Fill and Sign the Temporary Restraining Order 497430840 Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use Notice of Temporary Restraining Order and Injunction Hearing (Individual at Risk) Petitioner:       Date of Birth:       -vs- Respondent:       Address:             Case No.       On the basis of the petition, the court finds reasonable grounds to believe that the respondent has: (mark any of the following boxes that apply) Interfered with, or based on prior conduct of the respondent, may interfere with, an investigation of the individual at risk, the delivery of protective services to the individual at risk, a protective placement of the individual at risk, or the delivery of services to an elder adult at risk; and that the interference complained of, if continued, would make it difficult to determine whether physical abuse, emotional abuse, sexual abuse, treatment without consent, unreasonable confinement or restraint, financial exploitation, neglect, or self- neglect has occurred, is occurring, or may recur. AND/OR Engaged in or threatened to engage in with the individual at risk physical abuse, emotional abuse, sexual abuse, treatment without consent, unreasonable confinement or restraint, financial exploitation, neglect, harassment, stalking, or mistreatment of an animal. The court further finds that neither the individual at risk, guardian (if any), or the guardian ad litem (if any) consented in writing to contact with the respondent, and the court agrees it is not in the best interests of the individual at risk to have contact with the respondent. THE COURT ORDERS that a hearing for an injunction be held: Date       Time       Location       Court Official       and service of this order shall be made       prior to the date of the hearing. Time Period FAILURE TO APPEAR could result in a final injunction being issued directing that you: 1. Avoid interference with an investigation of the individual at risk, the delivery of protective services to the individual at risk, or a protective placement of the individual at risk, or the delivery of services to the elder adult at risk. 2. Cease engaging in or threatening to engage in physical abuse, emotional abuse, sexual abuse, treatment without consent, unreasonable confinement or restraint, financial exploitation, neglect, harassment, or stalking of an individual at risk, or mistreatment of an animal. 3. Avoid the residence of the individual at risk or any other location temporarily occupied by the individual at risk, or both. 4. Avoid contacting or causing any person other than a party’s attorney or a law enforcement officer to contact the individual at risk. 5. Follow any other appropriate orders. VIOLATION OF AN INJUNCTION issued at this hearing shall result in your arrest and may result in the imposition of criminal penalties regardless of whether you have been served with a copy of the injunction. Violation shall result in a fine of not more than $1,000 or imprisonment for not more than 9 months or both. This injunction is enforceable despite the existence of any other orders restraining or prohibiting contact with the individual at risk. CV-429, 10/06 Notice of Temporary Restraining Order and Injunction Hearing (Individual at Risk) § §813.123, 814.61, 817.70, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 Notice of Temporary Restraining Order and Injunction Hearing (Individual at Risk) Page 2 of 3 Case No. THE COURT ORDERS THE RESPONDENT TO: 1 . Avoid interference with an investigation of the individual at risk, the delivery of protective services to the individual at risk, a protective placement of the individual at risk, or the delivery of services to the elder adult at risk. 2. Cease engaging in or threatening to engage in physical abuse, emotional abuse, sexual abuse, treatment without consent, unreasonable confinement or restraint, financial exploitation, neglect, harassment, or stalking of the individual at risk, or mistreatment of an animal. 3. Not intentionally prevent a representative or employee of the county protective services agency from meeting, communicating, or being in visual or audio contact with the adult at risk, except as otherwise provided for in this order. (Note: This is not to be ordered unless either #1 or #2 above has been ordered.) 4. Avoid the residence of the individual at risk or any other location temporarily occupied by the individual at risk, or both. 5 . Avoid contacting or causing any person other than a party’s attorney or a law enforcement officer to contact the individual at risk. 6. Engage in any other appropriate remedy not inconsistent with the remedies requested in the petition. (List the specific remedies:       THE COURT FURTHER ORDERS THAT if the individual at risk is not the petitioner, a guardian ad litem be appointed for the petitioner. The court appoints (Guardian ad litem’s name):       THIS ORDER IS IN EFFECT UNTIL THE INJUNCTION HEARING. 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. This temporary restraining order and/or injunction is entitled to full faith and credit in every civil or criminal court of the United States, civil or criminal courts of any other state, and Indian tribal courts to the extent that such courts may have personal jurisdiction over nontribal members. BY THE COURT: If you need help in this matter because of a disability, please call:       Circuit Court Judge/ Court Commissioner       Name Printed or Typed       Date Distribution: 1. Original - Court 2. Petitioner 3. Respondent 4. Law Enforcement CV-429, 10/06 Notice of Temporary Restraining Order and Injunction Hearing (Individual at Risk) § §813.123, 814.61, 817.70, Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 CV-429 , 06/03 Notice of Hearing - Temporary Restraining Order (Vulnerable Adult) §813.123, 814.61, 817.70, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. 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