COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FORM SUMMARY : Name of Form: : Calendar No. Petition to Modify Bifurcated Sentence §302.113(9g) (Geriatric/Terminal) Plaintiff(s) Form Number: Index No. CR-254 -against- : JUDICIAL SUBPOENA : Statutory Reference: §302.113(9g), Wisconsin Statutes: Benchbook Reference: CR 38 : Defendant(s) : Purpose .of .Form:. . . . . . . . . . .To .petition .the .Program .Review .Committee for modification of ...... . ..... .. ...... .. ....... ...... . bifurcated sentence based on either age and time served, or terminal condition. THE PEOPLE OF THE STATE OF NEW YORK Who Completes It: TO Inmate Distribution of Form: Original to the Program Review Committee. Accompanying Forms: Physician affidavits if inmate has a terminal condition. GREETINGS: New Form/Modification: New form. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Modifications: located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed Comments: This form was created to comply with the requirements of 2001 or adjourned date, to testify and give evidence as a witness in this action on the part of the Wisconsin Act 109. §302.113(9g)(d) requires the court to set a hearing. About thisYour failure to comply with thisis the product of the Wisconsin Records Management form: This form subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf thisCommittee, a committee a maximum penalty of $50 and all damages sustained as a subpoena was issued for of the Director of State Court's Office and a result of your failure to comply. mandate of the Wisconsin Judicial Conference. Court in Witness, Honorable If you have additional information that does notthe Justices of the , one of change the County, meaning of the form, attach it on a separate page. The form day of , 20 itself shall not be altered. (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Date: 02/03/03 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Page 1 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : STATE OF WISCONSIN, CIRCUIT COURT, Name -against- Calendar No. Petition to Modify Bifurcated Sentence : JUDICIAL SUBPOENA Plaintiff(s) §302.113(9g) , Defendant (Geriatric/Terminal) : Case No. Date of Birth 1. For Official Use COUNTY : State of Wisconsin -vs- Index No. : I was sentenced for the crime of , on (date) : ∙ The total length of my bifurcated sentence for count is years, ∙ My initial term of confinement in prison is Defendant(s) years, months. : . .∙. .The . . . . . . . of. extended. supervision .ordered . . .the.court .at .the time of sentencing is . . . amount . . . . . . . . . . . . . . . . . . . . . . . by . . . . . . . . months. . months. years, I was sentenced for the crime of , on (date) is years, ∙ My initial term of confinement in prison is years, months. ∙ TO The amount of extended supervision ordered by the court at the time of sentencing is months. ∙ The total length of my bifurcated sentence for THE PEOPLE OF THE STATE OF NEW YORK count . months. years, I was sentenced for the crime of , on (date) . ∙ The total length of my bifurcated sentence for count is years, months. GREETINGS: ∙ My initial term of confinement in prison is years, months. ∙ The amount of extended supervision ordered by the court at the time of sentencing is years, WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before months. 2. 3. , the Honorable at the Court I am not serving a sentence for a Class A at B felony. located or County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed I have not previously filed a petition for modification of bifurcated sentence. or adjourned date, to testify and give evidence as a witness in this action on the part of the OR I have previously had a petition for modification of bifurcated sentence denied by the Program Review Committee. The denial was on (date) , and it has been over one year since that denial. OR Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to I have previously had a petition for modification of bifurcated sentence denied by the court. The denial was the (date) on whose behalf this subpoenaand itissued for a maximum penalty that denial. all damages sustained as a party was has been over one year since of $50 and on , result of your failure to comply. 4. I am 65 years of age or older and have served at least 5 years of the term of confinement in prison. OR Witness, Honorable , one of the Justices of the I am in Court60 years of age or older and have served at least 10 years of the term of confinement in prison. County, day of , 20 OR I have a terminal condition, and have attached and incorporated into this petition affidavits from two (2) physicians setting forth a diagnosis that I have a terminal condition. (Attorney must sign above and type name below) 5. My attorney, if any: Name: Address: Telephone: Fax: Attorney(s) for I request sentence modification. Office and P.O. Address Signature of Petitioner Name Typed or Printed Distribution: 1. Program Review Committee – Original CR-254, 02/03 Petition to Modify Bifurcated Sentence §302.113(9g) Telephone No.: Date Facsimile No.: E-Mail Address: Mobile Tel. No.: §302.113(9g), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.USCourtForms.com