For Official Use COUNTY STATE OF WISCONSIN, CIRCUIT COURT, Petition and Stipulation to Waive Appearance and Hearing, and State of Wisconsin, Plaintiff -vs- Order Extending Probation Judgment for Restitution Judgment for Court Ordered Financial Obligations Terminate Probation , Defendant Name Case No. DOC No. I am the defendant in this case and inform the court that: . 1. My address is . . My date of birth is My occupation is (mo/day/yr) . 2. I was convicted on (mo/day/yr) . • for committing the offense(s) of . • violating statute number(s) . months. This probation expires on years, 3. I was placed on probation for (mo/day/yr) 4. I have failed to complete the following conditions of probation: See attached listing of victims. Restitution: (Indicate below, name and address of victim, and amount unpaid.) 5. 6. 7. 8. 9. Amount unpaid Address Name . Court ordered financial obligations. Amount unpaid: $ Other: I understand that the Dept. of Corrections believes I have not made a good faith effort to pay and is asking the court to: months. years, Extend my probation for Terminate my probation and have a civil judgment entered against me for the unpaid restitution. have a civil judgment entered against me for unpaid court ordered financial obligations. waive my remaining court-ordered financial obligations. I also understand that I have the rights listed on the back of this form. I wish to waive my right to a hearing. I ask the court to grant the request of the Department. By signing this document, I certify that this waiver is made freely and voluntarily, without promises or threats. Date Signature of Defendant Signature of Agent Number of Agent COURT ORDER / JUDGMENT The court finds, orders, and adjudges that: 1. The defendant has waived a 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. months, from (current discharge date) years, 3. The defendant's probation is extended for ; or until all court obligations are to (new discharge date) completed, whichever comes first. This extension will serve the purposes for which probation was imposed. 4. Judgment is granted against the defendant in favor of the victim(s) listed in paragraph 4 above for the amount unpaid. The clerk is directed to enter this judgment on the judgment and lien docket without fee. 5a. Judgment is granted against the defendant for unpaid court ordered financial obligations in the amount of $ The clerk is directed to enter this judgment on the judgment and lien docket without fee. Twelve percent (12%) interest will be added from the date of entry of judgment. 5b. All remaining court ordered financial obligations of the defendant are waived. BY THE COURT: Distribution: 1. Court – Original Circuit Court Judge Name Printed or Typed CR-208, 10/07 Petition and Stipulation to Waive Appearance and Hearing, and Order Extending Probation/ DOC-101, 10/07 Judgment for Restitution/Judgment for Court Ordered Financial Obligations Date Chapter 806, §973.09(3)(b), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com . Petition and Stipulation to Waive Appearance and Hearing, and Order Extending Probation/ Judgment for Restitution/Judgment for Court Ordered Financial Obligations Page 2 of 2 Case No. 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 I have the ability to pay and 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 probation or enter a judgment against me. Please initial that you have read your rights. CR-208, 10/07 Petition and Stipulation to Waive Appearance and Hearing, and Order Extending Probation/ DOC-101, 10/07 Judgment for Restitution/Judgment for Court Ordered Financial Obligations Chapter 806, §973.09(3)(b), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com