CV-402, 05/19 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Domestic Abuse) 247247813.12 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 Petitioner : Amended Petition for Temporary Restraining Order and/or Petition and Motion f or Injunction Hearing (Domestic Abuse 30709 ) Case No. * If you are completing this Petition on behalf of the Petitioner, insert your name on page 3. Date of Birth: - vs - Respondent/Defendant: Address: : Sex Race Date of Birth Height Weight Hair color Eye color spouse cousin adoptive parent former spouse sibling grandparent person in dating re lationship 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 PETITION THE COURT for a Temporary Restraining Order and/or I njunction against the respondent under 247813.12, Wis . Stat s . , based on the following: 1. The adult respondent is [M ark any of the following boxes that apply ] a. a spouse or former spouse of the petitioner. b. a parent, child, or a person related by blood or adoption to the petitioner. c. a person in a current or former live - in relationship with the petitioner. d. a person with whom the petitioner has a child in common. e. a person who provides in home or community care for t he petitioner. f. a person with whom the petitioner has or had a dating relationship. 2. The petitioner is [Mark any of the following boxes that apply ] a. not married to the respondent. b. living on property owned by respondent and the petitioner does does not have a legal interest in that property. 3. The petitioner is is not in imminent danger of physical harm. 4. Stated on next pa ge or attached as part of this P etition i s a statement of facts indicating that respondent has engaged in, or based on prior conduct of the petitioner and the respondent may engage in, domestic abuse of the petitioner. ( Domestic abuse is defined in 247813.12(1)(am), Wis. Stats., as an intentional infliction of or threat to inflict physical pain, physical injury or illness; impairment of physical condition; damage to personal property; stalking; or sexual contact or sexual intercourse without consent. There must be facts showing an imminent danger of physical harm before a temporary restraining order can be issued.) (State when, where, what happened, and who did what to whom) See attached 5. Another no contact order between the petitioner and the respondent does not exist or the petitioner does not know or is uncertain as to whether another no contact order exists . does exist. American LegalNet, Inc. www.FormsWorkFlow.com CV-402, 05/19 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Domestic Abuse) 247247813.12 and 814.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 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: [M ark any of the following boxes that apply ] 1. I ssue a Temporary Restraining O rder requiring the respondent to a. refrain from committing acts or threats of domestic abuse against the petitioner. b. idence and/or any location temporarily occupied by the petitioner. c. avoid contacting the petitioner or officer to contact the petitioner. 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 petit ioner acting on his/her behalf to retrieve a household pet. f . Other: [List other specific behavior the petitioner want s 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. refrain from committing acts or threats of domestic abuse against the petitioner. b. c. avoid contacting the petitioner or causing officer to contact the petitioner. Contact includes: contact at petitioner home, work, school, public places, in person, by phone, in writing, by electronic communicati on 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 . Other: [L ist other specific behavior the petitioner wants the respondent to stop doing ] 3. If the T emporary Restraining O rder is d enied, the petitioner asks the C ourt to schedule an I njunction hearing. 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 CV - 437 form, 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 . Direct the sheriff to accompany the petitioner and assist in placing the petitioner in physical possession of his/her residence, if requested . SERVICE ON RESPONDENT Before the I njunction H server 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: Domestic Abuse (CV - 403) form , the respondent can be served by publication using Publication Notice (CV - 417) form. The petitioner must file with the C ourt an affidavit stating that service of the respondent by the sheriff or a American LegalNet, Inc. www.FormsWorkFlow.com CV-402, 05/19 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Domestic Abuse) 247247813.12 and 814.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 private process server was unsuccessful because the respondent was avoiding service by concealment or otherwise. The petitioner should get thi s affidavit from the sheriff or private process server. The petitioner also must send the Temporary Restraining Order and Notice of Injunction Hearing: Domestic Abuse (CV - 403) form to the respondent via mail or facsimile and must provide proof of transmi ssion (e.g. certified mail receipt, affidavit of mailing or faxing). The mailing or sending of a facsimile may be omitted if the post - office address or facsimile number cannot be ascertained with due diligence. 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. * I am: [Check one] The adult Petitioner. The guardian of Petitioner [Ward] found to be incompetent. ( Must have Letters of Guardianship ) I declare under the penalty of false swearing that the information I have provided is true and accurate. DISTRIBUTION: 1. Court 2. Petitioner/Guardian 3. Respondent 4 . Law Enforcement 5. Other: Petitioner/Guardian Name Printed or Typed Date