CH-170

Notice of Order Protecting 
Information of Minor

Clerk stamps date here when form is filed.

1

Confidential Information
The court has made some information in this case confidential.  
Details of the order for confidentiality are in form CH-165, Order on 
Request to Keep Minor's Information Confidential. Confidential 
information may be given only to law enforcement to enforce the 
restraining order.

2

Documents Attached to This Notice

The following documents contain confidential information:

a.

b.

c.

d.

e.
f.

g.

h.

Form CH-100, Request for Civil Harassment Restraining Orders

Form CH-109, Notice of Court Hearing

Form CH-110, Temporary Restraining Order

Form CH-160, Request to Keep Minor’s Information Confidential
Form CH-165, Order on Request to Keep Minor's Information 
Confidential

Form CH-175, Cover Sheet for Confidential Information (leave 
blank)

Other:

Fill in court name and street address:
Superior Court of California, County of

Instructions to Clerk 
When providing copies of 
unredacted filed documents to any 
party, you must attach this cover 
sheet on top of the document or set 
of documents. Complete item       to 
indicate the forms that are attached.

2

Form CH-130, Civil Harassment Restraining Order After Hearing

Case Number:

(Court fills in this case number when form is filed.)

3

4

Filing Documents
If you file any document that contains any confidential information in this case or other civil case with the same 
parties, you MUST also use form CH-175 as a cover sheet. See form CH-165, item       , for all information made 
confidential by the court.  

7

To person receiving this notice: 
Unless authorized by the court or by law, you may be sanctioned up to $1,000 or face other court penalties if you 
misuse or disclose the information that is confidential in this case to anyone other than law enforcement. See Code 
of Civil Procedure section 527.6(v)(3) for the limited situations in which disclosures can be made without the court's 
permission. 

Judicial Council of California, www.courts.ca.gov  
Rev. September 1, 2020, Mandatory Form 
Code of Civil Procedure, § 527.6(v) 

Notice of Order Protecting Information of Minor 
(Civil Harassment Prevention)

CH-170, Page 1 of 1