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(Harassment)

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Case No.

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

Weapon(s) were involved in an incident

involving the petitioner.

[past or present]

Rab (cov) riam phom yeej tau muab siv rau ib qhov xwm txheej

rau tus ua

[yav tag los yog tam sim no]

tsab ntawv foob.

I am:

[Check one]

Kuv yog:

[Kos rau ib qho]

stepparent of the petitioner.

guardian ad litem for child.

petitioner.

niam txiv tshiab ntawm tus ua ntawv

tus kws lij choj uas tsev hais plaub tsa los saib

tus neeg ua ntawv foob.

foob.

xyuas tus me nyuam.

parent of the petitioner.

legal guardian of the petitioner.

niam txiv ntawm tus ua ntawv foob.

tus neeg saib xyuas raws cai ntawm tus ua ntawv foob.

Other: Lwm tus:

I PETITION THE COURT for a temporary restraining order/or and injunction against the respondent under §813.125,

Wis. Stats., based on the following:

KUV UA NTAWV FOOB RAU LUB TSEV HAIS PLAUB kom ua ntawv xaaj muab kev tiv thaiv mus ib ntus thiab/los

yog tau kev txwv tawm tsam tus neeg raug foob raws li tsab cai §813.125, Wisconsin Cov Cai, vim muaj cov xwm

txheej hauv qab no:

1. Stated below or attached as part of this petition is a statement of facts indicating that respondent has engaged in

conduct which is believed to be harassment.

Muab teev rau hauv qab no los sis muab tuaj ua ke nrog daim ntawv foob no yog cov lus teev muaj tseeb qhia

txog cov xwm txheej uas tus neeg raug foob tau raus tes ua tus yam ntxwv ntseeg tau tias yog kev thab ua phem

tsis raws cai lawm.

(Harassment is defined as: (a) Striking, shoving, kicking or otherwise subjecting the person to physical contact; or (b)

Engaging in an act that would constitute child abuse under §48.02(1); or (c) Sexual assault under §940.225; or (d)

Stalking under §940.32; or attempts or threat to do same; or (e) Engaging in a course of conduct or repeatedly

committing acts which harass or intimidate the person and which serve no legitimate purpose.)

(Kev thab ua phem tsis raws cai txhais tau hais tias: (a) Ntaus, thawb, ncaws los sis ua rau tus neeg muaj kev raug rau lub

cev; los sis (b) Ua tej yam txhais tau hais tias yog tsim txom me nyuam raws li tsab cai §48.02(1); los sis (c)Ua Dev

Ua Npua raws li tsab cai §940.225; los sis (d) Tuaj Nyas Xauj raws li tsab cai §940.32; los sis sim los sis tso hem

thawj tias yuav ua; los sis (e)Ua cov yeeb yam los sis pheej ua cov yeeb yam qub los thab ua phem los sis ua kom tus

neeg ntshai yam tsis tsim nyog ua li.)

(State when, where, what happened, and who did what to whom)

See attached

(Teev seb yog thaum twg, nyob rau qhov twg, muaj dab tsi tshwm sim, thiab leej

Saib Daim Ntawv Txuas

twg ua dab tsi rau leej twg)

2. Another no contact order between the petitioner and the respondent

Muaj lwm daim ntawv xaaj tsis pub sib cuag ntawm tus neeg ua ntawv foob thiab tus neeg raug foob

does not exist or the petitioner does not know or is uncertain as to whether another no contact order exists.

tsis muaj los sis tus neeg ua ntawv foob tsis paub los sis tsis paub meej seb puas muaj lwm daim ntawv xaaj

tsis pub sib cuag.

does exist. muaj.

Name of other case:

Lub npe ntawm lwm rooj plaub:

County or State:

[If not Wisconsin]

Lub County los sis lub Xeev:

[yog hais tias tsis nyob rau lub xeev Wisconsin]

Type of Case:

Hom Plaub Dab Tsi:

Case Number:

[If known]

Rooj Plaub Tus Naj Npawb:

[yog hais tias paub]

Date of proceeding that resulted in no contact order:

[If known]

Hnub uas kev hais rooj plaub los xaus ua rau muaj daim ntawv xaaj tsis pub sib cuag

[yog hias tias paub]

Details of no contact order:

Cov lus hais meej ntawm daim ntawv xaaj tsis pub sib cuag:

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 Page 2

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