JC-1648, 08/12 Priority Placement Order (Interstate Compact on the Placement of Children) 24724748.988, 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 a person under the age of 18 Date of Birth Priority Placement Order (Interstate Compact on the Placement of Children) Case No. THE COURT FINDS: 1. The child is within the jurisdiction of this court. 2. [Name] is the proposed placement resource in the receiving state of and is a relative of the child as set forth in Article VIII(a) of the Interstate Compact on the Placement of Children (Compact) and 24748.988(8), Wis. Stats. 3. The placement is not for licensed foster family approved care or adoption and the child is not located in the receiving state in violation of the Compact. 4. of the following requirements: a. The child is under four years of age. b. The child is an older sibling of a child under four years of age sought to be placed with the same proposed placement resource. c. The child has a substantial relationship with the proposed placement resource. d. Any child in tgroup has a substantial relationship with the proposed placement resource and the child is sought to be placed with the same proposed placement resource. e. The child is currently in an emergency placement. f. There is an unexpected dependency due to sudden or recent incarceration, incapacitation, or death of a parent or guardian. 5. If a home study is approved by the receiving state, this placement would not be contrary to the best interest of the child. THE COURT ORDERS: 1. County is authorized to be the sending agency for the child under the terms of the Compact adopted by 24748.988, Wis. Stat., and designates and directs the county child welfare agency or any receiving state agency to complete, carry out and effectuate all obligations and responsibilities of the sending agency under the Compact. 2. County, or any receiving state agency, shall immediately commence procedures necessary for priority placement of the child with the placement resource indicated above. 3. Within two (2) business days the court shall provide a copy of this order to the authorized sending agency. American LegalNet, Inc. www.FormsWorkFlow.com JC-1648, 08/12 Priority Placement Order (Interstate Compact on the Placement of Children) 24724748.988, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 4. Within three (3) business days of receipt of this order, the sending agency shall transmit a copy of this order, completed forms ICPC 100-A and 101, and supporting documentation to the Compact Administrator of the sending state with notice of the priority status of this request for placement. 5. The Compact Administrator of the sending state and all other persons to whom Article VII of the ICPC applies shall comply with Priority Regulation No. 7 and shall fully implement the procedures for the request for priority placement. 6. The receiving state shall comply with Priority Regulation No. 7 and provide the completed home study to the State of Wisconsin Compact Administrator within 20 business days of receipt. Circuit Court Address and Phone Number DISTRIBUTION: 1. Court 2. Sending agency American LegalNet, Inc. www.FormsWorkFlow.com