CR-281, 09/16 Petition for Positive Adjustment Time 247973.198, Wis. Stats. 247973.198, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 1. I was sentenced for the crime of on [Date] . The total length of my bifurcated sentence on this count is years, months. My initial term of confinement on this count is years, months. My initial term of extended supervision on this count is years, months. I am currently confined on this count. 2. My sentence on this count is not for a Class A or a Class B felony. 3. My offense date on this count is after December 30, 1999. 4. I have earned positive adjustment time on this count because [C heck either box A. or B . ] A. my sentence was imposed prior to October 1, 2009. I served some or all of the confinement portion of the sentence between October 1, 2009 and August 2, 2011. Positive adjustment time can be earned for this period of confinement only. - OR - B. my sentence was imposed after September 30, 2009. The following event(s) occurred between October 1, 2009 and August 2, 2011: [Only check those that apply and list date(s)] My offense date [Date] . My conviction date [Date] . My s entencing date [Date] . Positive adjustment time can be earned for the entire period of confinement served after September 30, 2009. 5. I have attached the Verification of Eligibility for Positive Adjustment Time (CR - 282) form completed by the Department of Corrections that applies to this count. 6. I have filed this P etition not more than 90 days prior to serving the confinement portion on this count less the positive adjustment time that I have earned. 7. The following is/are the ground(s) for filing this P etition: [Check all that apply] A. My conduct, efforts at and progress in rehabilitation, or participation and progress in education, treatment, or other correctional programs since being sentenced supports my request. [See att ached copy(ies) of my prison program certifications(s)] B. Other: I request a hearing within si xty (60) days of the date this P etition is filed. If the court grants this P etition, I understand that the unserved confinement portion of my sentence will be added to the extended supervision portion on this count. The total length of sentence on this count will not change. DISTRIBUTION: 1. Court Petitioner Name Typed or Printed Date STATE OF WISCONSIN, CIRCUIT COURT, COUNTY State of Wisconsin, Plaintiff - vs - Inmate Number Inmate Address Date of Birth Amended Petition for Positive Adjustment Time 247 973.198, Wis. Stats. Case No. Count No. American LegalNet, Inc. www.FormsWorkFlow.com