JD-1763B, 02/18 Order Concerning Recoupment 24724748.275 and 938.275(2), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Order Concerning Recoupment Case No. The State Public Defender Response was filed on [Date] . THE COURT ORDERS : 1 . Th e parent(s) requesting review A. is indigent . The original Order for Recoupment, as it affects the parent(s) requesting review, is amended to provide that there is no obligation by that parent(s) to reimbu rse the State of Wisconsin. B . is partially indigent . The original Order for Recoupment of Costs of Legal Services, is amended to provide that the obligation by that parent(s) is the amount indicated in the Public Defender Response (JD - 1763A) . C . is not indigent . The original Order for Recoupment of Costs of Legal Services, as it affects the parent( s) requesting review, shall remain in effect, including the payment schedule. 2. Any failure by the parent(s) to comply with this order shall subject that party to penalties for contempt of court, including incarceration in the county jail for up to 6 mon ths, forfeitures of up to $2,000 per day for each day of noncompliance and any other order necessary to ensure compliance with this order. DISTRIBUTION: 1. Court 2. Parent(s) requesting Review 3. State Public Defender American LegalNet, Inc. www.FormsWorkFlow.com