AMENDED For Office Use Only STATE OF WISCONSIN, CIRCUIT COURT/BRANCH #, COUNTY JUDGMENT OF CONVICTION (Select One) Sentence to County Jail State of Wisconsin, Plaintiff Sentence to Wisconsin State Prisons Sentence to Wisconsin State Prisons and Extended Supervision Sentence Withheld, Probation Ordered Sentence Imposed & Stayed, Probation Ordered , Defendant CASE NUMBER Defendant’s Date of Birth The defendant was found guilty of the following crime(s): CT. CRIMES(S) List Aliases WISCONSIN STATUTE(S) VIOLATED PLEA FELONY OR MISDEMEANOR CLASS DATE(S) CRIME COMMITTED DATE(S) CONVICTED IT IS ADJUDGED that the defendant is guilty as convicted and sentenced as follows: on is confined to county jail/HOC for on is sentenced to prison for . on is confined to prison for followed by a period of . extended supervision for a total length of sentence of on . is placed on probation for . Pursuant to §§973.01(3g) and (3m) Wisconsin Statutes, the court determines the following: eligible for the Challenge Incarceration Program. is not The defendant is eligible for the Earned Release Program. is not The defendant is CONDITIONS OF PROBATION . Jail: To be incarcerated in the county jail/HOC for Obligations: (Total Amounts Only) Fine Court Cost Attorney Fees Restitution Other Surcharges/ Assessments/ Fees Mandatory Victim/Witness DNA Anal. Surcharge(s) MISCELLANEOUS CONDITIONS OF EXTENDED SUPERVISION IT IS ADJUDGED that days sentence credit are due pursuant to §973.155 Wisconsin Statutes. IT IS ORDERED that the Sheriff shall deliver the defendant into the custody of the Department. NAME OF JUDGE BY THE COURT: DISTRICT ATTORNEY Circuit Court Judge/Clerk/Deputy Clerk DEFENSE ATTORNEY Date Signed DEPARTMENT OF CORRECTIONS DOC-20 (Rev. 08/2007) CR-212 (Rev. 08/07) §§939.50, 939.51, 972.13 & Chapter 973, Wisconsin Statutes JUDGMENT OF CONVICTION AND SENTENCE American LegalNet, Inc. www.FormsWorkflow.com