JD-1763A, 02/18 Public Defender Response 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 Public Defender Response Concerning Recoupment Case No. 1. The child/juvenile was provided legal services through the Office of the State Public Defender, either as appointed or staff counsel. The court has ordered the parent(s) of this person to reimburse the State of Wisconsin for the cost of those services in the total amount of $ . The court ordered this sum to be paid: jointly by parents. totally by one parent: Parent 1 [Name] Parent 2 [Name] split between the parents as follows: Parent 1 $ . Parent 2 $ . 2. The following parent has requested an indigency review: Parent 1 . Parent 2 . this is an intact family; both parents ( above - named) have jointly requested review. 3. The Public Defender reviewed the ability of the requesting person(s) to pay the sums ordere d and reports to the court that the parent(s) : A . requesting review is indigent . That parent has no obligation for reimbursement and the original Order for Recoupment should be amended. B . requesting review is partially indigent. The original Order for Recoupment of Costs and Legal Services should be amended to indicate that the parent(s) is able to pay $ . C . requesting review is not indigent . The original Order for Recoupment of Costs of Legal Service s should not be modified. D . request was untimely. The original Order for Recoupment of Costs of Legal Services should not be modified. DISTRIBUTION: 1. Court 2. Parent(s) requesting Review 3. State Public Defender Signature Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com