Fill and Sign the Restraining Order and Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use Please print or type Petition for Temporary Restraining Order and/or Injunction (Domestic Abuse – 30709)Petitioner:       Date of Birth:       -VS- Respondent:       Address:             Case No.       Respondent’s : Date of Birth       Sex       Race       Height       Weight       Hair color       Eye color       Under oath, I petition the court for a temporary restraining order and/or injunction against the respondent under §813.12, Wisconsin Statutes, based upon the following: 1. I am a. an adult petitioner. b. the guardian of an adult incompetent person (ward). (Attach Letters of Guardianship) For guardians, all references to “I” or “me” below refer to the ward. 2. The adult respondent is (Mark any of the following boxes that apply) : a. a spouse, former spouse, parent, child, or a person related by blood or adoption to me. b. a person currently or formerly residing in a place of abode with me. c. a person with whom I have a child in common. d. a person who provides in home or community care for me. e. a person with whom I have or had a dating relationship. 3. (Mark any of the following boxes that apply.) a. I am not married to the respondent. b. Respondent owns the property on which I am living. c. I have no legal interest in this property. 4. I am am not in imminent danger of physical harm. 5. Stated below or attached as part of this petition is a statement of facts indicating that respondent has engaged in, or based on prior conduct of the petitioner and the respondent may engage in, domestic abuse of the petitioner. (Domestic abuse is defined in §813.12(1)(am), Wisconsin Statutes, as an intentional infliction of or threat to inflict physical pain, physical injury or illness; impairment of physical condition; damage to personal property; or sexual contact or sexual intercourse without consent. There must be facts showing an imminent danger of physical harm before a temporary restraining order can be issued.) (State when, where, what happened, and who did what to whom:) See attached. CV-402 , 08/02 Petition for Temporary Restraining Order and/or Injunction (Domestic Abuse) §813.12, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Petition for Temporary Restraining Order and/or Injunction (Domestic Abuse) Page 2 of 2 Case No.       I REQUEST THAT THE COURT: (Mark any of the following boxes that apply.) 1. Issue a temporary restraining order requiring the respondent to: a. refrain from committing acts of domestic abuse against me. b. avoid my residence and any location temporarily occupied by me. c. avoid contacting me and causing any other person except a party’s attorney or law enforcement officer to have contact with me in any way. d. Other:       2. Set a time for a hearing on the petition for an injunction requiring the respondent to: a. refrain from committing acts of domestic abuse against me. b. avoid my residence and any location temporarily occupied by me. c. avoid contacting me and causing any other person except a party’s attorney or law enforcement officer to have contact with me in any way. d. Other:       3. Grant an award in a reasonable amount for the costs of maintaining this action and attorney fees, if deemed appropriate, and such other relief as may be just and equitable. 4. Direct the sheriff to serve and assist in executing this Temporary Restraining Order. 5. Direct the sheriff to accompany the petitioner and assist in placing the petitioner in physical possession of his or her residence. 6. Enter an injunction for four years or the following shorter period:       Distribution: 1. Court – Original 2. Petitioner 3. Respondent 4. Law Enforcement Subscribed and sworn to before me on       Notary Public, State of Wisconsin My commission expires:       Signature of Petitioner/Guardian       Date CV-402 , 08/02 Petition for Temporary Restraining Order and/or Injunction (Domestic Abuse) §813.12, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2