CR-282, 05/18 Verification of Eligibility 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 State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Department of Corrections Representative Name Typed or Printed Date DISTRIBUTION: 1.Court STATE OF WISCONSIN, CIRCUIT COURT, COUNTY State of Wisconsin, Plaintiff - vs - Name Date of Birth DOC Number Amended Preliminary Full Verification of Eligibility for Positive Adjustment Time 247 973.198, Wis. Stats. Case No. Count No. 1. The inmate: A. was sentenced on this count prior to October 1, 2009. Between October 1, 2009 and August 2, 2011 [inclusive of those dates with a maximum of 671 days], the inmate served days in confinement on this count and is currently confined. B. was sentenced on this count after September 30, 2009. The offense, conviction, or sentencing date is between October 1, 2009 and August 2, 2011. Since October 1, 2009, the inmate served days in confinement on this count and is currently confined . 2. [Date] . Note: An inmate may petition for sentence adjustment 90 days before s/he has served the confinement portion of the sentence less positive adjustment time earned. The petition cannot be filed any sooner than 90 days before the following number of days prior to completion of the confinement term : Conviction Positive Adjustment Time that can be earned How to calculate Positive Adjustment Time Misdemeanor or Class F to I felony that is not a violent offense 1 day for every 2 days served in confinement Number of days listed in #1 divided by 2 Misdemeanor or Class F to I felony 1 day for every 3 days served in confinement Number of days listed in #1 divided by 3 Class C to E felony 1 day for every 5.7 days served in confinement Number of days listed in #1 divided by 5.7 3. The inmate was was not convicted of a Class A or B felony on this count. 4. The inmate is is not required to register under 247301.45, Wis. Stats. 5. The inmate is not serving and has not served another sentence during the current period of confinement on this count. is serving or has served another sentence during the current period of confinement on this count. [All Judgment(s) of Conviction served during the current period of confinement attached.] 6. A . If #1 through #6 above indicates that the inmate may not be eligible for positive adjustment time, then check the #7 through #12, unless otherwise ordered 7. The inmate has has not been convicted or found guilty by reason of mental disease or defect of a sex offense or found to have committed a sex offense in another jurisdiction or been committed under Chapter 975. 8. The inmate has has not been determined by the Department of Corrections assessment to pose a high risk of reoffending. [See attachment] 9. The inmate is is not the subject of a bulletin issued under 247301.46(2m), Wis. Stats. 10. The inmate will serve, is serving, or has served, during the current period of confinement, a sentence for a Class F to Class I felony that is a violent offense, as defined in 247301.048(2)(bm)1, Wis. Stats. Yes No ] 11. The inmate is is not serving a sentence for an offense against an elderly or vulnerable person or an offense related to ethical government or school safety. 12. The inmate is is not a violent offender under 247165.95, Wis . Stats. American LegalNet, Inc. www.FormsWorkFlow.com