CONFIDENTIAL COURT RECORD JC-1693, 05/19 Petition in Juvenile Court for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment) 24724748.25(6) and 813.125, 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 p erson to be p rotected (Petitioner) : Date of Birth of person to be protected (Petitioner) : Name of person completing Petition (if different from Petitioner ): Petition in Juvenile Court for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing ( Harassment 30711) Case No. - vs - Respondent/ Defendant: Address: I f there is a CHIPS proceeding involving the chi ld or the respondent is a minor, u se this form. : Sex Race Date of Birth Height Weight Hair color Eye color Please specify relationship (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 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 T emporary Restraining O rder and/or I njunction against the resp o ndent under 247813.125, Wis. Stat s . , based on the following: 1. [Name of Petitioner/Person to be Protected ] , is the alleged victim of harassment. 2 . Stated bel ow or attached as part of this P etition is a statement of facts indicating that respondent has engaged in conduct which is believed to be harassment. ( Harassment is defined as: (a) Striking, shoving, kicking or otherwise subjecting the person to physical contact; or (b) Engaging in an act that would constitute child abuse under 247 48.02(1); or (c) Sexual assault under 247940.225; or (d) Stalking under 247940.32; or attempts or threat to do same; or (e) Engaging in a course of conduct or repeatedly committing acts which harass or intimidate the person and which serve no legitimate purpose.) (State when, where, what happened, and who did wh at to whom) See attached 3. Another no contact o rder between the p etitioner and the respondent does not exist or the petitioner does not know or is uncertain as to whether another no contact o rder exists. does exist. Name of other case: County or State: [I f not Wisconsin ] Type of Case: Case Number: [I f known ] Date of proceeding that resulted in no contact order: [I f known ] American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL COURT RECORD JC-1693, 05/19 Petition in Juvenile Court for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment) 24724748.25(6) and 813.125, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 Details of no contact order: 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. cease or avoid harassing the petitioner. b. avoid the residence and/or any premises temporarily occupied by the petitioner . c. avoid contact th at harasses or intimidates the petitioner . Contact includes: contact at home, work, school, public 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 petitioner acting on his/her behalf to retrieve a household pet. f. avoid contacting the petitioner or causing any person other than a party's attorney or law enforcement officer to contact the petitioner . g. Other: [List other specific behavior the petitioner wants the respondent to stop doing] 2. S et a time for a hearing on the Petition for an I njunction requiring the respondent to a. cease or avoid harassing the petitioner . b. avoid the residence and/or any premises temporarily occ upied by the petitioner. c. avoid contact that harasses or intimidates the petitioner . Contact includes: contact at home, work, school, public 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 petitioner acting on his/her behalf to retrieve a household pet. f. avoid contacting the petitioner or causing any person other than a party's attorney or law enforcement officer to contact the petitioner. g. Other: [List other specific behavior the petitioner wan ts the respondent to stop doing ] 3. If the T em porary Restraining O rder is denied, the petitioner asks the C ourt to schedule an I njunction H earing. If the Temporary Restraining Order is denied, the petitioner is only entitled to an I njunction H earing if the P etition alleges conduct that is the same as or similar to conduct that is prohibited under 247940.32 [stalking]; or is the intentional infliction of physical pain, physical injury or illness; or is an intentional impairment of physical condition; or is a violation of 247940.225(1), (2) or (3) [sexual assault]; or is a violation of 247943.01 involving destruction of property that belongs to th e individual; or is a threat to engage in the above mentioned behavior. 4. I ssue 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 form CV - 437, 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 court 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. If the C ourt grants the I njunctio n, the petitioner requests the C ourt a . not order the respondent to surrender his/her firearm(s). OR b . order the respondent to surrender and not possess a firearm while the injunction is in effect because the petitioner believes that the respondent may use a firearm to cause physical harm to an other or endanger public safety. 7 . Direct the sheriff to accompany the petitioner and assist in placing the petitioner in physical possession of his or American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL COURT RECORD JC-1693, 05/19 Petition in Juvenile Court for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment) 24724748.25(6) and 813.125, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 her residence, if requested. SERVICE ON RESPONDENT Before the server to verify that the documents were served and proof of ser vice is filed with the Clerk of 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: Harassment (CV - 406) , the respondent can be served by publication using Publication Notice form (CV - 505). The petitioner must file with the C ourt an affidavit stating that service of the respondent by the sheriff or a private process server was unsuccessful because the respondent was avoiding service by concealment or otherwise. The petitioner should get this affidavit from the sheriff or priva te process server. The petitioner also must send the Temporary Restraining Order and Notice of Injunction Hearing: Harassment