Fill and Sign the Wi Domestic Abuse Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use Injunction (Domestic Abuse)Petitioner:       Date of Birth:       -VS- Respondent:       Address:             Case No.       Respondent’s : Date of Birth       Sex       Race       Height       Weight       Hair color       Eye color       THE COURT FINDS: 1. The petitioner has filed a petition alleging domestic abuse. 2. The respondent has been properly served. The respondent had an opportunity to be heard. This court has personal and subject matter jurisdiction. 3. Based on the hearing held on the petition, there are reasonable grounds to believe that the respondent has engaged in, or based upon prior conduct of the petitioner and the respondent may engage in, domestic abuse of the petitioner as defined in §813.12(1)(am), Wisconsin Statutes. THE COURT ORDERS: 1. The respondent refrain from committing acts of domestic abuse against the petitioner. 2. The respondent avoid the petitioner's residence or any location temporarily occupied by the petitioner now and in the future. 3. The respondent avoid contacting or causing any person other than a party's attorney or law enforcement officer to contact the petitioner unless the petitioner consents in writing. Contact includes contact at work, school, public places, by phone or in writing. 4. If requested, the sheriff shall serve and assist in executing this final injunction and accompany petitioner. 5. If requested, the sheriff shall assist in placing petitioner in physical possession of his or her residence. 6. Other: (May not be inconsistent with remedies requested in petition.) THE COURT FURTHER ORDERS 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 10 years, or both. A respondent may retain a firearm only if the respondent is a peace officer and only to the extent required by the peace officer's employer. 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):       (Address):       CV-404 , 10/05 Injunction (Domestic Abuse) §813.12, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.      Injunction (Domestic Abuse) Page 2 of 2 Case No. THIS INJUNCTION SHALL BE EFFECTIVE UNTIL       Not to exceed 4 years. 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 injunction is entitled to full faith and credit in every civil or criminal court of the United States or any other state, or Indian tribal courts (to the extent such tribal courts have personal jurisdiction over non tribal members). The respondent was present in court and personally served Distribution: with a copy of this order. 1. Original – Court 2. Petitioner 3. Respondent 4. Law Enforcement BY THE COURT: Circuit Court Judge / Circuit Court Commissioner       Name Printed or Typed       Date CV-404 , 10/05 Injunction (Domestic Abuse) §813.12, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2