CR-207A, 05/17 Petition for Civil Judgment for Restitution/Court Ordered Financial Obligations 247247973.045(1), 973.05(4)(a), 973.06, and 973.20, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY State of Wisconsin, Plaintiff - vs - Name Address Date of Birth Petition for Civil Judgment for Restitution Court Ordered Financial Obligations Case No. DOC No. 1. The defendant was convicted of the following offense(s) on the following date(s): Date Committing Offense Statute . 2. The defendant was released to parole/extended supervision/mandatory release on [Mo/Day/Yr] . This period of supervision expires on [Mo/Day/Yr] . 3. The defendant failed to pay the following financial obligations of parole/extended supervision/mandatory release: Restitution [Indicate below, name and address of victim, and amount unpaid] See attached listing of victims. Name Complete Address Amount unpaid Victim Witness Surcharge(s). Amount unpaid is $ . Other court ordered financial obligations. Amount unpaid is $ . Department of Corrections financial screen information is attached. 4. The Department of Corrections requests that the Court enter a civil judgment against the defendant for the unpaid restitution. unpaid victim witness surcharge(s). other unpaid court ordered financial obligations. DISTRIBUTION: 1. Court 2. Service providers Agent Number of Agent Date American LegalNet, Inc. www.FormsWorkFlow.com