For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Dispositional Order Delinquent IN THE INTEREST OF Name Case No. Date of Birth A petition was filed with the court. This dispositional hearing was held on (Date) , which is the effective date of this order. THE COURT FINDS: 1. The juvenile is delinquent because: Ct Description Wisconsin Statutes Plea Date of Offense 2. The juvenile committed an act that a. would be punishable by a sentence of 6 months or more if committed by an adult, the juvenile is a danger to the public and in need of restrictive custodial treatment, and placement in the serious juvenile offender program is not appropriate. b. would be a misdemeanor if committed by an adult and the juvenile has not successfully completed a Teen Court program in the 2 years before the date of the violation. c. would be subject to a penalty enhancement, if committed by an adult. d. made the juvenile eligible for placement in the serious juvenile offender program. 3. The juvenile is placed out of the home. a. Placement in the home at this time community. is is not contrary to the welfare of the juvenile and the b. Reasonable efforts to prevent removal were (Complete one of the following.) made by the department or agency responsible for providing services. made by the department or agency responsible for providing services, although an emergency situation resulted in immediate removal of the juvenile from the home. required, but the department or agency responsible for providing services failed to make reasonable efforts. c. Reasonable efforts to place the juvenile in a placement that enables the sibling group to remain together were  made. not required because the juvenile does not have siblings in out-of-home care. not required because it would be contrary to the safety or well being of the juvenile or any of the siblings. JD-1745, 08/11 Dispositional Order - Delinquent §§938.34, 938.355 and 938.396(2g)(m), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Dispositional Order - Delinquent Page 2 of 4 Case No. ____________ d. Permanency plan was not filed. was filed and reasonable efforts to achieve the goal(s) of the permanency plan, including through an out-of-state placement if appropriate, were: (Complete one of the following only if a permanency plan was filed.) made by the department or agency responsible for providing services. not made by the department or agency responsible for providing services. e. The parent(s) who appeared in court have been orally advised of the applicable grounds for termination of parental rights (TPR) and the conditions that are necessary for a safe return to the home or a restoration of visitation rights. Written TPR Warnings are attached. f. The mother father was present and was asked to provide the names and other identifying information of three adult relatives of the juvenile or other adult individuals whose home the parent requests the court to consider as placements for the juvenile, unless that information was previously provided. 4. As to the department or agency recommendation: a. The placement location recommended by the department or agency is adopted. OR b. After giving bona fide consideration to the recommendations of the department or agency and all parties, the placement location recommended is not adopted. 5. The rehabilitation and treatment/care of the juvenile cannot be accomplished by means of voluntary consent of the parent(s)/guardian, and a transfer of legal custody is necessary. 6. Restitution: a. The juvenile alone is financially able to pay restitution of $ and/or a forfeiture of $ . b. The juvenile is physically able to perform services for the victim (under age 14, 40 hour limit) and the victim agrees to accept such services. c. The custodial parent is financially able to pay reasonable restitution of $ and/or a forfeiture of $ . 7. Other: THE COURT ORDERS: 1. The juvenile is placed under court jurisdiction. 2. Placement: In-home at Expiration date of this order (Not to exceed 1 year) . Out-of-home at and into the placement and care responsibility of the county department, which has primary responsibility for providing services . Department of Children and Families, which has primary responsibility for providing services. Bureau of Milwaukee Child Welfare, which has primary responsibility for providing services. Expiration date of this order shall be the later of: One year from the date of this order; or th The date the juvenile reaches his or her 18 birthday; or th The date the juvenile reaches his or her 19 birthday if the juvenile is enrolled fulltime in a secondary school or vocational or technical equivalent and reasonably expected to complete the program prior to age 19. OR Expiration date of this order (Date) . JD-1745, 08/11 Dispositional Order - Delinquent §§938.34, 938.355 and 938.396(2g)(m), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkFlow.com Dispositional Order - Delinquent Page 3 of 4 Case No. ____________ Juvenile Corrections. Expiration date of this order (Not to exceed 2 years) . Serious juvenile offender program. Expiration date of this order (Not to exceed 5 years) . Type 2 residential care center for children and youth. Expiration date of this order (Not to exceed 2 years) . 3. This is an out-of-home placement. The juvenile has one or more siblings in out-of-home care and the juvenile is not placed with all those siblings. The department or agency shall make reasonable efforts to provide frequent visitation or other ongoing interaction between the juvenile and any siblings. The department or agency is not required to provide for frequent visitation or other ongoing interaction because it would be contrary to the safety or well being of the juvenile or any siblings. 4. This is an out-of-home placement and the department or agency shall conduct a diligent search in order to locate and provide notice as required by §938.355(2)(cm), Wis. Stats., to all adult relatives of the juvenile, including the three adult relatives provided by the parents under §938.335(6), Wis. Stats., , no later than 30 days from the date of the juvenile’s removal from the home, unless the search was previously conducted and notice provided. 5. This is an out-of-home placement. If a permanency plan has been prepared, filed and is consistent with this order, this order contains the plan. Otherwise, a permanency plan consistent with the court’s order shall be filed no later than 60 days from the date of the juvenile’s removal from the home and shall be made part of this order. If the recommended placement is to a juvenile correctional facility or secured residential care center and the court does not order that placement, then the permanency plan is due 60 days from the date of disposition. 6. Total restitution is $ $ , and (under age 14, $250 limit), to be paid: See restitution supplement Make repairs or provide services agreeable to the victim (under age 14, 40 hour limit): The juvenile is in an out-of-home placement and receiving income; the juvenile shall pay of that income for restitution. 7. Forfeiture of $ % , to be paid: 8. Supervised work program/community service: 9. Mandatory victim/witness fee of $20 per case, to be paid hours immediately. 10. Legal custody transferred to County Department of Human/Social Services. Wisconsin Department of Children and Families. Bureau of Milwaukee Child Welfare. Other: 11. Conditions of supervision and/or return: JD-1745, 08/11 Dispositional Order - Delinquent See attached §§938.34, 938.355 and 938.396(2g)(m), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkFlow.com Dispositional Order - Delinquent Page 4 of 4 Case No. ____________ 12. If the juvenile is placed outside of the home, the parent(s) shall provide a statement of income, assets, debts, and living expenses of the household, to the county department or agency. a. The parent(s)/guardian shall contribute toward the expenses of custody/services in the amount of $ . to be determined by (Agency): b. The amount of support to be paid by the parent(s), guardian or trustee for the out-of-home placement is: $ or % of gross income payable by wage assessment. to be set by the child support agency. The support obligation begins on the date of placement. 13. Driver’s license: suspension revocation restriction 14. Specific services to be provided to juvenile and family: See attached 15. DNA testing. 16. Sex offender registration. 17. Other: The juvenile was advised of possible sanctions for violations of the conditions of this order. THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL. DISTRIBUTION: 1. Original - Court 2. Juvenile 3. Juvenile’s Parent(s)/ Guardian/Legal Custodian/Trustee 4. Juvenile’s Attorney 5. District Attorney 6. School 7. Social Worker 8. Other: JD-1745, 08/11 Dispositional Order - Delinquent BY THE COURT: Circuit Court Judge Name Printed or Typed Date §§938.34, 938.355 and 938.396(2g)(m), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkFlow.com