CR-211A, 05/17 Petition Directing Compensation for Special Prosecutor 247978.045, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Petition Directing Compensation for Special Prosecutor (Print or type information. Submit an o riginal and two copies of this P etition to the court.) UNDER OATH I STATE: 1. I was a ppointed 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. 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. Payment should be sent to: Name of Special Prosecutor Complete Mailing Address Telephone Number Bar Number State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Special Prosecutor Title Date American LegalNet, Inc. www.FormsWorkFlow.com