Probable Cause Statement and Judicial Determination Name of Arrested Person Agency Case No. Case No. Date of Birth 1. I state as follows: For Official Use COUNTY STATE OF WISCONSIN, CIRCUIT COURT, a. I am the arresting officer in this case OR b. I am a law enforcement officer and make this statement on information and belief. a.m. at 2. The above-named person was arrested without a warrant on p.m. Other: (specify) WI D.L. verbally How identified: 3. I have probable cause to believe that the arrested person committed the following offense(s): Statute Number(s) Statute Number(s) Offense(s) Offense(s) 2. 1. 4. 3. 4. Information for following summary provided by: Other: Alleged Victim: did not did 5. I believe the arrested person committed this offense(s) because the alleged victim(s) See documentation consent to the above listed offense(s): Summarize below and/or attached. Subscribed and sworn to before me on: Signature of Person completing Affidavit Badge Number/Department Notary Public, State of Wisconsin My commission expires: am Time: Date: pm Probable Cause Determination I have reviewed the probable cause statement from the arresting officer. Based on this statement: as listed above OR 1. I find probable cause to believe that the arrested person committed the offense(s) as follows: Bail is set as follows: 2. I do not find sufficient probable cause to have been presented and direct that the arrested person be released from this custody. Reason(s) probable cause not found (optional): Telephone Conference Call Determining Probable Cause The initial probable cause was determined by a telephone conference call. The judge/commissioner instructed me to affix the decision, his/her signature, and date and time in the appropriate location, to be countersigned later by the judge/commissioner. BY THE COURT: Circuit Court Judge/Circuit Court Commissioner Name Printed or Typed Officer’s Signature Distribution: 1. Court - Original 2. Sheriff 3. Facility 4. Arrested Person/Counsel a.m. Date CR-215, 04/09 Probable Cause Statement and Judicial Determination p.m. Time §970.01,Wisconsin Statutes; 4th Amendment, US Constitution This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkFlow.com