JD-1814, 09/16 Request for Case Closure Order 24724748.355(4g) and 938.355(4g) and Ch. 767, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Request for Case Closure Order Case No. I STAT E ON INFORMATION AND BELIEF : 1. A dispositional order was made in the above - captioned case . 2. The child/juvenile is/will be placed in the home of a parent. 3. This proposal for case closure has been made by the court; OR This request for case closure is being brought by the child/juvenile. guardian ad litem. parent. guardian/custodian. prosecutor. agency responsible for implementing the dispositional order . 4. There is a pending or existing family court action involving the child/juvenile. I request t he family court order in [Case Number] in [County] be entered or modified with respect to the following: ( S elect all that apply ) Pa ternity Legal custody Periods of physical placement Visitation Child support Health care expenses Specify , in detail , the orde r being requested : See attached I request a hearing be held on the matter . DISTRIBUTION: 1. Court 2. Child/Juvenile 3. Attorney for Child/Juvenile 4. Guardian ad Litem 5. Parents 6. Guardian/Custodian 7. Case Worker 8. District Attorney/Corporation Counsel 9. Other: Requestor Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com