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STATE OF WISCONSIN, CIRCUIT COURT,

COUNTY

Name of person to

Amended Muab kho dua

be protected

(Petitioner):

Npe ntawm tus neeg

Petition for

uas yuav tau tiv

Temporary Restraining

thaiv nws

(Tus Neeg Ua Ntawv

Order and/or Petition

Foob):

Name of person

and Motion for Injunction

completing Petition

Hearing

Npe ntawm tus neeg

ua Daim Ntawv Foob

Tsab Ntawv Foob rau

(if different from

Kev Xaaj Tiv Thaiv Mus

Petitioner):

(yog hais tias tsis yog

Ib Ntus thiab/los sis

tus Neeg Ua Daim

Ntawv Foob thiab Thov

Ntawv Foob):

Date of Birth of

Kom Muaj Lub Rooj Sib

Petitioner:

Hnub Yug ntawm Tus

Hais Muab Kev Txwv

Neeg Ua Ntawv Foob

-vs- -tawm tsam-

(Harassment – 30711)

Respondent/

(Kev Thab Ua Phem – 30711)

Defendant:

Tus Neeg Raug Foob/

Tus Tiv Thaiv Rooj

Case No.

Plaub:

Rooj Plaub Tus Naj Npawb

Address:

Chaw Nyob:

Name

This form does not replace the need for an interpreter, any colloquies mandated by law, or the responsibility of the court and

counsel to ensure that persons with limited English proficiency fully comprehend their rights and obligations.

Daim foos no tsis hloov qhov xav tau ib tus neeg txhais lus, muaj kev sib tham txog dab tsi raws li txoj cai, los sis lub luag hauj lwm

ntawm lub tsev hais plaub thiab tus kws lij choj kom ntseeg tau tias cov neeg uas tsis txawj lus Meskas zoo muaj kev nkag siab txog

nws cov cai thiab nws cov hauj lwm yuav tau ua ntawd.

If there is a CHIPS proceeding involving the child or the respondent is a minor, Use JC-1693. Do not use this form.

Yog hais tias muaj ib rooj plaub CHIPS nrog tus me nyuam no los sis tus neeg raug foob tsis tau muaj hnub nyoog, Siv daim JC-

1693. Tsis txhob siv daim foos no.

Respondent’s

Sex

Race

Date of Birth

Height

Weight

Hair color

Eye color

Haiv neeg

Poj Niam/Txiv

Hnub Yug

Siab

Hnyav

Xim Plaub Hau

Xim Qhov Muag

Tus Neeg Raug

Neej

Foob yog:

Respondent’s Distinguishing Features:

Please specify Petitioner’s relationship(s) to Respondent:

Thov qhia tus Neeg Ua Daim Ntawv Foob qhov (cov) kev txheeb ze rau tus Neeg Raug Foob.

(such as scars, marks or tattoos)

spouse

cousin

adoptive parent

niam/txiv saws

Tus Neeg Raug Foob Tej Yam Ntxwv Ua Rau

tus txij nkawm

kwv tij/viv ncaus

me nyuam los tu

Cim Tau Nws:

former spouse

sibling

grandparent

nkauj

pog (niam tais)/yawg

(Xws li caws pliav, kos los sis kvc kos duab rau

tus txij nkawm yav tas los

muam nraug nus (yawm txiv)

tawv nqaij)

koom niam txiv

person in dating relationship

parent

child (biological/adoptive/step)

hluas nkauj/hluas nraug

niam/txiv

me nyuam (roj ntsha yug los/saws los

current or former live-in

step parent

tu/me nyuam tshiab)

None known.

relationship

tus neeg nrog

niam/txiv tshiab

nyob tam sim no los yog yav tag

Tsis paub seb puas muaj.

Other

Txeeb lwm qhov:

: [Be specific]

[Qhia kom meej]

CAUTION:

Respondent has access to weapon(s). Type of weapon(s):

(Check all that apply)

Tus Neeg Raug Foob muaj kev cuag tau (cov) riam phom. Hom (cov) riam phom zoo li cas:

CEEB FAJ:

Location of weapon(s):

(

Kos rau tas nrho

)

qhov hais raug

Rab (cov) riam phom nyob rau qhov twg:

CV-405, 05/16 Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing (Harassment) §§48.25(6) and 813.125, Wisconsin Statutes

Hmong 07/16

This form shall not be modified. It may be supplemented with additional material.

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Form Cv-405 - Petition For Temporary Restraining Order And/or Petition And Motion For Injunction Hearing

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