This form is only available from the CCAP system used by the circuit courts. American LegalNet, Inc. www.FormsWorkFlow.com STATE OF WISCONSIN blank line CIRCUIT COURT SAMPLE COUNTY For Official Use Only State of Wisconsin vs. Defendant Name JUDGMENT DEFERRED UNDER 961.47 blank line Probation Ordered blank line Date of Birth: MM-DD-YYYY Case Number: 2002CF000193 The Court found the defendant guilty of the following crime(s): blank line blank blank Ct. Crime(s) blank line blank line Wis Statute(s) Violated blank line blank Plea blank line Fel. or Misd. blank line Date(s) Crime Committed blank line 1 . Charge Description [ Stat. No. - Modifier Description ] blank line Stat. No. Plea Severity MM-DD-YYYY blank line . . The defendant consents to this disposition on MM-DD-YYYY. . The defendant is eligible for probation on MM-DD-YYYY. . IT IS ORDERED that entry of judgment of conviction is deferred and the defendant is placed on probation for X Year(s) ..Y Month(s) . Obligations: (Total amounts only) . . Fine Court Costs Attorney Fees . Restitution . Other Mandatory Victim/ Witness Surcharge XXXX.XX blank line . XXX.XX XXX.XX XXX.XX X.XX XX.XX Conditions: . Ct. Condition 1 . Length XXMO . Agency/Program Agency Name Begin Date MM-DD-YYYY Begin Time HH:MM am Comments Description of Time Condition Condition Description Miscellaneous Conditions: . Ct. Condition 1 . . Agency/Program Agency Name Comments Description of this condition Description It is adjudged that X days sentence credit are due pursuant to § 973.155 Wis. Stats. and shall be credited if probation is revoked. . It is ordered that the defendant surrender to custody of the Department of Corrections as it directs. . It is ordered that upon fulfillment of the terms and conditions of this Order this proceeding shall be dismissed and the defendant discharged. . BY THE COURT: . Department of Corrections Court Official Name, Judge DA Name, District Attorney Attorney Name, Defense Attorney . Circuit Court Judge/Clerk/Deputy Clerk . MM-DD-YYYY Date CR-214(CCAP) 06/97 Judgment Deferred DOC-61 § 961.47, Wisconsin Statutes This form may not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 1