FORM SUMMARY Name of Form: Petition and Stipulation to Waive appearance and Hearing/Order Extending Intensive Sanctions Confinement Period Form Number: CR-222 Statutory Reference: Wisconsin Administrative Code Chapter 333, §973.032(4), Wisconsin Statutes Purpose of Form: To allow inmates to waive their right to a hearing on a Department of Corrections request to extend an intensive sanctions confinement period. Who Completes It: Inmate or DOC agent Distribution of Form: Original to judge for signing and filing, copies to DOC and inmate Accompanying Forms: Generally none New Form/Modification: Modification; last update 1/95. 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: None 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 2001 © American LegalNet, Inc. For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY State of Wisconsin, Plaintiff, -vs, Defendant Name Inmate No. Petition and Stipulation to Waive Appearance and Hearing, and Order Extending Intensive Sanctions Confinement Period Case No. I am the defendant in this case and inform the court that: 1. My address is My occupation is . My date of birth is (mo/day/yr) 2. I was convicted on (mo/day/yr) • for committing the offense(s) of • violating statute number(s) 3. I was placed on DIS for years, months, with a confinement period of years, months. 4. I have been in confinement for the following dates and reasons: to reason: to reason: to reason: to reason: . . 5. I understand that the Department of Corrections is asking the court to extend my confinement time for years, months. 6. I also understand that I have the rights listed on the back of this form. 7. I wish to waive my appearance and right to a hearing. 8. I ask the court to grant the request to the Department. 9. By signing this document, I certify that this waiver is made freely and voluntarily, without promises or threats. Signature of Defendant Date Signed Signature of Agent Number of Agent COURT ORDER/JUDGMENT The court finds, orders and adjudges that: 1. The defendant has waived appearance and hearing. This waiver is free and voluntary and is a stipulation to grant the relief requested. 2. The Department’s request is justified. The relief requested is in the best interests of the defendant and the community. 3. The defendant’s confinement time is extended for years, months. This extension will serve the purposes for which intensive sanctions was imposed. BY THE COURT: Circuit Court Judge Name Printed or Typed Distribution: Court – Original Date CR-222, 11/99 Petition and Stipulation to Waive Appearance and Hearing, Chapter 333, §973.032(4), Wisconsin Statutes and Order Extending Intensive Sanctions Confinement Period DOC-1518, 11/99 This form shall not be modified. It may be supplemented with additional material. 2001 © American LegalNet, Inc. Rights Being Waived • I have a right to a hearing before the court on whether the Department’s request should be granted. • I have a right to be represented by an attorney and, if I cannot afford an attorney, one will be appointed for me. • At a hearing, the Department would have to show that an extension will further my rehabilitation as well as the interests of the community. • If I waive these rights, the court can enter an order extending my confinement time. Please initial that you have read your rights. 2001 © American LegalNet, Inc.