Fill and Sign the Please Specify Childs Relationships to Respondentdefendant Form

CONF IDENTIAL COURT RECORD CV-414, 05/16 Injunction ( Order of Protection – Child Abuse) §813.122, 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 Amended INJUNCTION – Child Abuse (Order of Protection - 30710) Case No. PETITIONER /CHILD Name of Petitioner (First, Middle, Last ) Name of Child (if different than Petitioner) Date of Birth of Child -VS - RESPONDENT/DEFENDANT Respondent/Defendant 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. THE COURT FINDS: Findings are on the following page(s) of this injunction. THE COURT ORDERS: Orders are on the following page(s) of this injunction. THIS INJUNCTION SHALL BE EFF ECTIVE UNTIL Not to exceed 2 years or until the child is 18 years of age, whichever occurs first , or not to exceed 5 years under 813.122(5)(dm)1. , W is. Stats. NOTIFICATIONS/WARNINGS TO RESPONDENT/DEFENDANT: This order shall be enforced, even without regi stration, and is entitled to full faith and credit in every civil or criminal court of any state, the District of Columbia, any U.S. Territory, and may be enforced by Tribal Lands (18 U.S.C. Section 2265; W is. Stats. 813.128). Crossing state, territorial, or tribal boundaries to violate this order may result in federal imprisonment (18 U.S.C. Section 2262). Federal law provides penalties for, and you may be prohibited from possessing, transporting, shipping, receiving, or purchasing a firearm, including, bu t not limited to, a rifle, shotgun, pistol, revolver, or ammunition, pursuant to 18 U.S.C . Section 922 (g)(8). Additional notifications/warnings are on the following page of this injunction. Violation of this order shall result in immediate arrest and is punishable by imprisonment not to exceed 9 months or a fine not to exceed $1,000, or both, and payment of filing and service fees. Only the court can change this order. Name of Respondent/Defendant (First, Middle, Last ) Respondent’s/Defendant’s Street Address, City, State, Zip Please specify Child’s relationship(s) to Respondent/Defendant: spouse cousin adoptive parent former spouse sibling grandparent person in dating relationship parent child (biological/adoptive/step) current o r former live -in step parent relationship Other: [Be specific ] SEX RACE DOB HT WT HAIR COLOR EYE COLOR Respondent’s/Defendant’s Distinguishing Features (such as scar s, marks or tattoos) None known. CAUTION: (Check all th at apply) Injunction (Order of Protection – Child Abuse) Page 2 of 3 Case No. CONFIDENTIAL COURT RECORD CV-414 , 05/16 Injunction (Order of Protection – Child Abuse) §813.122, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 THE COURT FINDS: 1. The child or the petitioner on behalf of the child filed a petition alleging child abuse under §813.122, W is. Stat s. 2. This court has personal and subject matter jurisdiction. The respondent has been properly served and had an opportunity to be heard. 3. There are reasonable grounds to believe that the respondent has en gaged in, or based upon prior conduct of the child and the respondent, may engage in abuse as defined in §813.122, W is . Stats. , as stated i n the court record. 4. Neither the child, guardian [if any ], or the guardian ad litem [if any ] consented in writing to have contact with the respondent, and the court agrees it is not in the best interests of the child to have contact with the respondent. 5. There is a substantial risk the respondent may commit 1st degree intentional homicide under §94 0.01, Wis. Stats., 2 nd degree intentional homicide under §940.05, Wis. Stats., 1 st, 2 nd, or 3 rd degree sexual assault under §§940.225(1), (2) or (3), W is. Stats., or 1 st or 2 nd degree sexual assault under §§948.02(1) or (2), Wis. Stats., against the child resulting in an injunction order for not more than 5 years. 6. The respondent was present in court and personally served with a copy of this order. 7. The respondent was present in court and personally served with a copy of the Order to Surrender Firearms and Notice of Firearm Surrender Hearing (CV -803). 8. The petitioner has requested the wirel ess telephone service provider transfer to the petitioner each telephone number(s) he/she or a minor c hild in his/her custody uses. THE COURT ORDERS: 1. The respondent refrain from abuse of the child. 2. The respondent avoid the child's residence and/or any premises temporarily occupied by the child. 3. The respondent avoid contacting the child or causing any person other than a party's attorney to contact the child unless the child /petitioner consents in writing and the court agrees the 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 communication or device, or in any other manner. Contact also means knowingly touching, meeting, communicating or being in visual or audio contact with t he child. 4. The respondent refrain from removing, hiding, damaging, harming, or mistreating, or disposing of, a household pet. 5. The respondent to allow the petitioner or a family member or household member of the p etitioner acting on his/her behalf to retrieve a household pet. 6. The wireless telephone service provider to transfer, within 72 hours of receipt of the order, to the petitioner each telephone number(s) he/she or a minor child in his/he r custody uses. (See Wireless Telephone Service Transfer Order in Injunction Case (CV -437) for more details.) 7. Other: [May not be inconsistent with remedies requested in the petition .] Injunction (Order of Protection – Child Abuse) Page 3 of 3 Case No. CONFIDENTIAL COURT RECORD CV-414 , 05/16 Injunction (Order of Protection – Child Abuse) §813.122, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 THE COURT FURTHER ORDERS: 1. The respondent is prohibited from possessing a firearm until the expiration of this injunction. Possession of a firearm is a Class G Felony punishable by a fine not to exceed $25,000 or imprisonment not to exceed 1 0 years, or both. The respondent shall immediately surrender any firearm(s) that he or she owns or has in his or her possession to the sheriff of this county. the sheriff of the county in which the respondent resides : . another person. [Name and Address] . Note: Court shall complete the Notice of Firearms Possession Penalties (CV -432) . 2. The respondent shall surrender firearms pursuant to Order to Surre nder Firearms and Notice of Firearm Surrender Hearing (CV -803). 3. The respondent was not present in court and shall be served a copy of Notice of Firearm Surrender Hearing (CV -802). THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL. BY TH E COURT: DISTRIBUTION: 1. Court 2. Petitioner (child) 3. Person filing on behalf of the child 4. Respondent 5. Guardian ad Litem (if any) 6. Law Enforcement 7. Other: Circuit Court Judge Title (Print or Type Name if not eSigned) Date