CR-250, 02/03 Petition to Modify Court-Imposed Conditions of Extended Supervision 247302.113(7m), Wisconsin Statutes 247302.113(7m), 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 Petition to Modify Court - Imposed Conditions of Extended Supervision 247 302.113(7m), Wis. Stats. Case No. (Check one of the following) The petitioner is presently serving the confinement portion of a bifurcated sentence. The scheduled date of release to extended supervision is [Date] , which is not more than one year from the date of this Petition. The petitioner has not previously petitioned for modification of conditions of extended supervision. Attached is the Verification of Date of Release to Extended Supervision. OR The petitioner is presently serving the extended supervision portion of a bifurcated sentence. The petitioner was released to extended supervision on [Date] , which is not within one year of this Petition. The petitioner has not filed another petition within one year of the filing of this Petition. Attached is the Verification of Date of Release to Extended Supervision. OR I am a representative of the Department of Corrections. I believe that the requested modification(s) meet the needs of the department and the public and would be consistent with the objectives of the sentence in this case. I request that the court modify the court - imposed conditions of extended supervision as follows: See attached DISTRIBUTION: 1. Court 2. Sentenced person 3. 4. Department of Corrections 5. District Attorney Name Typed or Printed Date American LegalNet, Inc. www.FormsWorkFlow.com