Fill and Sign the 813125 Wisconsin Legislature Form

CV-405 , 05/16 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment) §§48.25(6) and 813.125, W isconsin 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 person to be protected (Petitioner): Name of person completing Petition (if different from Petitioner): Amended Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment – 30711) Case No. Date of Birth of Petitioner : Name -vs- Respondent/ Defendant: Address: If there is a CHIPS proceeding involving the chi ld or the respondent is a minor, Use JC -1693 . Do not use this form. Respondent’s : Sex Race Date of Birth Height Weight Hair color Eye color Please specify Petitioner’s relatio nship(s) to Respondent : 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 Other: [Be specific] Respondent’s Distinguishing Features: (such as scars, marks or tattoos) None known. 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 /or and injunction against the respondent under §813.125, Wis. Stat s., based on the following: 1. Stated below or attached as part of this petition is a statement of facts indicating that respondent has engaged in conduct which is believed to be harassment. (Ha rassment 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 §48.02(1); or (c) Sexual assault under §940.225; or (d) Stalking under §940.32; 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 what to whom) See attached 2. 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. 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 : [If known ] Details of no contact order: I am: [Check one] petitioner. stepparent of the p etitioner. guardian ad l item for child parent of the p etitioner. legal guardian of the p etitioner. Other: CAUTION: (Check all that apply) Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment ) Page 2 of 3 Case No. CV-405 , 05/16 Petition for Temporary Restraining Order and/or P etition and Motion for Injunction Hearing (Harassment) §§48.25(6) and 813.125, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 I REQUEST THE COURT: [Mark any of the following boxes that appl y.] 1. Issue a temporary restraining or der requiring the respondent to a. cease or avoid harassing the petitioner . b. avoid the petitioner’s residence and/or any premises temporarily occupied by the petitioner . c. avoid contact that harasses or intimidates the petitioner . Contact includes: contact at petitioner’s home, work, school, public places, in person, by phone, in writing, by electronic communic ation 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 respon dent to stop doing.] 2. Set a time for a hearing on the petition for an injunct ion requiring the respondent to a. cease or avoid harassing the petitioner . b. avoid the petitioner’s residence and/or any premises temporarily occupied by the petitioner . c. avoid contact that harasses or intimidates the petitioner . Contact includes: contact at petitioner’s 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 respond ent to stop doing.] 3. If the temporary restraining order is denied, the petitioner asks the court to schedule an injunction hearing. If the temporary restraining order is denied, the petitioner is only entitled to an injunction hearing if the petition alleges conduct that is the same as or similar to conduct th at is prohibited under §940.32 (stalking) ; or is the intentional infliction of physical pain, physical injury or illness; or is an intentional impairment of physical condition; or is a violat ion of §940.225(1), (2) or (3) ( sexual assault ); or is a violation of §943.01 involving destruction of property that belongs to the individual ; or is a threat to engage in the above mentioned behavior. 4. Issue an injun ction 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 injunction, which is in effect for not more than 10 years, if 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 court grants the injunction, the petitioner requests the court 1. not order the respondent to surrender his/her firea rm(s). OR 2. 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 another or endanger public safety. 7. Direct the sheriff to accompany the petitioner and assist in placing the petitioner i n physical possession of his/ her residence, if requested. Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment ) Page 3 of 3 Case No. CV-405 , 05/16 Petition for Temporary Restraining Order and/or P etition and Motion for Injunction Hearing (Harassment) §§48.25(6) and 813.125, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 SERVICE ON RESPONDENT Before the injunction h earing, it is the petitioner’s responsibility to contact the sheriff’s office or other process server to verify that the documents were served and proof of service is filed with the Clerk of Circuit Court. The court 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 court an affidavit stating that service of the respondent by the sheriff or a private process server was unsuccessful because the respondent was avoid ing service by concealment or otherwise. The petitioner should get this 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 transmission (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 ascerta ined with due diligence. The clerk of circuit court shall forward the temporary restraining order to the sheriff and the sheriff shall assist the petitioner in serving the temporary restraining order. If a service fee is required by the sheriff under §814.70(1), Wis. Stats., the petitioner shall pay the fee directly to the sheriff. If the court checks box number 3. Under “The Court Orders” section of the Temporary Restraining Order and Notice of Injunction Hearing (CV -406), no service fee is required t o be paid to the sheriff. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires:  Petitioner or Person filing on behalf of Petitioner Name Printed or Typed Date DISTRIBUTION: 1. Court 2. Petitioner 3. Person fili ng on behalf of the Petitioner 4. Respondent 5. Law Enforcement 6. Other: