Fill and Sign the Wisconsin Restraining Order Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use Please print or type. IN THE INTEREST OF       Name Petition in Juvenile Court for Temporary Restraining Order and/or Injunction (Child Abuse)       Date of Birth Case No.       Under oath, I petition the court for a temporary restraining order and/or injunction against the respondent under §813.122, Wis. Stats, based on the following : 1. The petitioner is (name)       , a child. parent. stepparent. legal guardian. agency involved in CHIPS proceeding. 2. The respondent is a child. an adult and there is a pending CHIPS action in the juvenile court involving the child victim. 3. The respondent is is not the parent of the child. 4. The respondent is: Name       Address       Date of birth       Sex       Race       Height       Weight       Hair color       Eye color       5. 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 of §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 to §48.02(1)(gm), Wis. Stats. i. Manufacturing methamphetamines contrary to §48.02(1)(g), Wis. Stats. 6. Stated below or attached as part of this petition is a statement of facts indicating that the respondent has engaged in or threatened to engage in child abuse. ( State when, where, what happened, and who did what to whom :) See attached. JC-1690, 08/06 Petition in Juvenile Court for Temporary Restraining Order and/or Injunction (Child Abuse) §§48.25(6) and 813.122, Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 Petition in Juvenile Court for Page 2 of 3 Case No. Temporary Restraining Order and/or Injunction (Child Abuse)       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 a final 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 interests 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. Subscribed and sworn to before me on       Notary Public, State of Wisconsin My commission expires:       Distribution: 1. Original - Court 2. Petitioner 3. Respondent 4. Law Enforcement 5. Other:       Signature of Petitioner       Date JC-1690, 08/06 Petition in Juvenile Court for Temporary Restraining Order and/or Injunction (Child Abuse) §§48.25(6) and 813.122, Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 JC-1690 , 06/01 Petition in Juvenile Court for Temporary Restraining Order and/or Injunction §§48.25(6) and 813.122, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2