JD-1747, 02/10 Dispositional Order Civil Law/Ordinance Violation 247247938.342, 938.343, 938.344, and 938.37, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Dispositional Order Civil Law/Ordinance Violation Case No. THE COURT FINDS: 1. A dispositional hearing was held on [D ate ] . 2. The child has violated a civil law or ordinance: 3 . a. The child alone is financially able to pay restitution of $ and/or a forfeiture of $ . b. The child is physically able to perform services for the victim and the victim agrees to accept such services. c. The custodial parent is financially able to pay reasonable restitution of $ and/or forfeiture of $ . 4. The violation is related to the use or abuse of alcoholic beverages or controlled substances: 5. Other: THE COURT ORDERS : As a disposition in this matter, the following: 1. Counseling: 2. Restitution: $ , to be paid: See restitution supplement. Make repairs or provide services agreeable to the victim: 3. Forfeiture of $ to be paid: American LegalNet, Inc. www.FormsWorkFlow.com JD-1747, 02/10 Dispositional Order Civil Law/Ordinance Violation 247247938.342, 938.343, 938.344, and 938.37, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 4. Costs of (age 14 and over) $ , to be paid: Failure to pay forfeiture/costs shall result in a suspension of the following license for Mo tor vehicle operating privilege DNR , Ch. 29 license 5. Supervised work program: 6. Safety course or program: 7. DNR, Ch. 29 license suspension for: 8. Alcohol/drug abuse (AODA) dispositions: AODA assessment and, if recommended, an outpatient AODA program. Facility: Date completed by: AODA education program by: 9. Truancy disposition (in addition to any of the above) : Operating privilege suspension: days Community service: Supervised work program: Home detent ion: 10. Other: Person/agency responsible for services: Order effective date of hearing; expiration date: THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE. American LegalNet, Inc. www.FormsWorkFlow.com