CR-246A, 05/19 Petition for Civil Judgment (Probation Revoked/Discharged, Parole/Extended Supervision Terminated) DOC-2213, 04/03 247247973.09(3)(b), 973.09(3)(bm)4, 973.20, and 973.20(1r), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY State of Wisconsin, Plaintiff - vs - Date of Birth DOC No. Petition for Civil Judgment Probation Revoked Probation Discharged Parole Terminated Extended Supervision Terminated Case No. I am a representative of the Department of Corrections and state: 1. The defendant was placed on probation and the probation has been revoked, or the defendant was discharged. sentenced to prison and the term of parole or extended supervision has terminated. 2. The defendant has failed to complete the following conditions of probation, parole, or extended supervision: Restitution: [ Indicate below See attached list for additional victims. Victim Name or Other Identifier Amount u npaid Supervision Fees: Amount $ Payee: Department of Corrections, PO Box 8980, Madison, WI 53704 I request that the Court grant judgment against the defendant for these unpaid conditions of probation, parole or extended supervision. DISTRIBUTION: 1. Court 2. Defendant 3. District Attorney 4. Dept. of Corrections 5. Victim(s) Agent Agent Number Name Typed or Printed Date American LegalNet, Inc. www.FormsWorkFlow.com