Fill and Sign the Petition for Temporary Restraining Order and or Injunction Child Form

CONFIDENTIAL COURT RECORD CV-412 , 05/16 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Child Abuse ) §813.122 and 814.04, 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 Child : Amended Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Child Abuse – 30710) Case No. Name of Petitioner (if not the Child): -vs- Respondent/ Defendant: Respondent’s Address: If there is a CHIPS proceeding involving the child or the respondent is a minor, Use JC -1690 . Do not use this form. Respondent’s : Sex Race Date of Birth Height Weight Hair color Eye color Please specify Child’s relationship(s) to Respondent: spouse cousin adoptive parent former spouse sibling grandparent per son in dating relationship parent child (biological/adoptive/step) current or former live -in step parent relationship Other: [Be spec ific] 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 child. I PETITION THE COURT for a temporary restraining order and/or injunction against the respondent under §813.122, W is. Stat s., based on the following: 1. The name of the child is and date of birth is . 2. The respondent is is not a parent of the child . [If the respondent is a parent of the child, the court mu st appoint a guardian ad litem.] 3. The respondent has engaged in, has threatened to engage in, or based on prior conduct of the child an d the respondent, may engage in [Mark 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 cont rary to §§940.225, 948.02, 948.025, 948.095, W is. Stats. c. sexual exploitation of the child contrary to §948.05, Wis. Stats. d. permitting, allowing or encouraging the child to violate prostitution laws contrary to §944.30, W is. Stats. e. forcing the child to view sexual activity contrary to §948.055, W is. Stats. f. exposing genitals or pubic area to the child contrary to §948.10, W is. Stats. g. causing the child to expose genitals or pubic ar ea contrary to §948.10, Wis. Stats. h. emotional damage to the child as defined in §48.02(1)(gm), Wis. Stats. i. manufacturing methamphetamines contrary to §48.02(1)(g), Wis. Stats. 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 (Child Abuse ) Page 2 of 3 Case No. CONFIDENTIAL COURT RECORD CV-412 , 05/16 Petition for Temporary Restraining Order and/or Petition and Motion for Inj unction Hearing (Child Abuse) §813.122 and 814.04, W isconsin Statutes This form shall not be modified. It may be supplemented wi th additional material. Page 2 of 3 4. Stated below or attached as part of this petition 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 5. Another no contact order 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 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: 6. 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 En forcement Act Affidavit ( GF -150 ), which the clerk shall keep confidentia l and not disclose to the respondent . I REQUEST THE COURT: [Mark any of the following boxes that apply.] 1. Issue a temporary restraining ord er requiring the respondent to a. avoid the child’s residence and/or any premise s 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 prohibited from knowingly touching, meeting, communicating or being in visual or audio contact with the child unless the court grants visitation rights. Contact includes: contact at child’s home, work, 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 petitioner or a family member or household member of the petitioner acting on his/her behalf to retrieve a household pet. e. Other: [May not be inconsistent with remedies requested in petition ] 2. Set a time for a hearing on the petition for an injunction requiring the respondent to a. avoid the child’s residence and /or any premises temporarily occupied by the child . b. avoid contac ting the child or causing any other person to contact the child in any way unless the court agrees such contact is in the best interest of the child. Contact includes: contact at child’s home, work, school, public places, in person, by phone, in writing, by electronic c ommunication 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 petitioner or a family member or household member of the petitioner acting on his/her behalf to retrieve a household pet. e. Other: [May not be inconsistent with remedies noted above .] 3. If the temporary restraining order is denied, the child/ petitioner asks the court to schedule an injunction hearing. 4. Issue an injunction against the respondent for no 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 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. Orde r the injunction, which is in effect for not more than 5 years, if 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 degree sexual assault against the child. Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Child Abuse ) Page 3 of 3 Case No. CONFIDENTIAL COURT RECORD CV-412 , 05/16 Petition for Temporary Restraining Order and/or Petition and Motion for Inj unction Hearing (Child Abuse) §813.122 and 814.04, W isconsin Statutes This form shall not be modified. It may be supplemented wi th additional material. Page 3 of 3 6. Set reasonable or necessary child support. 7. Appoint a guardian ad litem for the child. SERVICE ON RESPONDENT Befo re the injunction hearing, it is the child's/petitioner's responsibility to contact the sheriff’s office or private process server to verify that the documents were served and proof of service filed with the Clerk of Circuit Court. The cou rt will not do this for the child/petitioner . If a temporary restraining order is granted, and you choose to have the sheriff’s office serve the documents on the respondent, it is your responsibility to contact the sheriff’s office before the injunction hearing to verify that the documents were served and proof of service has been filed with the Clerk of Circuit Court. The court will not do this for you. The clerk of circuit court shall forward the temporary restraining order to the sheriff and the sher iff shall assist the petitioner in serving the temporary restraining order. 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/Child Name Printed or Typed Date DISTRIBUTION: 1. Court 2. Petitioner (Child) 3. Person filing on behalf of the child 4. Respondent, 5. Guardian ad Litem, if appointed 6. Law Enforcement 7. Other: