CV-405, 05/19 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment) 24724748.25(6) and 813.125, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Name of person to be protected (Petitioner): Name of person completing Petition (i f different from P etitioner): Amended Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing ( Harassment 30711) Case No. Date of Birth of Petitioner : Name - vs - Respondent/ Defendant: Address: I f there is a CHIPS proceeding involving the chi ld or the respondent is a minor, Use JC - 1693 . D o not use this form. : Sex Race Date of Birth Height Weight Hair color Eye color Please specify relatio nship(s) to Respondent : spouse cousin adoptive parent former spouse sibling grandparent person in dating relationship parent child (biological/adoptive/step) current or former live - in step parent relationship O ther: [Be specific] (such as scars, marks or tattoos) None known. CAUTION: (Check all that apply) Respondent has access to weapon(s). Type of weapon(s): Location of weapon(s ): Weapon(s) were involved in an incident [past or present] involving the petitioner. I am: [Check one] p etitioner. stepparent of the p etitioner. guardian ad l item for child . parent of the p etitioner. legal guardian of the p etitioner. Other: I PETITION THE COURT for a Temporary Restraining Order/or and I njunction against the respondent under 247813.125, Wis. Stat s . , based on the following: 1. Stated below or attached as part of this P etition is a statement of facts indicating that respondent has engaged in conduct which is believed to be harassment . ( Harassment is defined as: (a) Striking, shoving, kicking or otherwise subjecting the person to physical contact; or (b) Engaging in an act that would constitute child abuse under 247 48.02(1); or (c) Sexual assault under 247940.225; or (d) Stalking under 247940.32; or attempts or threat to do same; or (e) Engaging in a course of conduct or repeatedly committing acts which harass or intimidate the person and which serve no legitimate purpose. ) (State when, where, what happe ned, and who did what to whom) See attached 2. Another no contact order between the petitioner and the responden t does not exist or the petitioner does not know or is uncertain as to whether another no contact order exists . does exist. Name of other case: County or State: [If not Wisconsin] Type of Case: Case Number: [If known] Date of proceeding that resulted in no contact order: [I f known ] Details of no contact order: I REQUEST THE COURT: [Mark any of the following boxes that appl y ] 1. Issue a Temporary Restraining O rder requiring the respondent to American LegalNet, Inc. www.FormsWorkFlow.com CV-405, 05/19 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment) 24724748.25(6) and 813.125, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 a. cease or avoid harassing the petitioner. b . avoid the c. avoid contact that harasses or intimidates the petitioner. work, school, public places, in person, by phone, in writing, by electronic communication or device, or in any other manner. d. refrain from removing, hiding, damaging, harming, or mistreating, or disposing of, a household pet. e. allow the petitioner or a family member or household member of the petitioner acting on his/her behalf to retrieve a household pet. f. avoid contacting the petitioner or causing any person other than a party's attorney or law enforcement officer to contact the petitioner. g. Other: [List other specific behavior the petitioner wants the respondent to stop doing] 2. S et a time for a hearing on the P etition for an I njunction requiring the respondent to a. cease or avoid harassing the petitioner. b. c. avoid contact that harasses or intimidates the petitioner. work, school, public places, in person, by phone, in writing, by electronic communication or device, or in any other manner. d. refrain from removing, hiding, damaging, harming, or mistreating, or disposing of, a household pet. e. allow the petitioner or a family member or household member of the petitioner acting on his/her behalf to retrieve a household pet. f. avoid contacting the petitioner or causing any person other than a party's attorney or law enforcement officer to contact the petitioner. g. Other: [List other specific behavior the petitioner wants the respondent to stop doing] 3. If the Temporary Restraining O rder is denied, the petitioner asks the court to schedule an I njunction H earing. If the Temporary Restraining O rder is denied, the petitioner is only entitled to an Injunction Hearing if the P etition alleges conduct that is the same as or similar to conduct that is prohibited under 247940.32 (stalking); or is the intentional infliction of physical pain, physical injury or illness; or is an intentional impairment of p hysical condition; or is a violation of 247940.225(1), (2) or (3) (sexual assault); or is a violation of 247943.01 involving destruction of property that belongs to the individual; or is a threat to engage in the above mentioned behavior . 4. Issue an I njunction against the respondent for four years or the following shorter period: . Order t he wireless telephone service provider to transfer to the petitioner each telephone number(s) he/she or a minor child in his/her custody uses. The provider will transfer to the petitioner all financial responsibility for and right to the use of any telephone number(s) transferred. (See form CV - 437, Wireless Telephone Transfer Service in Injunction Case.) 5. Order the I njunction, which is in effect for not more than 10 years, i f the C ourt finds a substantial risk the respondent may commit 1 st or 2 nd degree intentional homicide, or 1 st , 2 nd or 3 rd degree sexual assault against the petitioner. 6. If the C ourt grants the I njunctio n, the petitioner requests the C ourt a . not order the respondent to surrender his/her firearm(s). OR b . order the respondent to surrender and n ot possess a firearm while the I njunction is in effect because the petitioner believes that the respondent may use a firearm to cause physical harm to an other or endanger public safety. 7 . Direct the sheriff to accompany the petitioner and assist in placing the petitioner i n physical possession of his/ her residence, if requested. SERVICE ON RESPONDENT Before the I njunction H to verify that the documents were served and proof of service is filed with t he Clerk of Circuit Court. The C ourt will not do this for the petitioner. If available in your county, another way to verify if the documents were served is to register with VPO (VINE Protective Order) on its website at www.vinelink.com . If the respondent cannot be personally served with Temporary Restraining Order and Notice of Injunction Hearing: Harassment (CV - 406), the respondent can be served by publication using Publication Notice form (CV - 505). American LegalNet, Inc. www.FormsWorkFlow.com CV-405, 05/19 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment) 24724748.25(6) and 813.125, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 The petitioner must file with the C ourt an affidavit stating that service of the respo ndent by the sheriff or a private process server was unsuccessful because the respondent was avoiding service by concealment or otherwise. The petitioner should get this affidavit from the sheriff or private process server. The petitioner also must send the Temporary Restraining Order and Notice of Injunction Hearing: Harassment (CV - 406 ) form to the respondent via mail or facsimile and must provide proof of transmission (e.g. certified mail receipt, affidavit of mailing or fa xing). The mailing or sending of a facsimile may be omitted if the post - office address or facsimile number cannot be ascertained with due diligence. T