CONFIDENTIAL COURT RECORD CV-412, 05/19 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Child Abuse) 247247813.122 and 814.04, 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 Child : Amended Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing ( Child Abuse 30710) Case No. Name of Petitioner (if not the Child): - vs - Respondent/ Defendant: Address: If there is a CHIPS proceeding involving the child or the respondent is a minor, Use JC - 1690 . Do not use this form. : Sex Race Date of Birth Height Weight Hair color Eye color /Defendant : spouse cousin classmate former spouse sibling grand child person in dating relationship neighbor child (biological/adoptive/step) current or former live - in relationship O ther: [B e spec ific] (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 child. I PETITION THE COURT for a Temporary Restraining Order and/or I njunction against the respondent under 247813.122, Wis. Stat s . , based on the following: 1. The name of the child is and date of birth is . 2 . The respondent is is not a parent of the child . [If the respondent is a parent of the child, the court must appoint a guardian ad litem ] 3 . The respondent has engaged in, has threatened to engage in, or based on prior conduct of the child an d the respondent, may engage in [M ark any of the following boxes that apply ] a. physical injury inflicted on the child by other than accidental means. b. sexual intercourse or sexual contact co ntrary to 247247940.225, 948.02, 948.025, 948.095, Wis. Stats. c. sexual exploitation of the child contrary to 247948.05, Wis. Stats. d. permitting, allowing or encouraging the child to violate prostitution laws contrary to 247944.30, Wis. Stats. e. fo rcing the child to view sexual activity contrary to 247948.055, Wis. Stats. f. exposing genitals or pubic area to the child contrary to 247948.10, Wis. Stats. g. causing the child to expose genitals or pubic area contrary to 247948.10, Wis. Stats. h. emotional damage to the child as defined in 24748.02(1)(gm), Wis. Stats. i. manufacturing methamphetamines contrary to 24748.02(1)(g), Wis. Stats. 4. Stated bel ow or attached as part of this P etition is a statement of facts indicating that the respondent has engaged in, or based on prior conduct of the child and the respondent, may engage in abuse of the child. (State when, where, what happened, and who did what to whom) See attached 5 . Another no contact order between the child and the respondent 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: American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL COURT RECORD CV-412, 05/19 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Child Abuse) 247247813.122 and 814.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 does not exist or the petitioner/child 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: [If known] Details of no contact order: 6. If the respondent is the parent or legal guardian of the child or has court - ordered visitation with the child, the petitioner must complete the Uniform Child Custody Jurisdiction and Enforcement Act Affidavit (GF - 150), which the clerk shall keep confidenti al and not disclose to the respondent. I REQUEST THE COURT: [Mark any of the following boxes that apply ] 1. Issue a Temporary R estraining O rder requiring the respondent to a. b. avoid contacting the child or causing any other person to have contact with the child in any way unless the court agrees such contact is in the best interest of the child. The respondent is prohibited from knowingly touching, meeting, communicating or being in visual or audio conta ct with the child unless the court grants visitation rights. phone, in writing, by electronic communication or device, or in any other manner . c . refrain from removing, hiding, damaging, harming, or mistreating, or disposing of, a household pet. d. allow the petitioner or a family member or household member of the petitioner acting on his/her behalf to retrieve a household pet. e. Other: [May not be inconsist ent with remedies noted above ] 2. S et a time for a hearing on the Petition for an I njunction requiring the respondent to a. b. avoid contacting the child or causing any other person to contact the child in any way unless the court agrees such contact is in the best interest of the child. Contact includes: contact at c public places, in person, by phone, in writing, by electronic communication or device, or in any other manner. c. refrain from removing, hiding, damaging, harming, or mistreating, or disposing of, a household pet. d. allow the petitioner or a family member or household member of the petitioner acting on his/her behalf t o retrieve a household pet. e. Other: [May not be inconsi stent with remedies noted above ] 3. If the Temporary Restraining O rder is denied, the child/petitioner asks the C ourt to schedule an I njunction H earing. 4. Issue an I njunction against the respondent for no more than two years, or until the child reaches 18 years of age, whichever occurs first. 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 5 years, i f the court finds a substantial risk respondent may commit 1 st or 2 nd degree intentional homicide, or 1 st , 2 nd or 3 rd degree sexual assault against the child. 6. Set reasonable or necessary child support. 7 . Appoint a guardian ad litem for the child. American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL COURT RECORD CV-412, 05/19 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Child Abuse) 247247813.122 and 814.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 SERVICE ON RESPONDENT B efore the Injunction H process server to verify that the documents were served and proof of service filed with th e Clerk of Circuit Court. The C ourt will not do this for the child/petitioner. If a Temporary Restraining O ffice serve the documents on the respondent, it is your responsibility to contact t njunction hearing to verify that the documents were served and proof of service has been filed with th e Clerk of Circuit Court. The C ourt wi ll not do this for you. The Clerk of Circuit C ourt shall forward the Temporary Restraining O rder to the sheriff and the sheriff shall assist the petitioner in serving the Temporary Restraining O rder. DISTRIBUTION: 1. Court 2. Petitioner (Child) 3. Person filing on behalf of the child 4. Respondent, 5. Guardian ad Litem, if appointed 6. Law Enforcement 7. Other: I declare under the penalty of false swearing that the information I have provided is true and accurate. Petitioner or Person filing on behalf of Petitioner/Child Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com