JD-1786, 05/14 Order for Revision of Dispositional Order 24724748.357, 48.363, 938.357 and 938.363, 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 Revision of Dispositional Order Case No. A request for revision of dispositional order was filed with the court. A hearing on the request was held on , which is the effective date of this order. THE COURT FINDS: 1. The allegations of the request are not proven. 2. The allegations of the request(s) are proven and the court adopts them as findings of fact. 3. Other: THE COURT ORDERS: 1. This request for revision is DENIED . 2. The revision(s) is/are GRANTED as requested. as requested except as follows: a . The parent(s) shall contribute toward the expenses of custody/services in the amount of $ . to be determined by : [ A gency] 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. The support obligation begins on the date of placement. to be set by the child support agency. c. The parent(s) w ho 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. Conditions for return/visitation are part of this order or attached. d. All provisions of the dispositional order not changed by this order remain in full force and effect. 3. Other: THIS I S A FINAL ORDER FOR THE PURPOSE OF APPEAL. 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. Social 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