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P R IN T i n B LA C K i n k FA -4 12 9V , 0 1/0 8 O rd er to S ho w C ause a n d A ffid avit fo r T em po ra ry O rd er-W it h o ut M in or C hild re n §§7 67.1 1 7, 7 6 7.1 27, a n d 7 67 .2 2 5, W is co nsin S ta tu te s T h is f o rm s h all n ot b e m odif ie d . It m ay b e s u pple m en te d w it h a d dit io nal m ate ria l. P age 1 o f 3 E nte r t h e n am e o f t h e c o unty i n w hic h y o u a re f ilin g t h is c ase . S TA TE O F W IS C O NSIN , C IR CUIT C O URT, C O UNTY E nte r t h e n am e a n d a d dre ss o f t h e p etiti o n er. I f j o in t p etitio n ers , e n te r t h e n am e o f t h e w if e . F or O ff ic ia l U se In R E: T he m arria ge o f: P etit io ner/J o in t P etit io ner-W if e : F ir s t n am e M id dle n am e L ast n am e A ddre ss A ddre ss C it y S ta te Z ip a nd E nte r t h e n am e a n d a d dre ss o f t h e r e sp on den t. I f j o in t p etitio n ers , e n te r t h e n am e o f t h e h usb an d . C heck d iv o rc e o r l e g al s e p ara tio n. E nte r t h e c ase n u m ber, i f k n ow n. I f u nkn ow n, l e av e b la n k. R esp onden t/J o in t P etit io ner-H usb an d: Fir s t n am e M id dle n am e L ast n am e A ddre ss A ddre ss C it y S ta te Z ip O rd er t o S how C au se a n d A ffid avit f o r T em pora ry O rd er W it h out M in o r C hild re n D iv o rc e-4 0 101 L eg al S ep ara tio n-4 02 01 C ase N o. O RDER T O S H O W C AU SE B ase d o n t h e a tta ch ed A ffid avit a nd R eq uest f o r H earin g f o r T em pora ry O rd er, I T IS O RDER ED t h at t h e p artie s S how C au se, In P ers o n: B efo re : C ir c u it C ourt J u dge o r C ir c u it C ourt C om mis sio ner L oca tio n: D ate : T im e: a .m ./p .m . o r a s s o on a s th e m atte r m ay b e h eard , w hy a te m pora ry o rd er s h ou ld n ot b e e nte re d f o r th e r e lie f r e queste d in t h e a tt a ch ed a ffid avit . P EN DIN G F U RTH ER C O URT O RDER o r w rit t e n s tip u la tio n o f th e p artie s, n eit h er p arty s h all e n gag e in a ny a ctiv it y th at n eg ativ e ly a ffe cts th e h ealt h , s a fe ty o r w elf a re o f e it h er p arty in clu d in g b ut n ot lim it e d to : F or C ou rt U se O nly : T he c le rk w ill c o m ple te t h is s e ctio n. Ord er to S how C ause a nd A ffid avit fo r T em pora ry O rd er-W it h out M in or C hild re n Page 2 o f 3 Case N o. _ _________ ______ FA -4 12 9V , 0 1/0 8 O rd e r t o S how C ause a nd A ffid a vit f o r T em pora ry O rd e r-W it h ou t M in o r C hil d re n §§7 67.1 1 7, 7 6 7.1 27, a n d 7 67 .2 2 5, W is co nsin S ta tu te s T h is f o rm s h all n ot b e m odif ie d . It m ay b e s u pple m en te d w it h a d dit io nal m ate ria l. P age 2 o f 3 · Both p artie s a re r e str a in ed fr o m h ara ssin g, in tim id atin g , p h ys ic a ll y a b usin g, o r i m posin g a n y r e str a in t o n t h e p ers o na l lib erty o f th e o th er p arty , o r th e o th er p arty ’s e m plo ye r. · Both p artie s a re p ro h ib it e d fr o m g oin g u pon th e p re m is e s o ccu pie d b y t h e o th er a s a r e sid ence . · Both p artie s a re r e str a in ed fr o m m akin g a n y f u rth er d e bts a ga in st t h e c re d it o f t h e o th er p arty . F urth er, u n le ss o th erw is e o rd ere d , a n y d ebt in cu rre d a fte r th e d ate o f th is o rd er is th e s o le r e sp onsib ili t y o f th e p arty in cu rrin g th e d e bt. · Both p artie s a re r e str a in ed fr o m d is co nnectin g a n y u tili t y s e rv ic e o r c a usin g a n y o th er e sse n tia l s e rv ic e s o f t h e r e sid ence o f e it h er p arty to b e d is co nnecte d. · Both p artie s s h a ll m ain ta in a ll c u rre nt b enefic ia rie s o n a ll lif e , m edic a l, h osp it a l, a uto m obil e , h ouse h old o r o th er in su ra nce s a nd in a n y c u rre nt w ills w hile t h is a ctio n is p end in g . I T I S F U RTH ER O RDER ED th at b o th p artie s b rin g to th is h ea rin g a c o m ple te d F in an cia l D is clo su re S ta te m en t. IT IS F U RTH ER O RDER ED th at a c o p y o f th is o rd er, to geth er w it h t h e s u pportin g p apers , b e s e rv e d in p ers o n a t le ast 5 b usin ess d ays b efo re th e tim e o f th is h e arin g, u pon th e : W if e H usb an d O th er: F ailu re t o a p pea r a s o rd ere d m ay r e su lt in t h e i s su an ce o f a w arr a n t d ir e ctin g t h e S herif f t o a rr e st y o u a n d b rin g y o u t o c o urt. F ailu re t o a p pea r w ill n ot s to p t h e c o urt f r o m p ro ce ed in g w it h t h e h earin g a n d m akin g t h e o rd ers r e q ueste d b y y o ur s p ouse. P artie s a re e nco ura ged to a rriv e e arly a nd d ete rm in e if a n y is su es c a n b e r e so lv e d b efo re th e h earin g. B Y T H E C O URT: F or C ou rt U se O nly Cir c u it C ourt J u d ge /C ir c u it C ourt C om mis sio ne r P rin t o r T yp e N am e Date C heck y o ur s p ou se a n d c h eck o th er i f t h ere i s a n oth er p arty (s ) t o t h e a ctio n, a n d e n te r t h e p artie s n am e. Ord er to S how C ause a nd A ffid avit fo r T em pora ry O rd er-W it h out M in or C hild re n Page 3 o f 3 Case N o. _ _________ ______ FA -4 12 9V , 0 1/0 8 O rd e r t o S how C ause a nd A ffid a vit f o r T em pora ry O rd e r-W it h ou t M in o r C hil d re n §§7 67.1 1 7, 7 6 7.1 27, a n d 7 67 .2 2 5, W is co nsin S ta tu te s T h is f o rm s h all n ot b e m odif ie d . It m ay b e s u pple m en te d w it h a d dit io nal m ate ria l. P age 3 o f 3 A FFID AVIT 1. M y s p ouse a nd I h a ve n ot a gre e d o n a t e m pora ry a rra ngem ent w hile th is a ctio n is p en din g, a nd t h ere is a n ee d f o r s u ch a n o rd er. 2. I r e quest th at a h earin g b e h eld c o nce rn in g o n e o r m ore o f th e f o llo w in g is su es: · · · · Main te n ance · · · · Use o f th e r e sid ence a n d o th er p ro p erty · · · · Paym ent o f d e bts a n d f in a ncia l o blig atio ns · · · · Paym ent o f in su ra nce a nd h ea lt h c a re e xp e nse s · · · · Oth er r e lie f th e c o urt b elie ve s a ppro pria te · · · · Oth er s p ecif ic r e lie f I b e li e ve a p pro pria te a s f o llo w s: S ee a tta ch ed 3 . I r e quest a h earin g b e h eld a nd a te m pora ry o rd er b e e nte re d p urs u a nt to § 7 67 .2 3 (1 ), W is . S ta ts . I f y o u n eed h elp in t h is m atte r b ec au se o f a d is ab ili t y , p le a se c all: ST O P! T ak e t h is d ocu m en t t o a N ota ry P ublic B E FO RE y ou s ig n i t . A fte r y o u h av e b een s w orn b y a N ota ry P ublic , s ig n a n d p rin t y o ur n am e a n d d ate t h e d o cu m en t i n f r o nt o f t h e N ota ry P ublic . S ig natu re Prin t o r T yp e N am e Date H av e t h e N ota ry P ub lic s ig n , d ate , a n d s e al t h e d ocu m en t. Subscrib ed a nd s w orn to b efo re m e o n N ota ry P ublic , S ta te o f W is co nsin M y c o m m is sio n e xp ir e s: ( S ea l) L is t a n y a d ditio n al d is p ute d m atte rs y o u n eed r e so lv ed a t t h e t e m pora ry h earin g.