(a) For purposes of this section: (1) âAbuse or violenceâ means domestic violence as defined in Section 6211 of the Family Code, sexual assault as defined in Section 1219, stalking as defined in Section 1708.7 of the Civil Code or Section 646.9 of the Penal Code, human trafficking as defined in Section 236.1 of the Penal Code, abuse of an elder or a dependent adult as defined in Section 15610.07 of the Welfare and Institutions Code, or any act described in paragraphs (6) to (8), inclusive, of subdivision (a) of Section 1946.7 of the Civil Code. (2) âDocumentation evidencing abuse or violence against the tenant, the tenantâs immediate family member, or the tenantâs household memberâ means any of the following: (A) A temporary restraining order, emergency protective order, or protective order lawfully issued within the last 180 days pursuant to Section 527.6, Part 3 (commencing with Section 6240), Part 4 (commencing with Section 6300), or Part 5 (commencing with Section 6400) of Division 10 of the Family Code, Section 136.2 of the Penal Code, or Section 213.5 or 15657.03 of the Welfare and Institutions Code that protects the tenant, the tenantâs immediate family member, or the tenantâs household member from abuse or violence. (B) A copy of a written report, written within the last 180 days, by a peace officer employed by a state or local law enforcement agency acting in the officerâs official capacity, stating that the tenant, the tenantâs immediate family member, or the tenantâs household member has filed a report alleging that they are a victim of abuse or violence. (C) (i) Documentation from a qualified third party based on information received by that third party while acting in their professional capacity to indicate that the tenant, the tenantâs immediate family member, or the tenantâs household member is seeking assistance for physical or mental injuries or abuse resulting from an act of abuse or violence, which shall contain, in substantially the same form, the following: Tenant Statement and Qualified Third Party Statement under Code of Civil Procedure Section 1161.3 Part I. Statement By Tenant I, [insert name of tenant], state as follows: I, my immediate family member, or a member of my household, have been a victim of: [insert one or more of the following: domestic violence, sexual assault, stalking, human trafficking, elder abuse, dependent adult abuse, a crime that caused bodily injury or death, a crime that included the exhibition, drawing, brandishing, or use of a firearm or other deadly weapon or instrument, or a crime that included the use or threat of force against the victim.] The most recent incident(s) happened on or about: [insert date or dates.] The incident(s) was/were committed by the following person(s), with these physical description(s), if known and safe to provide: [if known and safe to provide, insert name(s) and physical description(s).] (signature of tenant) (date) Part II. Qualified Third Party Statement I, [insert name of qualified third party], state as follows: My business address and phone number are: [insert business address and phone number.] Check and complete one of the following: ____I meet the requirements for a sexual assault counselor provided in Section 1035.2 of the Evidence Code and I am either engaged in an office, hospital, institution, or center commonly known as a rape crisis center described in that section or employed by an organization providing the programs specified in Section 13835.2 of the Penal Code. ____I meet the requirements for a domestic violence counselor provided in Section 1037.1 of the Evidence Code and I am employed, whether financially compensated or not, by a domestic violence victim service organization, as defined in that section. ____I meet the requirements for a human trafficking caseworker provided in Section 1038.2 of the Evidence Code and I am employed, whether financially compensated or not, by an organization that provides
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