CONFIDENTIAL COURT RECORD JC-1690, 05/19 Petition in Juvenile Court for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Child Abuse) 24724748.25(6), 813.122 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: Name of Petitioner: (if not the Child) Amended Petition in Juvenile Court for Temporary Restr aining Order and/or Petition and Motion for Injunction Hearing ( Child Abuse 30710) Case No. - vs . - Respondent/ Defendant: Address: If there is a CHIPS proceeding involving the child or the respondent is a minor, u se this form. : Sex Race Date of Birth Height Weight Hair color Eye color /Defendant : spouse cousin classmate former spouse sibling grandchild person in dating relationship neighbor child (biological/adoptive/step) current or former live - in relationship O ther: ( B e 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 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 petitioner is the child. parent. stepparent. legal guardian. agency involved in CHIPS proceeding. 2. The name of the child is and date of birth is . 3. 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.) 4. The respondent is a child. an adult and there is a pending CHIPS action in the juvenile court involving the child victim. 5. Th e respondent has engaged in, has threatened to engage in, or based on prior conduct of the child and th e 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 contrar y to 24748.02(1)(g), Wis. Stats. 6 . 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 American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL COURT RECORD JC-1690, 05/19 Petition in Juvenile Court for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Child Abuse) 24724748.25(6), 813.122 and 814.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 7. Another no contact o rder between the child and the respondent does not exist or the petitioner/ child does not know or is uncertain as to whether another no contact o rder exists. does exist. Name of other case: County or State: [if not Wisconsin] Type of Case: Case Number: [if known] Date of proceedi ng that resulted in no contact o rder: [if known] Details of no contact o rder: 8. 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 form (GF - 150), which the clerk shall keep confi dential and not disclose to the respondent. I REQUEST THE COURT: [Mark any of the following boxes that apply] 1. I ssue a Temporary Restraining O rder requiring the respondent to a. ses temporarily occupied by the child. 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 pr ohibited from knowingly touching, meeting, communicating or being in visual or audio contact with the child unless the court grants visitation rights. 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 child or a family member or household member of the child acting on his/her behalf to retrieve a household pet. e. Other: [ May not be inconsistent with remedies noted above ] 2. S et a time for a hearing on the Petition for an I njunction requiring the respondent to a. avoid and /or any premises temporarily occupied by the child. b. avoid contacting the child or causing any other person to have contact the child in any way unless the court agrees such contact is in the best interest of the child. Contact includes: contact school, 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 child or a family member or household member of the child acting on his/her behalf to retrieve a household pet. e. Other: [ May not be inconsistent with remedies noted above ] 3. If the T emporary 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 not 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 child each telephone number(s) he/she or a minor child in his/her custody uses. The provider will transfer to the child /petitione r 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 degre e 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 JC-1690, 05/19 Petition in Juvenile Court for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Child Abuse) 24724748.25(6), 813.122 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 process server to verify that the documents were served and proof of service filed with the Clerk of Court. The C ourt will not do this for the child/petitioner. serve the documents on s office before the Injunction H earing to verify that the documents were served and proof of service has been filed with the Clerk of Court. The C ourt will not do this for you. The C l erk of C ourt shall forward the Temporary Restraining O rder to the sheriff and the sheriff shall assist the petitioner in serving the Temporary Restraining Order. DISTRIBUTION: 1. Court 2. 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 penalty of false swearing that the information I have provided is true and accurate. Petitioner Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com