Fill out elder or dependent adult abuse restraining order forms

The first step in getting an elder or dependent adult abuse restraining order is to tell the court about the harm, pain, or mental suffering the elderly or dependent adult has experienced. You do this by filling out a set of court forms. This usually takes one to several hours for most people.

Before you start

You will need to give details about why a restraining order is needed. Writing about abuse can be upsetting and bring up a lot of emotions. You can get help from your court's free Self-Help Center or ask someone you trust to help you fill out the forms. 

You don't need a lawyer but you can hire one if you have the resources. Many people don't have the money to hire a lawyer and rely on free help. You can get free help from your local Self-Help Center. Check with your local bar association for resources available in your area.

Request an elder or dependent adult abuse restraining order

You will need to fill out at least four forms to ask for a restraining order. 

Forms will not save automatically. To save a form (so you can work on it later), download the form by clicking on the upper righthand corner, save to a computer that you can safely use, and open the saved form.
  • Fill out all required forms

    1. Request for Elder or Dependent Adult Abuse Restraining Orders (form EA-100)

     Use this form to tell the judge:   

    • How the elderly person or dependent adult has been abused
    • What orders you want the judge to make
    • If you want protection right away (if so, on form EA-100, check item 16)

    This section is important because the judge will decide whether to grant you a restraining order based on what you write in this section. On form EA-100, item 8, you will describe the abuse.

    Abuse of an elderly or dependent adult means treatment that causes physical harm, pain, or mental suffering. This includes hitting, sexually assaulting, abducting, or threatening to do any of these things. It also includes abandoning, neglecting, or withholding basic needs, like food or medical care. It does not have to be physical to be abuse. You can also ask for this kind of restraining order if there was financial abuse.

    Start with the most recent incident first, even if it is not the worst incident. Write down the facts of what happened. The judge needs facts to make a decision. For example, if the person has been abusive, tell the judge what the person did to the elderly or dependent adult, like how many times they contacted the elderly/dependent adult, how often they contacted them, and what they said each time they contacted them. If you have proof (like an email or a text message), you can include it with your request.  

    Once you are finished writing about the most recent event, you can write about another incident you want the judge to know about in item 8(d). Give as much detail as you can. If there has been more than one incident, be sure to write down how long the abuse has been going on, how often it has happened, and any physical or emotional harm it has caused. If you need more space to write, you can use form MC-025.

    What if I don't have exact dates?

    If you don't remember the exact day something happened, give an estimate and write down that it is an estimate. To help you remember,  think about whether the incident happened around a holiday or special occasion.


    On form EA-100, item 13, you can ask the judge to order the other person to move out of the home (residence) where the elderly or dependent adult lives. For the judge to grant a move-out order, you must show:

    1. The elderly or dependent adult will suffer physical or emotional harm if the other person does not leave the residence;
    2. The other person assaulted or threatened the elderly or dependent adult; and
    3. The elderly or dependent adult has a legal right to live at the residence (for example, they are on the title (deed) or lease).

    The court can’t order the other person to move out of the residence if they are the only person on the title or lease, or if the other person is on the title or lease with other people besides the elderly or dependent adult.

    If you have proof (like a copy of the title or lease), you can include it with your request. If you need more space to write, you can use form MC-025.

    2. Confidential CLETS Information (form CLETS-001)

    The information on this form will help police enforce your restraining order. The court will not use the information on this form and the person you want a restraining order against will not get a copy. Some information is mandatory and is marked with an asterisk (*). You may not have all the other information about the restrained person. Fill in as much as you can.

    3. Notice of Court Hearing (form EA-109

    The court will complete most of this form. You only need to complete items 1 and 2. 

    4. Temporary Restraining Order (form EA-110)

    You need this form if you are asking for protection right away (if you checked form EA-100, item 16). The court will complete most of this form. You only need to complete items 1, 2, and 3.

  • Check to see if you have any local forms to complete

    Some county courts have additional local forms they require you to use. The most common local form will have questions about whether you told the other side that you are asking for a restraining order. Contact your court's free Self-Help Center, or the court clerk’s office, to see if they have any local forms you need to use. You can find your local court at Find My Court.

  • Make two copies of all your forms

    After you’ve completed and signed all your forms, make 2 copies. You'll need the two copies, plus the original, when you file with the court.

File Your Request

What's Next

Once you’ve completed the forms and made copies, you’ll file them with the court. 

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