COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. FORM SUMMARY : Index No. Name of Form: Form Number: Statutory Reference: Benchbook Reference: Calendar No. Order on Petition to Revoke Conditional Release (Not Guilty by Reason of Mental Disease or Defect) : Plaintiff(s) : JUDICIAL SUBPOENA CR-276 -against§971.17, Wisconsin Statutes CR 34 : : : Defendant(s) : Purpose . . Form: For . . . . . . . . . . . . . . . on . . . . . . . . . . of . . . . . . . . . . . . . . . . . . . .use. when. the. court .acts . . . a petition to revoke conditional release. Who Completes It: The court. sheriff of county of conviction, §51.42 Board of county of defendant's residence. A copy of Order of Commitment. Order for Placement, if the court orders revocation of conditional release. New form. THE PEOPLE of Form:STATE OF NEW to court, copy to district attorney, defense attorney, DHFS, Distribution OF THE Original YORK TO Accompanying Forms: GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Modifications: located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed Comments: This form recognizes that conditional release part of the or adjourned date, to testify and give evidence as a witness in this action on thepetitions may result in New Form/Modification: revocation of placement on conditional release. Once this placement is revoked, the court must complete CR-275, Order for Placement, to order the new placement in institutional care and to address, if needed, Your failure to comply withissuesubpoena is punishable as a contempt of court and will make you liable to the this of involuntary administration of medication Committee, a committee of the Director of State Court's Office and a , one mandate of the Wisconsin Judicial Conference. of the Justices of the day of , 20 the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of this form: to comply. This form is the product of the Wisconsin Records Management About your failure Witness, Honorable Court in County, If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Date: 03/01/04 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 1 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : STATE OF WISCONSIN, CIRCUIT COURT, State of Wisconsin, Plaintiff -vs- Index No. For Official Use : Plaintiff(s) COUNTY Calendar No. -against, Defendant Name Order on Petition to Revoke : JUDICIAL Conditional Release SUBPOENA (Not Guilty by Reason of : Mental Disease or Defect) Case No. Date of Birth : : ...... ...... THE. COURT. FINDS: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. The defendant was committed to the Department of Health and Family Services (DHFS) on (date) . A copy of the Order of Commitment is attached. 2. The defendant was STATE OF NEW YORK THE PEOPLE OF THEplaced on conditional release. 3. TO A petition to revoke conditional release was filed and a hearing on the petition was held. 4a. The defendant stipulated that the terms of conditional release were violated and the defendant stipulated to revocation of conditional release. OR GREETINGS: 4b. The State has has not proven by clear and convincing evidence that: a rule or condition of release was violated, and/or WE COMMAND defendant or others requiresexcuses being laid aside, you and each of you attend before YOU, that all business and revocation. the safety of the Defendant(s) : , the Honorable at the Court located at County of , day of , 20 , at o'clock in the noon, and at any recessed THEin room ORDERS:on the COURT or adjourned date, to testify and give evidence as a witness in this action on the part of the 1. Placement on conditional release be revoked and an Order for Placement is completed and a copy is attached. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to 2. The petition is denied and conditional release will continue. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable County, , one of the Justices of the day of , THE COURT: BY20 Circuit Court Judge Court in Distribution: 1. Court (Original) 2. District Attorney 3. Defense Attorney 4. Department of Health and Family Services 5. Sheriff (of county of defendant's residence) 6. §51.42 Board (of county of defendant's residence) 7. Dept. of Corrections (Attorney must sign above and type name below) Name Printed or Typed Date Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: CR-276, 03/04 Order on Petition to Revoke Conditional Release (Not Guilty by Reason of Mental Disease or Defect) This form shall not be modified. It may be supplemented with additional material. §971.17, Wisconsin Statutes American LegalNet, Inc. www.USCourtForms.com