This form is only available from the CCAP system used by the circuit courts. American LegalNet, Inc. www.USCourtForms.com STATE OF WISCONSIN CIRCUIT COURT SAMPLE COUNTY Send "Chief Judge" and "Assigned Judge" copies to your District Court Administrator * Application for Judicial Assignment Specific Case Number(s) 2003CV123456 General Case Caption (General Assignment, Dates - Times) County Case Caption Code Sample 99 Date Case Filed MM-DD-YYYY Current Court Official Code C.O. Name 1590 Branch No. District No. 5 4 Type of Case Felony (Charge): Misdemeanor (Charge): Traffic Criminal Traffic Indicate one Civil Small Claims Forfeiture Family Probate Juvenile Class Code for Civil, Small Claims, Family: Class Code - Description Case Status Information Last Activity in Case Date Scheduled Activity Description MM-DD-YYYY Next Scheduled (or to be scheduled) Activity Date Scheduled Activity Description MM-DD-YYYY Jury Trial Post Judgment Other: Description of Case Status Information helpful to chief judge and judge assigned (e.g., time limits in effect, defendant in custody, other judges already substituted or disqualified, other attorneys): Additional information entered from the Print dialog window. Attorney Information Attorney for Plaintiff/Petitioner Attorney for Defendant/Respondent _ _ _ _ Attorney Name Firm Name Primary Address City, WI 54321-1234 123-456-7890 _ _ fullName firm primAddr city, state zip phone _ _ Attorney Name Firm Name Primary Address City, WI 54321-1234 123-456-7890 _ Attorney Name Firm Name Primary Address City, WI 54321-1234 123-456-7890 _ Reason for Assignment Application 1. Substitution request, dated: Date 8. Expedite Litigation: by plaintiff defendant 9. Vacancy 2. Disqualification - Wis. Stats: 10. Mentoring Reason: 11. Meeting: 3. On Assignment 12. Chief Judge Duties 4. Congestion 13. Military Service 5. Vacation 14. Jury Duty 6. Family Medical Leave 15. Disciplinary Action 7. Judicial Education: 16. Other: Page 1 of 2 GF-168(CCAP) 04/02 Application for Judicial Assignment This form may not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.USCourtForms.com STATE OF WISCONSIN CIRCUIT COURT SAMPLE COUNTY Send "Chief Judge" and "Assigned Judge" copies to your District Court Administrator * Application for Judicial Assignment Specific Case Number(s) 2003CV123456 General Case Caption (General Assignment, Dates - Times) County Case Caption Code Sample 99 Date Case Filed MM-DD-YYYY Current Court Official C.O. Name Branch No. 5 Current Court Official Approval Code 1590 District No. 4 Chief Judge/Deputy Chief Judge/DCA Approval __________________________________________ __________________________________________ Approved Application Prepared By Name __________________________________________ Approved Denied (Explain):_____________________________________________ _______________________________________________________________ By: Denied (Explain):_____________________________________________ _______________________________________________________________ By: _____________________________ Chief Judge/Deputy Chief Judge/DCA _________ Date __________________________________________ ___________________________________________ Current Court Official ______________ Date Assigned Judge:_________________________________________________ Page 2 of 2 GF-168(CCAP) 04/02 Application for Judicial Assignment This form may not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.USCourtForms.com