CONFIDENTIAL COURT RECORD JC-1692, 05/19 Injunction in Juvenile Court (Order of Protection Child Abuse) 24724748.25(6) and 813.122, 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 Amended INJUNCTION IN JUVENILE COURT Child Abuse ( Order of Protection - 30710 ) Case No. PETITIONER /CHILD Name of Petitioner (First, Middle, Last ) Name of Child (If different than Petitioner ) Date of Birth of Child - vs - RESPONDENT/DEFENDANT Name of Respondent/Defendant (First, Middle, Last ) SEX RACE DOB HT WT Street Address, City, State, Zip HAIR COLOR EYE COLOR (Such as scars, marks or tattoos) None known. spouse cousin classmate former spouse sibling grandchild person in dating re lationship neighbor child (biological/adoptive/step) current or former live - in relationship O ther: [Be specific] 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 child. THE COURT FINDS: Findings are on the following page(s) of this I njunction. THE COURT ORDERS : Orders are on the following page(s) of this I njunction. THIS INJUNCTION SHALL BE EFFECTIVE UNTIL Not to exceed 2 years or until the child is 18 years of age, whichever occurs first, or not to exceed 5 years under 813.122(5)(dm)1., Wis. Stats. American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL COURT RECORD JC-1692, 05/19 Injunction in Juvenile Court (Order of Protection Child Abuse) 24724748.25(6) and 813.122, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 NOTIFICATIONS/WARNINGS TO RE S PONDENT/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, transp orting, shipping, receiving, or purchasing a firearm, including, but not limited to, a rifle, shotgun, pistol, revolver, or ammunition, pursuant to 18 U.S .C. Section 922(g)(8). Additional notifications/warnings are on the following page of this I njunction . Violation of this 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 C ourt can change this Order. THE COURT FINDS: 1. The child or the petitioner on behalf of the child filed a P etition alleging child abuse under 247813.122, Wis. Stats. 2. This C ourt has personal and subject matter jurisdiction. The respondent has been properly served and had an opportunity to be heard. 3. There are reasonable grounds to believe that the respondent has engaged in, or based upon prior conduct of the child and the respondent, may engage in abuse as defined in 247813.122, Wis. Stats., as stated in the court record. 4. Neither the child, 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 child t o have contact with the respondent. 5. There is a substantial risk the respondent may commit 1 st degree intentional homicide under 247940.01, Wis. Stats., 2 nd degree intentional homici de under 247940.05, Wis. Stats., 1 st , 2 nd , or 3 rd d egree sexual assault under 247247940.225(1), (2) or (3), Wis. Stats., or 1 st or 2 nd degree sexual assault under 247247948.02(1) or (2), Wis. Stats., against the child resulting in an Injunction O rder for not more than 5 years. 6. The respondent was present in C ourt and personally served with a copy of this O rder. 7. The respondent was present in C ourt and personally served with a copy of the Order to Surrender Firearms and Notice of Firearm Surrender Hearing (CV - 803) form . 8. The petitioner has requested the wireless telephone service provider transfer to the petitioner each telephone number(s) he/she or a minor child in his/her custody uses. THE COURT ORDERS: 1. The respondent refrain from abuse of the child. 2. The respondent a void the child's residence and/or any premises temporarily occupied by the child. 3. The respondent a void contacting the child or causing any person other than a party's attorney to contact the child unless the child/petitioner consents in writing and the court agrees the contact is in the best interest of the child . Contact includes: contact electronic communication or device, or in any other manner. Contact also means knowingly touching, meeting, communicating or being in visual or audio contact with the child. 4. The respondent refrain from removing, hiding, damaging, harming, or mistreating, or disposing of, a household pet. 5. The respondent to allow the petitioner or a family member or household member of the petitioner acting on his/her behalf to retrieve a household pet. 6. The wireless telephone service provider to transfer, wit hin 72 hours of receipt of the O rder, to the petitioner each telephone number(s) he/she or a minor child in his/her custody uses. (See W ireless Telephone Service Transfer Order in Injunction Case (CV - 437) form for more details.) 7. Other: [May not be inconsistent with remedies requested in the P etition ] American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL COURT RECORD JC-1692, 05/19 Injunction in Juvenile Court (Order of Protection Child Abuse) 24724748.25(6) and 813.122, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 THE COURT FURTHER ORDERS: 1. The respondent is prohibited from possessing a firear m until the expiration of this I njunction. Possession of a firearm is a Class G Felony punishable by a fine not to exceed $25,000 or imprisonment not to exceed 10 years, or both. The respondent shall immediately surrender any firearm(s) that he or she owns or has in his or her possession to the sheriff of this county. the sheriff of the county in which the respondent resides: . another person. [Name and Address] . Note: Court shall complete the Notice of Firearms P ossession P enalties (CV - 432) form . 2. The respondent shall surrender firearms pursuant to Order to Surrender Firearms and Notice of Firearm Surrender Hearing (CV - 803) form. 3. The respondent was not present in C ourt and shall be served a copy of Notice of Firearm Surrender Hearing (C V - 802) form . TH IS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL. DISTRIBUTION: 1 . Court 2. Petitioner or Child (if not the Petitioner) 3. Person filing on behalf of the Petitioner (child) 4. Respondent 5 . Guardian ad Litem (if any) 6 . Law Enforcement 7 . Other: American LegalNet, Inc. www.FormsWorkFlow.com