STATE OF WISCONSIN, CIRCUIT COURT, Amended COUNTY State of Wisconsin -vsName Petition for Determination of Eligibility for the , Defendant Substance Abuse Program §302.05(3)(e), Wis. Stats. Case No. Date of Birth 1. I am presently serving the confinement portion of a bifurcated sentence. 2. I was not convicted of a crime specified in chapter 940 or §§948.02, 948.025, 948.03, 948.05, 948.055, 948.06, 948.07, 948.075, 948.08 or 948.095, Wis. Stats. 3. My sentence was imposed A. before July 26, 2003, the effective date of the Substance Abuse Program. OR B. on or after July 26, 2003, and the sentencing court did not determine if I was eligible or ineligible to participate in the Substance Abuse Program. 4. Attached is form CR-264, Department of Corrections Approval to File Petition for Determination of Eligibility for the Substance Abuse Program. 5. A copy of this petition is being served on the district attorney in the county of conviction. The district attorney may file a written response. I request the sentencing court to determine if I am eligible or ineligible to participate in the Substance Abuse Program within 90 days after the filing of this petition. Petitioner DISTRIBUTION: 1. Court 2. Inmate 3. District Attorney Name Printed or Typed Date CR-263, 08/11 Petition for Determination of Eligibility for the Substance Abuse Program §302.05(3)(e), Wisconsin Statutes DOC-2251A This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkFlow.com