JD-1750A, 05/19 Request to Impose Stayed Delinquency Dispositional Order 247938.34(16), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Request to Impose Stayed Delinquency Dispositional Order Case No. 1. I am the Agency Representative Corporation Counsel District Attorney. 2. The juvenile was found to be delinquent in this case. The court has imposed and stayed: the entire dispositional order. a portion of the dispositional order. 3. The juvenile violated the following condition(s) of the dispositional order: 4. I request the following stayed condition(s) of the dispositional order be imposed: 5. The juvenile: waives a court hearing to determine whether the original dispositional order should be imposed. objects and requests t he court hold a hearing within 30 days of this notice. Agency Representative / Corporation Counsel / District Attorney Name Printed or Typed Date Juvenile Waiver T he case worker and I agree that imposing the stayed conditions will not move me from an in - home placement to an out - of - home placement. I agree: o a hearing is not necessary because I admit I violated the dispositional order. o the condition(s) of the dispositional order I violated was/were explained to me prior to my violation. I do no t object to the court imposing the condition(s) of the original dispositional order. I am making this decision of my own free will. Although I understand the C ourt is not bound by this request and may impose the entire terms of the dispositional order, t he caseworker and I are requesting the following condition ( s ) be imposed: Juvenile Name Printed or Typed Date DISTRIBUTION: 1. Court 2. Caseworker 3. Juvenile American LegalNet, Inc. www.FormsWorkFlow.com