To the Person in

1

Fill in court name and street address:

Superior Court of California, County of

If the hearing is canceled, any temporary orders made on Form DV-110, Temporary Restraining Order will end 
on the hearing date.  You may file a new request for temporary restraining orders on the same or different facts at 
a later date.

Fill in case number:
Case Number:

Some or all of the temporary restraining orders you requested were 
denied for the reasons listed on Form DV-109, Notice of Court Hearing. 
The court has set a hearing and might make the orders you want after 
the hearing.  

• Use this form only if you want to cancel the hearing date listed on Form 
DV-109, item      . If you want to cancel the hearing, sign this form 
below and file it with the court clerk. Do not serve Form DV-109 and 
other papers on the person in      .

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2

If you already served Form DV-109 and other papers on the person in
     , you must notify that person that you have canceled the hearing. If 
2
the person in       files a response before you file this form, the court may 
still hear the case.

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• •

•

•

I have read this form and I understand that I have a right to a court hearing. By signing below, I am asking the court 
to cancel the hearing listed on Form DV-109, Notice of Court Hearing.  I understand that any orders already made 
by the court on Form DV-110, Temporary Restraining Order will end on the hearing date.

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

Date:

Type or print your name

Sign your name

DV-112

Waiver of Hearing on Denied Request 
for Temporary Restraining Order

Clerk stamps date here when form is filed.

Use this form only to waive (cancel) the hearing date in item        on Form 
DV-109, Notice of Court Hearing.                     

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1

Name of Person Asking for Protection:

2

Name of Person to Be Restrained:

Judicial Council of California, www.courts.ca.gov
Revised January 1, 2012, Optional Form      
Family Code, § 6320.5

This is not a Court Order.

Waiver of Hearing on Denied Request 
for Temporary Restraining Order
(Domestic Violence Prevention)

DV-112, Page 1 of 1