Fill and Sign the Restraining Order and 497430826 Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use Please print or type Petition in Civil Court for Temporary Restraining Order and/or Injunction (Child Abuse – 30710)Petitioner:       Address: (Optional)             -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 §813.122, Wis. Stats, based upon the following: 1. The petitioner is       a child. parent. stepparent. legal guardian. Name 2. The child is       whose date of birth is       . Name 3. The respondent is an adult and is is not a parent of the child. 4. The respondent has engaged in, or based on prior conduct of the child and 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 contrary to §§940.225, 948.02, 948.025, 948.095, Wis. Stats. c. Sexual exploitation of the child contrary to §948.05, Wis. Stats. d. Permitting, allowing or encouraging the child to violate the prostitution laws contrary to §944.30, Wis. Stats. e. Forcing the child to view sexual activity contrary to §948.055, Wis. Stats. f. Exposing genitals or pubic area to the child contrary to §948.10, Wis. Stats. g. Causing the child to expose genitals or pubic area 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. 5. 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.       I REQUEST THAT THE COURT: (Mark any of the following boxes that apply.) 1. Immediately issue a temporary restraining order and set a time for a hearing on an injunction requiring the respondent to: a. avoid the residence of the child and any premises temporarily occupied by him or her. b. avoid contacting the child and causing any other person to have contact with him or her in any way unless the court agrees such contact is in the best interest of the child. c. other:       2. Appoint a guardian ad litem for the child. 3. Set reasonable or necessary child support. 4. 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. 5. Direct the sheriff to assist in executing or serving this temporary restraining order and injunction. CV-412 , 08/06 Petition in Civil Court for Temporary Restraining Order and/or Injunction (Child Abuse - 30710) §813.122, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 Petition in Civil Court for Temporary Restraining Order and/or Injunction (Child Abuse - 30710) Page 2 of 2 Case No. Subscribed and sworn to before me Distribution: on 1. Original - Court 2. Petitioner 3. Respondent Notary Public, State of Wisconsin 4. Law Enforcement My commission expires 5. Other: Signature of Petitioner       Name Printed or Typed       Date CV-412 , 08/06 Petition in Civil Court for Temporary Restraining Order and/or Injunction (Child Abuse - 30710) §813.122, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2