CV-429 Pro Se, 05/16 Temporary Restraining Order and Notice of Injunction Hearing (TRO-Individual at Risk) 247813.123, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 BY THE COURT: Circuit Court Judge Circuit Court Commissioner Print or Type Name Date STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Amended Temporary Restraining Order (Temporary Order of Protection) and Notice of Injunction Hearing ( Individual at Risk - 30713) Case No. PETITIONER (INDIVIDUAL AT RISK) Name of Petitioner (First, Middle, Last ) Date of Birth of Individual at Risk -VS- RESPONDENT/DEFENDANT CAUTION: (Check all that apply Respondent/Defendant 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 individual at risk . THE COURT FINDS: Findings are on the following page(s) of this Temporary Restraining O rder . THE COURT ORDERS: Orders are on the following page(s) of this T emporary Restraining O rder. THIS TEMPORARY RESTRAINING ORDER SHALL BE EFFECTIVE UNTIL Injunction Hearing Date - Not to exceed 14 days Name of Respondent/Defendant (First, Middle, Last) Please specify relationsh ip(s) to Respondent/Defendant: spouse cousin adoptive parent former spouse sibling grandparent person in dating relationship parent child (biological/adoptive/step) current or former live - in step pare nt relationship O ther: [B e specific ] SEX RACE DOB HT WT HAIR COLOR EYE COLOR (such as scars, marks or tattoos) None known. American LegalNet, Inc. www.FormsWorkFlow.com CV-429 Pro Se, 05/16 Temporary Restraining Order and Notice of Injunction Hearing (TRO-Individual at Risk) 247813.123, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 NOTIFICATIONS/WARNINGS TO RESPONDENT/DEFENDANT: This O rder shall be enforced, even without registration, and is entitled to full faith and credit in every civil or criminal court of any state, the District of Columbia, any U.S. Territory, and may be enforced by Tribal Lands (18 U.S.C. Section 2265; Wis. Stats . 813.128). Crossing state, territorial, or tri bal boundaries to violate this O rder may result in federal imprisonment (18 U.S.C. Section 2262). Federal law provides penalties for, and you may be prohibited from possessing, transporting, shipping, receivi ng or purchasing a firearm, including, but not limited to, a rifle, shotgun, pistol, revolver, or ammunition, pursuant to 18 U.S.C. 922(g)(8). Additional notifications/warnings are on the following page of this Temporary Restraining O rder. Violatio n of t his Temporary Restraining O rder shall result in immediate arrest and is punishable by imprisonment not to exceed 9 months or a fine not to exceed $1,000, or both, and payment of filing and service fees. Only the Court can change this Order. THE COURT FINDS: 1. The individual at risk or person /agency on behalf of the individual at risk filed a P etition alleging the elements under 247813.123, Wis. Stats. 2. This C ourt has personal and subject matter jurisdiction. 3. There are reasonable grounds to believe that the respondent has interfered with, engaged in or based on prior conduct of the respondent, may engage in abuse as defined in 247813.123, Wis. Stats., as stated in the court record. 4. Neither the individual at risk, guardian [if any] , or the guardian ad litem [if any] consented in writing to have contac t with the respondent, and the C ourt agrees it is not in the best interests of the individual at risk to have contact with the respondent. 5. The Court orders a Temporary Restraining Order and sets a date for an Injunction H earing . THE COURT ORDERS: 1. A he aring for an I njunction be held on Date Time Location Circuit Court Judge 2. Service of this Notice and O rder shall be made at least hours prior to the hearing. 3. The respondent avoid interference with an investigation of the individual at risk, th e delivery of protective services to the individual at risk, or a protective placement of the individual at risk, or the delivery of services to the elder adult at risk. 4. The respondent cease engaging in or threatening to engage in physical abuse, emotional abuse, sexual abuse, treatment without consent, unreasonable confinement or restraint, financial exploitat ion, neglect, harassment, stalking of the individual at risk, or mistreatment of an animal. 5. The respondent avoid the residence of the individual at risk and/or any other loca tion temporarily occupied by the individual at risk. 6. enforcement officer to contact the individual at risk. Contact includes: co school, public places, in person, by phone, in writing, by electronic communication or device, or in any other manner. 7. The respondent refrain from removing, hiding, damaging, harming, or mistreating, or disposing of, a household pet. 8. The respondent allow the petitioner or a family member or household member of the petitioner acting on his/her behalf to retrieve a household pet. 9. The respondent shall not intentionally p revent a representative or employee of the county protective services agency from meeting, communicating, or being in visual or audio contact with the adult at risk, except as ordered here: American LegalNet, Inc. www.FormsWorkFlow.com CV-429 Pro Se, 05/16 Temporary Restraining Order and Notice of Injunction Hearing (TRO-Individual at Risk) 247813.123, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 10. If a person/agency filed this petition on behalf of the individual at risk , a guardian ad litem be appointed fo r the individual at risk. The C ourt appoints [ ] . 11 . Other: [May not be inconsistent with remedies requested in the P etition ] FAILURE TO APPEAR could result in a injunction being issued directing you to : avoid interference with an investigation of the individual at risk; avoid interference with the delivery of protective services to the individual at risk, or a protective placement of the individual at risk; avoid interference with the delivery of services to the elder adult at risk; avoid contacting the individual at risk or causing officer to contact the individual at risk . engaging in or threatening to engage in physical abuse, emotional abuse, sexual abuse, treatment without consent, unreasonable confinement or restraint, financial exploitation, neglect, harassment, stalking of the individu al at risk, or mistreatment of an animal; AND follow any other appropriate orders not inconsistent with the remedies requested in the P etition. VIOLATION OF AN INJUNCTION if issued at this hearing shall result in your arrest and may result in the imposition of criminal penalties regardless of whether you have been served a copy of the injuncti on. Service of a copy of this Notice of Injunction Hearing and the Petition for the T emp orary Restraining Order and/or I njunction is constructive kno wledge of the existence of the I njunction . THIS TEMPORARY RESTRAINING ORDER IS IN EFFECT UNTIL THE INJUNCTION HEARING. If you require reasonable accommodations due to a disability, please call prior to the scheduled court date. Please note that the court does not provide transportation. DISTRIBUTION : 1. Court 2. Petitioner(Individual at Risk) 3. Person/Agency acting on behalf of Individual at Risk 4. Respondent 5. Guardian ad Litem, if appointed 6. Law Enforcement 7. Other: American LegalNet, Inc. www.FormsWorkFlow.com