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(Harassment)

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Case No.

Petition for Temporary Restraining Order and/or Petition and Motion for Injunction Hearing

I REQUEST THE COURT:

[Mark any of the following boxes that apply.]

1. Issue a temporary restraining order requiring the respondent to

a. cease or avoid harassing the petitioner.

b. avoid the petitioner’s residence and/or any premises temporarily occupied by the petitioner.

Contact includes: contact at petitioner’s

c. avoid contact that harasses or intimidates the petitioner.

home, work, school, public places, in person, by phone, in writing, by electronic

communication or device, or in any other manner.

d. refrain from removing, hiding, damaging, harming, or mistreating, or disposing of, a household pet.

e. allow the petitioner or a family member or household member of the petitioner acting on his/her behalf to

retrieve a household pet.

f. avoid contacting the petitioner or causing any person other than a party's attorney or law enforcement

officer to contact the petitioner.

g. Other:

[List other specific behavior the petitioner wants the respondent to stop doing.]

2. Set a time for a hearing on the petition for an injunction requiring the respondent to

a. cease or avoid harassing the petitioner.

b. avoid the petitioner’s residence and/or any premises temporarily occupied by the petitioner.

Contact includes: contact at petitioner’s home,

c. avoid contact that harasses or intimidates the petitioner.

work, school, public places, in person, by phone, in writing, by electronic communication or device, or

in any other manner.

d. refrain from removing, hiding, damaging, harming, or mistreating, or disposing of, a household pet.

e. allow the petitioner or a family member or household member of the petitioner acting on his/her behalf to

retrieve a household pet.

f. avoid contacting the petitioner or causing any person other than a party's attorney or law enforcement

officer to contact the petitioner.

g. Other:

[List other specific behavior the petitioner wants the respondent to stop doing.]

3. If the temporary restraining order is denied, the petitioner asks the court to schedule an injunction hearing.

If the temporary restraining order is denied, the petitioner is only entitled to an injunction hearing if the petition alleges

conduct that is the same as or similar to conduct that is prohibited under §940.32 (stalking); or is the intentional infliction

of physical pain, physical injury or illness; or is an intentional impairment of physical condition; or is a violation of

§940.225(1), (2) or (3) (sexual assault); or is a violation of §943.01 involving destruction of property that belongs to the

individual; or is a threat to engage in the above mentioned behavior.

4. Issue an injunction against the respondent for four years or the following shorter period:

Order the wireless telephone service provider to transfer to the petitioner each telephone number(s)

he/she or a minor child in his/her custody uses. The provider will transfer to the petitioner all financial

responsibility for and right to the use of any telephone number(s) transferred. (See form CV-437,

Wireless Telephone Transfer Service in Injunction Case.)

5. Order the injunction, which is in effect for not more than 10 years, if the court finds a substantial risk the

respondent may commit 1

or 2

degree intentional homicide, or 1

, 2

or 3

degree sexual assault against

the petitioner.

6. If the court grants the injunction, the petitioner requests the court

1. not order the respondent to surrender his/her firearm(s). OR

2. order the respondent to surrender and not possess a firearm while the injunction is in effect

because the petitioner believes that the respondent may use a firearm to cause physical harm to

another or endanger public safety.

7. Direct the sheriff to accompany the petitioner and assist in placing the petitioner in physical possession of

his/her residence, if requested.

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

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 Page 2

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