JD-1792, 09/16 Order for Change in Placement (Out-of-Home to In-Home Only) 24724748.357, 48.363, 48.365, 938.357, 938.363 and 938.365, 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 for Change in Placement (Out - of - Home to In - Home Placement Only) Case No. THE COURT FINDS: 1. The child/juvenile is currently under a temporary physical custody order. dispositional order. 2. A notice of change in placement has been filed and no objection to the change in placement has been received. 3. A request for a hearing on change in placement has been filed and the hearing was held on [Date] . 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. THE COURT ORDERS: 1. Placement in-home at If child/juvenile is subject to a dispositional order, the expiration date is [Not to exceed 1 year] . 2. Transportation to the new placement shall be provided by . 3. All provisions of the temporary physical custody or dispositional order not changed herein remain in full force and effect. 4. Other: THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE. DISTRIBUTION: 1. Court 2. Child/Juvenile/Attorney/Guardian ad Litem 3. Parents/Guardian/Indian Custodian 4. Legal and/or Physical Custodian/Attorney (if any) 5. Case Worker 6. Foster Parent/Treatment Foster Home (if any) 7. District Attorney/Corporation Counsel 8. Tribe (if any) 9. Other : American LegalNet, Inc. www.FormsWorkFlow.com