INSTRUCTIONS FOR PROGRAM OPERATORS
LAWSUITS TO PROHIBIT ABUSE OR PROGRAM MISCONDUCT
(Transitional Housing Misconduct Act)
(Civil Code section 1954.10 et seq.)

TH-200

Read the "General Instructions" first. Then read the special instructions for program operators 
on page three.

GENERAL INSTRUCTIONS

WHO CAN GET ORDERS PROHIBITING ABUSE OR MISCONDUCT?

Individuals or organizations that run a transitional housing program can ask the court for these orders. The Transitional 
Housing Misconduct Act applies only if the housing program

(1)

(2)
(3)
(4)
(5)

is run by a government agency, a private nonprofit corporation that receives program funds from a  
government agency, or an operator hired by one of the above to run the program;
helps homeless persons obtain the skills necessary for independent living in permanent housing;
includes regular individualized case management services;
provides a structured living environment and requires compliance with program rules; and
restricts the occupancy period to not less than 30 days but not more than 24 months.

Only the program operator can ask the court for orders against a participant. A program participant cannot ask the court 
for orders against a fellow participant, nor can program employees or neighbors of the program site ask for orders. The 
program operator can, however, petition on their behalf.

TO WHOM DO THESE ORDERS APPLY?

A program operator can ask the court for orders against a homeless person who is now a participant in the housing 
program. Someone is a homeless person if, before coming to the housing program, he or she lacked a regular and 
adequate nighttime residence or the most recent nighttime residence was

(1)

(2)

(3)

a supervised shelter designed to provide temporary housing; or 

an institution that provides temporary housing for individuals intended to be institutionalized; or

a place not designed or ordinarily used as sleeping accommodations for humans.

Someone is a participant in a housing program if he or she signed a contract with the program as a condition to getting 
housing. The program operator can get orders only against a participant who has signed a contract that includes

(3)

(1)
(2)

the housing program's rules;
a statement of the program operator's right of control and access over the unit occupied by the 
participant; and
a restatement of the procedures and rights created by the Transitional Housing Misconduct Act.
The program operator can ask for orders against the participant and anyone living with the participant at the program site. 
The operator must prove program misconduct or abuse, however, for each individual against whom orders are granted.    
Restraining orders issued under this act apply only to the persons named in the order. That means that if the court orders 
only one member of a family to move out of program housing, the rest of the family members may remain in the program 
(unless they are all minors).

Form Adopted for Mandatory Use 
Judicial Council of California 
TH-200 [Rev. September 1, 2018]

INSTRUCTIONS FOR PROGRAM OPERATORS 
(Transitional Housing Misconduct)

(Continued on reverse)

Page 1 of 8

Civil Code,§ 1954.10 et seq. 
www.courts.ca.gov

TH-200

WHEN CAN THE COURT MAKE ORDERS PROHIBITING ABUSE OR MISCONDUCT?

Program operators can ask the court for orders if the participant has engaged in program misconduct or abuse. 
Theparticipant's conduct is program misconduct if

(1)
(2)

(3)

the participant intentionally broke the program rules;
the participant's conduct substantially interferes with the program operator's ability to run the 
housingprogram; and
the conduct relates to
(a)
(b)

drunkenness, sale or use of drugs, theft, arson, or destruction of another person's property; or
violence or threats of violence directed at, and harassment of, immediate neighbors of the program site, 
program employees, or other participants.

The participant's conduct is abuse if

(1)

(2)

the participant did or attempted to attack, strike, batter, or sexually assault other participants, program 
employees, or immediate neighbors of the program site; or
the participant threatened to attack, strike, batter, or sexually assault the above individuals.

WHAT KINDS OF ORDERS ARE AVAILABLE TO PREVENT ABUSE OR MISCONDUCT?

A program operator can request a Temporary Restraining Order or a "permanent" order (Order After Hearing), or both. 
These both are court orders forbidding someone from engaging in the activity described in the order. A Temporary 
Restraining Order is issued by a judge after a request for a permanent order has been filed, but before there has been a 
full hearing. Permanent orders can be issued only after a full hearing before a judge, where both the participant and the 
program operator can be represented by attorneys and have the opportunity to present evidence.

TEMPORARY RESTRAINING ORDERS ("TRO") BEFORE THE HEARING

A TRO orders the participant to stop the abuse or misconduct and goes into effect immediately. The order lasts a maxi- 
mum of five days. The court may not be able to grant a hearing within five days, in which case the order will last until the 
hearing. To get a TRO the program operator must prove that the participant has engaged in program misconduct or abuse 
and that great or irreparable harm will result before the hearing if the TRO is not granted.
In limited circumstances, the judge can use a TRO to order the participant to move out. The judge will do this only if it is 
necessary to protect another participant, a program employee, or an individual who lives within 100 feet of the program 
site from imminent serious bodily injury. To get a TRO excluding the participant from program housing, the program 
operator must provide clear and convincing evidence that the participant engaged in abuse and that great or irreparable 
injury will result before the hearing if the participant is not ordered to move out or stay away from the housing program, or 
both.
If the participant has been living in program housing under contract for six months or longer, the program operator cannot 
get a TRO unless an action is pending against the participant or a TRO is already in effect and is subject to further orders. 
The program operator may still use unlawful detainer procedures or file for a permanent order only. 

You must give notice to the participant before asking for a TRO. Notice requires you to show the judge that

(1)

(2)

(3)

before applying for the TRO you told the participant or the participant's attorney when and where the 
application would be made; or
you made a good-faith effort to tell the participant or the participant's attorney; or
you should not have to give notice because great harm would result to a program operator, participant, or 
immediate neighbor of the program site before the hearing.

ORDER AFTER HEARING ("PERMANENT" ORDERS)
Temporary restraining orders last a maximum of five days or until the hearing. When the judge issues the TRO, he or she 
will set a date for the hearing on the permanent order (also called the Order After Hearing or "injunction"). A "per-manent" 
order issued after a hearing lasts up to one year.
The program operator seeking the order must have the following papers delivered (served) to the participant at leasttwo 
days before the hearing

(1)
(2)
(3)
(4)
(5)

a copy of the Order to Show Cause (Transitional Housing Misconduct);
a copy of the Temporary Restraining Orders (if any);
a copy of the Petition for Order Prohibiting Abuse or Program Misconduct;
a blank Participant's Response (Transitional Housing Misconduct);
two copies of a blank Attached Declaration (form MC-031);

TH-200 [Rev. September 1, 2018]

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(Continued on reverse)

INSTRUCTIONS FOR PROGRAM OPERATORS 
(Transitional Housing Misconduct)

TH-200

Order After Hearing continued

(6)
(7)
(8)

a blank Proof of Personal Service (Transitional Housing Misconduct);
a copy of these instructions; and
copies of all materials (affidavits and supporting memoranda) to be used in the hearing.

The Order to Show Cause must contain the name and phone number of the Legal Services Office in the county where the 
petition was filed, and must inform the participant this office may be called for legal advice about responding to the 
request for court orders.
In limited circumstances the court will make a permanent order for the participant to move out of or keep away from the 
program site. To get this type of order, the program operator must provide clear and convincing evidence that the 
participant engaged in abuse and that great or irreparable injury will result if the order is not  granted.

1.

2.

3.

4.

1.

2.

3.

4.

5.

WHAT IS NEEDED TO GET THE COURT ORDERS OR TO OBJECT TO THEM?
Transitional Housing Misconduct forms, available from the superior court clerk's office or from legal publishers. The 
court clerk can tell you where to get the forms.
A typewriter with which to fill out the forms. The forms should be typed. Some volunteer legal service groups have 
typewriters you can use, and some libraries offer the use of typewriters for a small fee. If you cannot type, print clearly.
Money for a court filing fee, unless the court excuses you from paying. If you cannot afford to pay the court filing fee, 
ask the clerk for the Information Sheet on Waiver of Court Fees and Costs. If you are a participant objecting to the 
court orders, you do not have to pay to file your response.
Someone 18 years of age or older to deliver (serve) certain papers to the other party. This person must be someone 
other than yourself, and not an employee of the program.

WHAT FORMS ARE AVAILABLE FOR OBTAINING OR OPPOSING AN ORDER?

Petition for Order Prohibiting Abuse or Program Misconduct [''Petition"]. This four-page form tells the judge the 
facts of  the program operator's case and what orders the program operator wants the judge to make.
Order to Show Cause and Temporary Restraining Order ["OSC/TRO"]. The judge signs this order to tell the 
participant to come to court for the court hearing. It may contain court orders that take effect immediately and stay in 
effect for up to five days or until the hearing.
Participant's Response ["Response"]. The participant may file this form to object to the orders the program operator 
asked the court to make, and to give his or her side of the story.
Order After Hearing [''Order'']. This is the permanent order or injunction. This form is signed by the court following 
the hearing. It will expire in one year or less unless the court terminates, modifies, or extends it.
Proof of Personal Service. This form shows that a participant or program operator has been served with legal papers 
as required by law.

INSTRUCTIONS FOR THE PROGRAM OPERATOR

STEPS TO TAKE TO GET A  COURT ORDER

1.

Complete the forms. Fill in the Petition and the OSC/TRO except for the date of the court hearing and the judge's 
signature. (Remember, most courts require that all forms be typewritten.)

If you are not represented by an attorney, fill in the name of the person signing the petition, the program name, 
mailing address, and phone number at the top of each form. If you do not want to disclose your home or work 
address or phone number, you may use an address or phone number where you will be able to receive any 
communications.
Fill in the name of the county where the action will be filed and the address of the superior court.

Type your full name and the participant's full name.

Mark with an "X" all boxes that apply to your case. Read each item carefully and fill in the necessary information.  
Be specific.
You can type any witness statements (called affidavits or declarations) on form MC-031 and attach the form to 
your Petition.

a.

b.

c.

d.

e.

f.

Remember to date and sign the Petition.

TH-200 [Rev. September 1, 2018]

Page 3 of 8

(Continued on reverse)

INSTRUCTIONS FOR PROGRAM OPERATORS 
(Transitional Housing Misconduct)

TH-200

Steps to Take to Get a Court Order (continued)
2.  Make copies. You will need at least five copies of each Transitional Housing Misconduct form: one for a 

worksheet,the original to file with the court, a copy to be personally delivered (served) to the participant, and two 
copies for yourself. You will need more than five copies of the OSC/TRO, the Order, and the Proof of Service form. In 
additionto the five copies above, get one for each law  enforcement agency you want to enforce your orders, and two 
for yourself.

3.  TRO. If you are requesting a TRO you must give details of the participant's misconduct or abuse, the problems it has 

caused you, and why you need an order before a full hearing. Place an "X" in the box marked "To be ordered now and 
to be effective until the hearing" under numbers 8, 9,10, 11, or 13 on the Petition.

4.  Court clerk. Take all your completed forms and all copies to the clerk's office in the superior court. The clerk will tell 

you where to take your papers and when to pay your filing fee, if required.

5.  Court papers. If the judge signs the OSC/TRO, take the original and all copies back to the court clerk. The clerk will 
stamp all the papers with a case number. The copies must include an "Endorsed-Filed" stamp (showing the date of 
filing), the judge's signature, and the date of signing. The clerk will file the originals and give you the copies. KEEP 
TWO ENDORSED-FILED COPIES FOR YOURSELF. Carry one with you and keep one in a safe place. You may 
need one if you have to call the police.

6.  Personal service. Have the participant personally served with copies of the Petition and the OSC/TRO, a blank copy 
of the Response, two blank copies of form MC-031, a blank copy of the Proof of Personal Service, a copy of these 
instructions, and a copy of all materials (affidavits and supporting memoranda) to be used in the hearing. On the OSC/
TRO you must fill in the box on the first page with the name, address, and phone number of the Legal Services Office 
in the county in which the petition is filed.
You cannot serve the participant yourself. Service may be made by a licensed process server, the sheriff's 
department, or any person 18 years of age or older, other than you or a program employee. The papers must be 
delivered to the participant personally, and cannot be mailed or left at the participant's dwelling unit.
Service is very important. It tells the participant about the order and the hearing. Without it there will not bea court 
hearing and your TRO will no longer be good unless it is extended by the court. The participant must bepersonally 
served at least two days before the hearing.

7.  Copy to the police. If you have requested a TRO and the judge has granted them, immediately deliver copies to 

eachlaw enforcement agency (police, marshal, or sheriff's office) that you want to enforce the order.

8.  After service. After the participant has been personally served, the person who served the participant must complete 
and sign the original of the Proof of Personal Service form. Take the signed original and the copies back to the court 
clerk. The clerk will file the original and stamp "Endorsed-Filed" on the copies. Deliver one Endorsed-Filed copy to 
each law enforcement agency at which you filed your TRO. Keep two Endorsed-Filed copies for yourself.

9.  Court hearing. Go to the court hearing with any evidence you have. Any witnesses to the participant's conduct also 

should come to the hearing. The Order should be filled in and given to the judge for signing.

10. File the Order. If the judge signs the Order, file the original with the clerk, get the copies stamped with an "Endorsed-

Filed" stamp, and immediately deliver copies to law enforcement agencies.
If the participant was not present in court for the hearing, arrange to have the participant personally served with a copy 
of the Order. File the completed Proof of Personal Service with the court and deliver copies stamped "Endorsed-Filed" 
to law enforcement agencies. KEEP TWO COPIES FOR YOURSELF. Carry one with you and keep one in a safe 
place.

11. Renewal. An Order will expire within one year, but you can apply for an extension. The law requires you to file for a 

renewal by filing a new Petition any time within three months before the Order expires. Do not check the modification 
box on the Petition when you file for renewal.

WHAT TO DO IF THE PARTICIPANT DISOBEYS THE ORDER

1.  Reports. Report violations of the Order as soon as possible to your local law enforcement agency. Keep a written 

record of the incidents and obtain copies of police reports concerning them.

2.  Contempt of court. Violation of a restraining order is punishable by civil contempt of court. You must file a civil con-
tempt action in the same court that issued the restraining order. If the participant is in contempt of court, you can file 
for a modification of the order (use form TH-100) and ask the court to order the participant to move out of the program 
housing.

NOTE: See sample filled-in Petition on pages 5–8.

TH-200 [Rev. September 1, 2018]

Page 4 of 8

(Continued on reverse)

INSTRUCTIONS FOR PROGRAM OPERATORS 
(Transitional Housing Misconduct)

The next four pages show a Petition that has 
been completed with examples of the kind of 
information a court is likely to want.

After this form is filed, the clerk 
will stamp this box on the copies 
so everyone knows it is a copy of 
an official paper. This is the place 
for the "Endorsed--Filed" stamp.

TH-200

The county clerk will 
give you this number. 
Use it on all forms you 
file later.

If you are not represented 
by an attorney, fill in your 
name, mailing address, 
and phone number at the 
top of each form.

County where you are 
filing your case. Contact 
the county clerk if you do 
not know the address.

Your full name or the 
name of the organization 
requesting the orders.

The full name of the per-
son you want the orders 
against.

Check this box if you are 
asking for orders to go 
into effect immediately 
when the TRO is signed 
by the judge. You will also 
need to check the boxes 
in 8-14 and give the 
necessary information.

Put an X in the box that 
applies in items 2 and 3.  
You must check one box 
in each of those items.

Name all the people you 
want the judge to grant 
orders against. Only those 
people named here will be 
restrained or excluded by 
the orders. 

Name any people here 
who live with the partici- 
pant but should not have 
orders granted against 
them.

Be sure to attach a copy 
of the contract that was 
signed by the participant.

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address):

FOR COURT USE ONLY

Robert Hoe, Program Director       (123) 456-7890
Family First Transitional Housing Program
123 Front St., Suite 230
Big City, California 90135

ATTORNEY  FOR (Name):  

 In Pro. Per.

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ANY COUNTY

STREET ADDRESS:

MAILING ADDRESS: 

CITY AND ZIP CODE:

BRANCH NAME:

100 Elm Street
P.O. Box 109
Anytown, California 91235

PROGRAM OPERATOR:  

PARTICIPANT: 

Family First Transitional Housing  
Program
Danny Doe

CASE NUMBER:

PETITION FOR ORDER PROHIBITING ABUSE
OR PROGRAM MISCONDUCT
Application for Temporary Restraining Order

X

Modification of Previous Order (date):

• Read the Instructions for Program Operators before completing this form. 
• You must have a copy served on the participant at least two days before the hearing.

1.

Jurisdiction. This suit is filed in this county because participant resides in this county.

(THIS IS NOT AN ORDER)

2.

Program Operator (name): Family First Transitional Housing Program
operates a "transitional housing program" as defined in Health and Safety Code section 50582(g).

Governmental agency (specify):

Private nonprofit corporation receiving program funds from a governmental agency. 
The funding agency is (specify): Department of Housing

Manager or operator

Manager or operator

X

3.

Program site (specify street address, city, ZIP code):
a.

Dwelling unit of participant (address optional):  200 Hill St., Apt. 16
Other locations of the program (addresses):

Big City, California 90135

a.

b.

b.

X

X

4.

Participant to " restrained or excluded is a "homeless person" dwelling at a "program site" as defined in Health and 
SafetyCode section 50582 (name all to be restrained or excluded):

 Age (if under 18)

 Name

Danny Doe

5.

Persons living with participant h participant's dwelling unit who are not to be restrained or excluded  (name all below). If none, 
check this box:

Name

Family relationship

Age (if under 18)

Margaret Doe
Denise Doe

wife
daughter

5 years

6.

Participant has signed a contract with the program operator. The contract includes (attach a copy of the signed contract)

a. Program rules and regulations.
b. A statement of program operator's right of control over and access to the program unit occupied by participant.
c. A summary of the requirements and procedures of Health and Safety Code sections 50580-50591.

Form Adopted by the
 Judicial Council of California
 TH-100 [Rev. September 1, 2018]

(Continued on reverse)

PETITION FOR ORDER PROHIBITING ABUSE
OR PROGRAM MISCONDUCT
(Transitional Housing Misconduct)

Page 1 of 4

Civil Code, § 1954.13

TH-200 [Rev. September 1, 2018]

Page 5 of 8

(Continued on reverse)

INSTRUCTIONS FOR PROGRAM OPERATORS 
(Transitional Housing Misconduct)

Fill this in.

Leave this blank.

TH-200

PROGRAM OPERATOR:

Family First Transitional Housing Program

CASE NUMBER:

PARTICIPANT:

Danny Doe

(THlS IS NOT AN ORDER)

Put an X in the boxes  that 
apply to your case. Leave 
the boxes empty if they do 
not apply to your case.  At 
least two boxes  must be 
checked in either a or b. 
Boxes in both a and b can 
apply.

7.

Participant to be restrained or excluded (names):
a.

X

(Program misconduct) has intentionally violated the program rules and regulations. The violation substantially interferes 
with the orderly operation of the program AND involves (check at least one and cite the rule number):

X

drunkenness on the program site (rule no.): 4(a)
unlawful use or sale of controlled substances (drugs) (rule no.):

(i)

(ii)

(iii)

(iv)

(v)

theft (rule no.):

arson (rule no.):

destruction of property of the program operator, program employees, other participants, or persons living 
within 100 feet of the program site (names and relationships to program and rule no.):

(vi)

X

violence or threats of violence and harassment of program employees, other participants, or persons living 
within 100 feet of the program site (names and relationships to program and rule no.):

Margaret Doe, participant in program. (Rule 7(b).)
John Roe, night manager in Danny Doe's building and program 
employee. (Rule 7(a).)

b.

(Abuse) has intentionally or recklessly

(1)

(2)

(3)

caused or attempted bodily injury

caused or attempted sexual assault
caused fear of serious bodily injury

to program employees, other participants, or persons Iiving within 100 feet of the program site (names and relationships
to program):  Margaret Doe, participant in the program.

John Roe, night manager in Danny Doe's building and program employee.

c.

FACTS. Describe in detail the most recent incidents of program misconduct or abuse. State what happened, the dates and 
times,and who did what to whom. Describe any injuries or damage. For alleged program misconduct, cite the rules and regulations 
violated by each incident of misconduct.  If more space is needed, attach additional pages and check this box:             (You may 
use form MC-031 (on the reverse of form MC-030) as an attachment or for the declarations (affidavits) of witnesses.)

     Participant, his wife, and their five-year-old daughter live in an apartment in a 
security building where a program employee is always on duty.
     On June 22, 1992, participant returned home after the program curfew of 11 p.m. 
(Rule 10(a).)  He staggered in with the smell of alcohol on his breath and clothes and 
required the assistance of his wife and the night manager to make it to bed.  (Rule 
4(a).) On June 24, 1992, participant yelled loudly at his wife, disturbing other 
residents, when she asked him to stop drinking. On June 25, 1992, participant again 
returned home drunk. (Rule 4(a).) When his wife attempted to help him to their 
apartment, participant cursed at her, hit her in the face, and tried to push her down 
the stairs. (Rule 7(b).) When the night manager attempted to intervene, participant 
cursed at him and told him to mind his own business. (Rule 7(a).)
     On June 26, 1992, participant's wife had a cut lip and large bruise near her mouth 
as a result of participant's actions. (Rule 7(b).) That evening, participant returned 
home sober, but told the night manager (John Roe) that he (participant) would "get him" 
if he intervened between participant and his wife again. (Rule 7(a).)
     Several residents have complained about the noise made by participant. Partici-
pant's drinking interferes with other residents' efforts to refrain from drinking. 
Residents do not understand why participant is not disciplined for breaking the pro- 
gram rules against drinking and disruptive behavior. (Rule 7(b).) The night manager is 
afraid to work a shift alone when participant might again return home drunk. (Rule 
7(a).)

TH-100 [Rev. September 1, 2018]

Page 2 of 4

(Continued on next page)

PETITION FOR ORDER PROHIBITING ABUSE 
OR PROGRAM MISCONDUCT 
(Transitional Housing Misconduct)

l

Item 7c is the most 
important part of your 
petition. This information 
is all the judge will know 
about your case until the 
hearing. Give details of 
the most recent incidents.

If you have so many facts 
they will not all fit, put an X 
in this box and write the 
facts on a separate piece 
of paper and attach it to 
the back of your petition, 
after page four. Use white 
paper the same size as 
this form or form MC-031 .

TH-200 [Rev. September 1, 2018]

Page 6 of 8

(Continued on reverse)

INSTRUCTIONS FOR PROGRAM OPERATORS 
(Transitional Housing Misconduct)

Fill this in.

Leave this blank.

TH-200

l

(THIS  IS NOT AN ORDER)

PROGRAM OPERATOR:

Family First Transitional Housing Program

CASE NUMBER:

PARTICIPANT:

Danny Doe

PROGRAM  OPERATOR REQUESTS THE COURT TO MAKE THE ORDERS INDICATED BY THE CHECK MARKS IN THE BOXES BELOW.

8.

X

PROGRAM MISCONDUCT RESTRAINING ORDERS (BREAKING RULES). Participant must not intentionally violate the 
program rules and regulations so as to interfere substantially with the orderly operation of the program and specificallythe 
rules and regulations on

X

drunkenness on the program site (ruleno.): 4(a)
unlawful use or sale of controlled substances (drugs) (rule no.):

theft (rule no.):

arson (rule no.):

destruction of property (rule no.):
violence or threats of violence and harassment  (rule no.) : 7(a), 7(b)

9.

X

ABUSE RESTRAINING ORDERS. Participant must not attack, strike, batter, or sexually assault, or threaten 
to attack, strike, batter, or sexually assault

program employees

program participants
persons living within 100 feet of the program site

and specifically the following persons (names):

Margaret Doe, wife of participant. 
John Roe, program employee.

10.

PROGRAM SITE EXCLUSION ORDERS.  Participant must immediately move from and must not return to the program site and 
dwelling unit assigned to participant (address optional):

and may take participant's personal property needed until the hearing.

11.

STAY-AWAY ORDERS. Participant must stay at least 200 feet away from the following places:

Dwelling unit assigned to participant (address optional):

Other program site locations (addresses):

12.

OTHER ORDERS (specify other orders you request to help carry out the orders requested in items 8-11):

-

13.

I request that copies of orders be given to the following law enforcement agencies  (specify all with jurisdiction over program sites):

Law Enforcement Agency

Address

Big City Police Department
Anycounty Sheriff's Dept.
Faraway Police Department

100 Dale Ave., Big City, CA 90134
200 Government Hall, Anytown, CA 90135
90 Valley Blvd., Faraway, CA 90147

14.

PREVIOUS PETITIONS. I have asked for restraining orders against participant before (specify case numbers and dates):

X

X

X

a.

b.

c.

d.

e.
f.

a.

b.

c.

X

a.

b.

TH-100 [Rev. September 1, 2018]

Page 3 of 4

(Continued on next page)

PETITION FOR ORDER PROHIBITING ABUSE 
OR PROGRAM MISCONDUCT 
(Transitional Housing Misconduct)

Put an X in the boxes that 
apply to your case. Leave 
the boxes empty if they do 
not apply to your case.

This space is where you 
ask for other orders you 
need. If you use this 
space, be sure to put in 
facts and dates in item 7c 
on page two of your 
petition that would give the 
court a reason to order 
what you ask for here.

List all the agencies you 
may want to enforce your 
order. The court will either 
tell the clerk to mail 
copies of the orders to the 
agencies or direct you or 
your attorney (if you have 
one) to deliver them 
personally.

TH-200 [Rev. September 1, 2018]

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(Continued on reverse)

INSTRUCTIONS FOR PROGRAM OPERATORS 
(Transitional Housing Misconduct)

Whenever you check these 
boxes you are asking for 
the order to go into effect 
immediately, as soon as 
the TRO is signed by the 
judge. You will also need to 
give the necessary 
information in item 15c.

Check this box if you are 
requesting TROs. Check 
the boxes for the item 
numbers in which you 
requested TROs.

If you are requesting 
TROs, you must choose 
one option under both a 
and b. Check the boxes 
that apply.

If you are asking for the 
orders to go into effect 
immediately, as soon as 
the judge signs the TRO, 
you must state the 
reasons. State what harm 
would result to you if the 
orders were not made 
immediately.

VERY IMPORTANT:    
1. The date you sign.   
2. Your signature. 
DO NOT FORGET 
THESE OR ALL YOUR 
WORK WILL BE 
WASTED.

Fill this in.

Leave this blank.

TH-200

PROGRAM OPERATOR:

Family First Transitional Housing Program

CASE NUMBER:

PARTICIPANT:

Danny Doe

(THIS IS NOT AN ORDER)

X

REQUEST FOR TEMPORARY RESTRAINING ORDER
To Be Effective From Now Until the Hearing

15.

X

I request that the orders requested in items

 8

X

 9

X

 10

 11

 12     be effective

from now until the hearing . (Note: Temporary exclusion orders under items 10-11 require an emergency.)
a.

Participant
(1)

X

(2)

has not been under contact with the program for more than six months (date of contract): 5/1/92
has been under contract with the program for more than six months, but
(i)

a restraining order is in effect and subject to further orders  (specify in item 14).

(ii)

an action is pending against participant  (specify in item 14).

b.

Notice to participant.
(1)

X

X

Program operator                Operator's attorney (attach attorneys affidavit)

informed participant or his or her attorney on (date): June 27, 1992
at (time): 10:30 a.m. of the date, time, and place this petition would be filed.
made the following good-faith efforts to inform participant or his or her attorney of the date, time, and 
place this petition would be filed (specify efforts):

(2)

(3)

c.

should not be required to inform the participant or his or her attorney of the date, time, and place this 
petition would be filed because (specify reasons):

NEED FOR IMMEDIATE ORDER BEFORE THE HEARING. Program operator, program participants, or persons living 
within 100 feet of the program site will suffer great and irreparable harm before this petition can be heard in court unless 
the court makes those orders requested above effective now and until the hearing. (Specify the harm andwhy it will 
occur before the hearing.  For temporary exclusion orders under items 10-11, show emergency and need to prevent 
imminent serious bodily injury.)

     Participant has threatened the night manager (John Roe), and 
the manager is afraid to work a shift alone in participant's 
building. The program has a limited staff, and we cannot replace 
John until the hearing. Other participants have been disturbed by 
participant's behavior and we need to be able to restrain him to 
continue to operate the program in his building. The night manager 
may need the assistance of the police to protect Margaret Doe from 
her husband if participant again returns home drunk.

15.

X

Number of pages attached: 3

Contract dated May 1, 1992)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date: June 29, 1992

Robert Hoe

(TYPE OR PRINT NAME)

TITLE of person signing: Program Director

TH-100 [Rev. September 1, 2018]

Robert Hoe

(SIGNATURE OF PROGRAM OPERATOR)

PETITION FOR ORDER PROHIBITING ABUSE
OR PROGRAM MISCONDUCT
(Transitional Housing Misconduct)

Page 4 of 4

TH-200 [Rev. September 1, 2018]

INSTRUCTIONS FOR PROGRAM OPERATORS 
(Transitional Housing Misconduct)

Page 8 of 8