
fever 87 Temporary Restraining Order (CLETS—TWH) W110, Page See
(Workplace Violence Prevention)5
cal O}
Warnings and Notices to the Restrained Person in@
You Cannot Have Guns or Firearms
You cannot own, have, possess, buy or try to buy, receive or ty to receive, or otherwise get guns, other firearms, oF
ammunition while this Order is in effect. Ifyou do, you can go to jail and pay a $1,000 fine. You must sell to or store with
2 licensed gun dealer or tum in to a law enforcement agency any guns or other firearms that you have or control as stated
in item@®) above. The court will require you to prove that you did so.
Notice Regarding Nonappearance at Hearing and Service of Order
Ifyou have been personally served with this Temporary Restraining Order and form WV-109, Notice of Court Hearing,
but you do not appear atthe hearing either in person or by a lawyer, and a restraining order that is the same as this
‘Temporary Restraining Order except for the expiration date is issued atthe hearing, @ copy of the order will be served on
you by mail atthe address in item (3).
If this address is not correct or you wish to verify that the Temporary Restraining Order was converted into a restraining
onder at the hearing without substantive change, o to find out the duration of the order, contac the clerk of the court.
After You Have Been Served With a Restraining Order
+ Obey all the orders. Any intentional violation of this Order is a misdemeanor punishable by a fine or by
imprisonment in a county jail, or by both fine and imprisonment. (Pen. Code, § 273.6.)
+ Read form WV-120-INFO, How Can I Respond to a Petition for Orders to Stop Workplace Violence?, to learn
how to respond to this Order.
+ If you want to respond, fill out form WV-120, Response to Petition for Workplace Violence Restraining Orders,
‘and file it with the court clerk, You do not have to pay any fee to file your response ifthe petition claims that you
threatened violence against or stalked the employee, or placed the employee in reasonable fear of violence.
+ You must have fort WV-120 served on the petitioner or the petitioner's attorney by mail. You cannot do this yourself,
‘The person who does the service should complete and sign form WV-250, Proof of Service of Response by Mail. File
the completed proof of service with the court clerk before the hearing date or bring it with you to the hearing,
+ Invaddition to the response, you may file and have declarations served, signed by you and other persons who have
personal knowledge of he facts. You may use form MC-030, Declaration, for this purpose. It is available from the
clerk’s office atthe court shown on page I of this form or at www.couris.ca goviforms. If you do not know how to
prepare a declaration, you should see a lawyer.
+ Whether or not you file a response, you should attend the hearing. Ifyou have any witnesses, they must also go to the
hearing,
+ Atthe hearing, the judge can make restraining orders against you that last for up to three years, Tell the judge why you
disagree with the orders requested.
eve ny. 207 ‘Temporary Restraining Order (CLETS—TWH) WV.110, Pope of 5
(Workplace Violence Prevention) >eae nis
Enforcing the Restraining Order
This order is enforceable by any law enforcement agency that has received the order, is shown a copy of the order, or has
verifed its existence on the California Restraining and Protective Orders System (CARPOS). Agencies ere encouraged to
enter violation messages into CARPOS. Ifthe law enforcement agency has not received proof of service on the restrained
person, the agency must advise the restrained person of the terms of the order and then must enforce it. Violations ofthis
| Order te subject o ermal penalties,
Start Date and End Date of Orders
‘This order starts on the date next tothe judge’s signature on page 4. The order ends on the expiration date in item S on
page 1.
If the Protected Person Contacts the Restrained Person
Even if the protected person invites or consents to contact with the restrained person, this order remains in effect and must
be enforced. The protected person cannot be arrested for inviting or consenting to contact with the restrained person. The
order can be changed only by another court order. (Pen. Code, § 13710(b).)
Conflicting Orders—Priorities for Enforcement
ifmore than one restraining order has been Issued, the orders must be enforced according to
} the following priorities: (See Pen. Code, § 136.2, Fam, Code, §§ 6383(h)(2), 6405(b).)
1. EPO: If one of the orders is an Emergency Protective Order (form EPO-001) and is more restrictive than other
restraining or protective orders, it has precedence in enforcement over all other orders.
2. No Contact Order: If there is no EPO, a no-contact onder that is included in a restraining or protective order has
precedence over any other restraining or protective order.
3. Criminal Order: If none ofthe orders includes a no contact order, a domestic violence protective order issued in &
criminal case takes precedence in enforcement over any conflicting civil court order. Any nonconflicting 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 oF protective order
has been issued, the one that was issued last must be enforced.
(Clerk will fill out this part)
—Clerk’s Certificate—
| certify that this Temporary Restraining Order is a true and correct copy of the
original on file inthe court.
/; 1
pate 2// /92.2
eet wna 1217 Temporary Restraining Order (CLETS—TWH) WV-110, Pepe 05
(Workplace Violence Prevention)ME Notice of Court Hearing
Petitioner (Employer) ‘SUPERIOR 0 CALIFORNIA]
© Petitioner Employer vada AAD Bt
Lawyer for Petitioner (ifany for this case). FEB 4 2
Name; Trevor Koski __ State Bar No.:250230__ AON
Firm Name: Office of the County Counsel exeoUfve OFFICER & CLERK
b. Address (you have a lawyer, give your lawyer's information.)
Rood Administrative Center 950 Maidu Ave.
Address:
| city, Nevada City State;CA
| Telephone: 930-265-1319
Fax:
| E-Mail Address:
[email protected]
@ Employee in Need of Protection
Full Name: Natalie Adona and Suzanne Hardin cli2"- 08619
(&) Respondent (Person From Whom Protection Is Sought) 2
Full Name; Teine Rebane Kenney
ian wars daa hava whos Tne Wd,
By: M. MORGAN, Deputy Clerk
Film cou ama nd seat adi
[Supertor Court of California, County of
Nevada County Superior Court
[201 Church Street
INevada City, CA 95959
7p:95959
‘ilingaee number
The court will complete the rest of this form.
@) Notice of Hearing
A court hearing is scheduled on the request for restraining orders against the respondent:
(me Pome Cf2H{ 201 Hp
‘e
Dept.: Room:
‘Name and address of court if different from above:
©) Temporary Restraining Orders (Any orders granted are on Form WY-110, served with this notice)
‘Temporary Restraining Orders for personal conduct and stay away orders as requested in Form WV-100,
Request for Workplace Violence Restraining Orders, are (check only one box below):
(1) SEAN GRANTED until he cour hearing,
2) O AN DENIED until the court hearing, (Specify reasons for denial in b, below.)
(3) Cl Partly GRANTED and partly DENIED until the court hearing. (Specify reasons for denial in
6, below.)
Sa Ron are
Notice of Court Hearing
(Workplace Violence Prevention)Number
. Reasons that Temporary Restraining Orders as requested in Form WV-100, Petition for Workplace
Violence Restraining Orders, for personal conduct or stay away are denied are:
(1) CJ The facts as stated in Form WV-100 do not sufficiently show reasonable proof that the employee
has suffered unlawful violence or a credible threat of violence by the respondent, and that great or
irreparable harm to the employee would result ifa temporary restraining order is not issued,
2) O Other (specify): 01 As stated on Attachment Sb.
© Service of Documents by the Petitioner
Atleast £2 five 1 days before the hearing, someme age 18 or older—not you or anyone to be
protected—imust personally gine (serve) a court file-stamped copy of this Form WV-109, Notice of Court Hearing,
to the respondent slong with copy ofall the forms indicated below:
& WV-100, Petition for Workplace Violence Restraining Orders ile-stamped)
b. C1 WV-110, Temporary Restraining Order (file-stamped) IF GRANTED
©. WV-120, Response fo Petition for Workplace Violence Restraining Orders (blank form)
4. WV-120-INFO, How Can I Respond to a Petition for Workplace Violence Restraining Orders?.
& WV-250, Proof of Service of Response by Mall (blank form)
£ Other Gags sme
nll, 2000-
ial Office
ieee nee
+ The court cannot make the restraining orders after the court hearing unless the respondent has been personally
given (served) a copy of your request and any temporary orders. To show that the respondent has been served,
the person who served the forms must fill outa proof of service form. Form WV-200, Proof of Personal
Service, may be used.
+ For information about service, read Form WV-200-INFO, What ls “Proof of Personal Service”?
+ Ifyou are unable to serve the respondent in time, you may ask for more time to serve the documents. Use
Form WV-115, Request 1o Continue Court Hearing and to Reissue Temporary Restraining Order.
Notice of Court Hearing
(Workplace Violence Prevention)[base Number:
* Ifyou want to respond tothe request for orders in writing, file Form WV-120, Response fo Request for
Workplace Violence Restraining Orders, and have someone age 18 or oldet—not you oF anyone to be
protected—mail it to the petitioner.
*+ The person who mailed the form must fil outa proof of service form. Form WV-250, Proof of Service of
Response by Mail, may be used, File the completed form with the court before the hearing and bring a copy with
‘you to the court hearing.
* 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 three years and
‘may order you (o sell or turn in any firearms that you own or possess.
Request for Accommodations
Assistive listening systems, computer-tsisted real-time captioning or sign language
interpreter services are available if you ask atleast five day’ before the hearing. Contact the
clerk's office or go to www.courts.ca.gov/forms for Request for Accommodations by Persons
| ‘with Disabilities and Response (Form MC-410), (Civ. Code, § 548.)
(Clerk will fill ou this part)
| —Clerk’s Certificate—
| certify that this Notice of Court Hearing is a true and correct copy of the original on file in the court.
pues 2 Dop2
ret ty VVC _oepuy
ao Notioa of Gear Hea W09, Para
9
(Workplace Violence Prevention)