JD-1783A, 02/18 Stipulation to Revise Dispositional Order 24724748.363 and 938.363, 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 Stipulation to Revise Dispositional Order Case No. STIPULATION: The undersigned agree to the following revision(s) to the dispositional order without a court hearing: ( Note: Cannot include change of placement or extension) See attached Reason(s) for revision(s): Signature of Parent 1 Print or Type Name Date Signature of Parent 2 Print or Type Name Date Signature Print or Type Name Date Signature Print or Type Name Date Signature Print or Type Name Date Signature Print or Type Name Date DISTRIBUTION: 1. Court 2. Child/Juvenile/Attorney/Guardian ad Litem 3. Parents/Guardian/Indian Custodian 4. Legal and/or Physical Custodian/Attorney (if any) 5. Social Worker 6. Foster Parent/Treatment Foster Home (if any) 7 District Attorney/Corporation Counsel 8. Tribe (if any) 9. Other American LegalNet, Inc. www.FormsWorkFlow.com