Fill and Sign the That Original Case File Form

GF-183, 08/07 Petition, Affidavit and Order concerning Removal of Address Information from Online Records This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 - - Enter the name of the county in which the case with the address information is filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter the name of the petitioner or plaintiff in that original case file. Petitioner/Plaintiff : First name Middle name Last name -vs- Petition, Affidavit and Order C oncerning Removal of Address Information from Online Records Cas e No. Enter the name of the respondent or defendant in that original case file. Respondent/Defendant : First name Middle name Last name Enter the case number. Check if this IS or IS NOT a criminal case. Please Note: There must be an actual, demonstrated threat of physical or bodily harm to you, a family member, or a member of your household . Merely being a m ember of a group or employment category that has experienced threats in the past is not sufficient. UNDER OATH I STATE: This is NOT a criminal case and I am one of the parties in this case. This IS a criminal case an d I am not the defendant in this case. I am requesting that my street and city address information be removed from the online record of this case on the Wisconsin Circuit Court Access website. I have not made a similar request to another judge concerning this case file that has been denied. The reason for my request is that there is a demonstrated potential of physical or bodily harm or threat of such harm to me, a family member or a member of my household if that address information is available on the internet website maintained by the W isconsin Court System. At this time I believe the person who may want this information does not know my current address. Check 1 or 2. If 1 , answer question a, b, and c. When answering question d, provide detailed information concerning why you believe there is a current threat of physical or bodily harm. The basis for my belief that there is a demonstrated threat of physical or bodily harm or threat is: 1. Another person has been charged with or co nvicted of an offense relating to battery, domestic abuse, sexual assault, or stalking in which myself, a family member, or a member of household is a victim. I have a reasonable basis for believing that this person continues to be a threat. a. Na me of perso n who has been charged : b. County in which other case is filed: c. Case number of other case: d. The reason why I believe this person is a continuing threat is: See attached If 2, provide detailed information concerning who the person is, what the person has done, when this occurred, and why this is a threat to you, a family member, or another person in your household. If you need more room, attach an additional sheet. 2. Another pe rson has made actual threats against the physical safety of myself, a family member, or a member of my household but that person has not been charged or convicted of such an offense at this time. The facts supporting this belief are: See attached Therefore, I ask that the court enter an order directing the Clerk of Court to remove my street address and city designation from the address portion of the online record of this case on the Wisconsin Circuit Court Access website. Affidavit and Order concerning Removal of Address Information from Online Records Page 2 of 2 Case No. _______________ GF-183, 08/07 Petition, Affidavit and Order concerning Removal of Address Information from Online Records This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 STOP! Take this document to a Notary Public BEFORE you sign it. After you have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public. Signature Name Printed or Typed Date After you have signed the document, have the Notary Public sign, date, and seal the document. State of County of Subscribed and sworn to before me o n Notary Public/Court Official Name Printed or Typed My commission/term expires: (SEAL) IT IS ORDERED : For Court Use Only . The Petition is GRANTED becaus e the petitioner has shown a potential of harm or a threat of harm to the petitioner or a member of the petitioner’s household or family member from the online records of this case. The Clerk of Court is directed to remove the address and city information from the online record of this case. The Petition is DENIED because: 1. This is NOT a criminal case and the petitioner is not a party in this case. 2. This IS a criminal case and the petitioner is the defendant in this case. 3. The petitioner has not met the burden of showing there is a potential of harm or a threat of a harm to the petitioner or a member of the petitioner’s household or family member because of the petitioner’s a ddress being on the online record of this case. 4. Other: BY THE COURT: Circuit Court Judge Title (Print or Type Name if not eSigned) Date