EA-109

Notice of Court Hearing

Clerk stamps date here when form is filed.

1 Elder or Dependent Adult in Need of Protection

a. Full Name:

Person requesting protection for the elder or dependent adult, if 
different (person named in item       of form EA-100):
Full Name:

3

Lawyer for person named above (if any for this case):
Name:

State Bar No.:

Firm Name:

b. Address for person named above (If you have a lawyer, give your 

lawyer’s information. If you do not have a lawyer, give information  
for the person requesting the order. If you want to keep your home 
address private, you may give a different mailing address instead.  
You do not have to give telephone, fax, or email.):
Address:

City:

Telephone:

Email Address:

State:

Fax:

2 Person You Want Protection From

Full Name:

Fill in court name and street address:

Superior Court of California, County of

Court fills in case number when form is filed.

Zip:

Case Number:

3 Notice of Hearing

The court will complete the rest of this form.

A court hearing is scheduled on the request for restraining orders against the person in     :2

Name and address of court if different from above:

Hearing 
Date

Date:

Dept.:

Time:

Room:

4 Temporary Restraining Orders (Any orders granted are on form EA-110, served with this notice.)

a. Temporary Restraining Orders for personal conduct and stay-away orders as requested in form EA-100,  

Request for Elder on Dependent Adult Abuse Restraining Orders are (check only one box below):

(1)

(2)

(3)

All GRANTED until the court hearing.

All DENIED until the court hearing. (Specify reasons for denial in b, below.)

Partly GRANTED and partly DENIED until the court hearing. (Specify reasons for denial in  
b, below.)

Judicial Council of California,   
Rev. January 1, 2023, Mandatory Form 
Welfare and Institutions Code, § 15657.03 
Approved by DOJ

 Notice of Court Hearing 
(Elder or Dependent Adult Abuse Prevention)

EA-109, Page 1 of 3

Case Number:

4 Temporary Restraining Orders (Continued)

b. Reasons for denial of some or all of those personal conduct and stay-away orders as requested in form  

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

(1)

(2)

The facts as stated in form EA-100 do not sufficiently show reasonable proof of a past act or 
acts of abuse of the elder or dependent adult by the person in      .2

Other (specify):

As stated on Attachment 4b.

5 Service of Documents by the Person in  1

five

At least                                               days before the hearing, someone age 18 or older—not you or anyone to 
be protected—must personally give (serve) a court file-stamped copy of this form EA-109, Notice of Court 
Hearing, to the person in        along with a copy of all the forms indicated below:

2

a. EA-100, Request for Elder or Dependent Adult Abuse Restraining Orders (file-stamped)
b.
c. EA-120, Response to Request for Elder or Dependent Adult Abuse Restraining Orders (blank form)

EA-110, Temporary Restraining Order (file-stamped) IF GRANTED

d. EA-250, Proof of Service of Response by Mail (blank form)
e. EA-120-INFO, How Can I Respond to a Request for Elder or Dependent Adult Abuse Restraining Orders?

f.

Other

(specify):

Date:

Judicial Officer

To the Person in     :1

•  The court cannot make the restraining orders after the court hearing unless the person in       has been personally given  
(served) a copy of your request and any temporary orders. To show that the person in      has been served, the person  
who served the forms must fill out a proof of service form. Form EA-200, Proof of Personal Service, may be used.

2

2

• For information about service, read form EA-200-INFO, What Is “Proof of Personal Service”?

• If you are unable to serve the person in      in time, you may ask for more time to serve the documents. Use  

2

form EA-115, Request to Continue Court Hearing.

Rev. January 1, 2023

 Notice of Court Hearing 
(Elder or Dependent Adult Abuse Prevention)

EA-109, Page 2 of 3

Case Number:

To the Person in     :2

• If you want to respond to the request for orders in writing, file form EA-120, Response to Request for Elder or 
Dependent Adult Abuse Restraining Orders, and have someone age 18 or older—not you or anyone to be  
protected—mail it to the person in       . 1

• The person who mailed the form must fill out a proof of service form. Form EA-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 five years and may 

order you to sell or turn in any firearms (guns) and firearm parts that you own or possess. 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).

Request for Accommodations

Assistive listening systems, computer-assisted real-time captioning, or sign language 
interpreter services are available if you ask at least five days before the hearing. Contact the 
clerk’s office or go to www.courts.ca.gov/forms for Disability Accommodation Request 
(form MC-410). (Civ. Code, § 54.8.)

(Clerk will fill out this part.)

—Clerk's Certificate—

I certify that this Notice of Court Hearing is a true and correct copy of the original on file in the court. 

Clerk’s Certificate
[seal]

Date:

Clerk, by

, Deputy

Rev. January 1, 2023

 Notice of Court Hearing 
(Elder or Dependent Adult Abuse  Prevention)

EA-109, Page 3 of 3