LASC-FAM-221Local

Request For Elder Or Dependent Adult Restraining Order Allowing Contact Forms Packet

Los Angeles Superior Court · Family Law

This form was updated 43 days ago — make sure you're using the latest version.

Last updated June 18, 2026

A complete packet of forms to request a restraining order protecting an elder or dependent adult while allowing limited court-approved contact.

This form must be printed and filled by hand, or opened in Adobe Acrobat.
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