FORM SUMMARY _______________________________________________________________________________ Name of Form: Petition and Order Directing Compensation for Special Prosecutor Form Number: CR-211 _______________________________________________________________________________ Statutory Reference: §§978.045, Wisconsin Statutes Purpose of Form: To order payment for special prosecutor services. Who Completes It: Attorney completes petition; judge completes order. Distribution of Form: Original to court, copy to State Prosecutors Office and county clerk (if county ordered to pay costs). Accompanying Forms: Itemization of time (on form DOA-5188 used by the Department of Administration). New Form/Modification: Modification, last update 10/97. Modifications: Added a file/date stamp area to upper left corner. Added a statement on the bottom indicating that the form shall not be modified. Comments: The Department of Administration is responsible for compensation for attorney fees. The county receiving the service is responsible for any other costs and disbursements incurred by the special prosecutor. About this form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. 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. Date: 11/19/99 Page 1 2001 © American LegalNet, Inc. For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Petition and Order Directing Compensation for Special Prosecutor (Print or type information. Submit an original and two copies of this petition to the court.) Under oath I state: 1. I was appointed special prosecutor for: State of Wisconsin Other: vs. , Case No. . The period to . 2. A complete and truthful itemization on form DOA–5186, issued by the Department of Administration, of the time involved in completing this appointment is attached. This is an interim request for compensation. The duties of special prosecutor have not yet been completed. This is a final billing. All duties must have been completed. 3. I request payment by the Department of Administration for these services. 4. An itemization of disbursements is attached, for which I request payment by the county. Name of Special Prosecutor Payment should be sent to: Complete Mailing Address Telephone Number Bar Number Social Security No. or Taxpayer ID No. (for income tax purposes) Subscribed and sworn to before me on Signature of Special Prosecutor Notary Public, State of Wisconsin Date My commission expires: ORDER DIRECTING COMPENSATION IT IS ORDERED: 1. The Secretary of the Department and Administration pay the total sum of $ compensation for the special prosecutor. 2. as County pay disbursements in the amount of $ > Submit this order and itemization to: 1. Director State Prosecutor’s Office Department of Administration P.O. Box 7869 Madison, WI 53707-7869 Telephone: (608)267-2700 2. County Clerk of county responsible for paying disbursements, if ordered under #2. . BY THE COURT: Signature of Circuit Judge Name Printed or Typed Date Telephone Number CR-211, 11/99 Petition and Order Directing Compensation for Special Prosecutor §978.045, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. 2001 © American LegalNet, Inc.