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Petition For Temporary Restraining Order And-Or Injunction (Individual At Risk) CV-428 - Wisconsin
| Petition For Temporary Restraining Order And-Or Injunction (Individual At Risk) Form. This is a Wisconsin form and can be used in Civil Circuit Court Statewide . |
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STATE OF WISCONSIN, CIRCUIT COURT, Petitioner (Individual at Risk): Date of Birth of Individual at Risk: COUNTY Amended For Official Use *If completing this petition on behalf of the Individual at Risk, insert your name on page 3. Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Individual at Risk - 30713) Case No. -vsRespondent/ Defendant: Address: Respondent's: Sex Race Date of Birth Height Weight Hair color Eye color Please specify Individual at Risk's relationship(s) to Respondent: spouse cousin adoptive parent former spouse sibling grandparent person in dating relationship parent child (biological/adoptive/step) current or former live-in step parent relationship Other: [Be specific)] Respondent's Distinguishing Features: (such as scars, marks or tattoos) None known. CAUTION: (Check all that apply) Respondent has access to weapon(s). Type of weapon(s): Location of weapon(s): Weapon(s) were involved in an incident [past or present] involving the individual at risk. UNDER OATH, I PETITION THE COURT for a temporary restraining order and/or injunction against the respondent under §813.123, Wis. Stats., based on the following: 1. The petitioner (individual at risk) is [Check one] a. an adult at risk (an adult who has a physical or mental condition that substantially impairs his/her ability to care for his/her needs and who has experienced, is currently experiencing, or is at risk of experiencing physical abuse, emotional abuse, sexual abuse, treatment without consent, unreasonable confinement or restraint, neglect, self-neglect, or financial exploitation). b. an elder adult at risk (a person age 60 or older who has experienced, is currently experiencing, or is at risk of experiencing physical abuse, emotional abuse, sexual abuse, treatment without consent, unreasonable confinement or restraint, neglect, self-neglect, or financial exploitation). 2. The adult respondent has [Mark any of the following boxes that apply.] a. interfered with, or based upon prior conduct of the respondent, may interfere with 1. an investigation of the individual at risk; or 2. the delivery of protective services to the individual at risk; or 3. the delivery of protective placement to the individual at risk; or 4. the delivery of services to the 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. OR b. engaged in or threatened to engage in with the individual at risk physical abuse. emotional abuse. sexual abuse. treatment without consent. financial exploitation. unreasonable confinement or restraint. neglect. harassment. stalking. mistreatment of an animal. CV-428, 08/12 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Individual at Risk) §813.123, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkFlow.com This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Individual at Risk) Page 2 of 3 Case No. 3. Stated below or attached as part of this petition is a statement of facts indicating that respondent has met the criteria set forth in either or both 2.a. or 2.b. above. (State when, where, what happened, and who did what to whom) See attached 4. Another no contact order between myself and the respondent does not exist or the petitioner does not know or is uncertain as to whether another no contact order exists. does exist. Name of other case: County or State: [If not Wisconsin] Type of Case: Case Number: [If known] Date of proceeding that resulted in no contact order [If known]: Details of no contact order: I REQUEST THE COURT: [Mark any of the following boxes that apply.] 1. Issue a temporary restraining order requiring the respondent to a. avoid interference with an investigation of the individual at risk or the elder adult at risk. b. avoid interference with the delivery of protective services to the individual at risk. c. avoid interference with a protective placement of the individual at risk. d. avoid interference with the delivery of services to the elder adult at risk. e. 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, stalking of the individual at risk, or mistreatment of an animal. f. avoid the residence of the individual at risk and/or any other location temporarily occupied by the individual at risk. g. avoid contacting or causing any person other than a party's attorney or a law enforcement officer to contact the individual at risk. Contact includes: contact at the individual at risk's home, work, school, public places, in person, by phone, in writing, by electronic communication or device, or in any other manner. h. Other: [May not be inconsistent with the other remedies noted above.] 2. Set a time for a hearing on the petition for an injunction requiring the respondent to a. avoid interference with an investigation of the individual at risk. b. avoid interference with the delivery of protective services to the individual at risk. c. avoid interference with a protective placement of the individual at risk. d. avoid interference with the delivery of services to the elder adult at risk. e. 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, stalking of the individual at risk, or mistreatment of an animal. f. avoid the residence of the individual at risk or any/or other location temporarily occupied by the individual at risk. g. avoid contacting or causing any person other than a party's attorney or a law enforcement officer to contact the individual at risk. Contact includes: contact at individual at risk's home, work, school, public places, in person, by phone, in writing, by electronic communication or device, or in any other manner. h. Other: [May not be inconsistent with the remedies noted above.] 3. If the temporary restraining order is denied, the petitioner asks the court to schedule an injunct
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