IW-1785A, 09/16 Stipulation for Consent Decree (Out-of-Home Placement Only) Indian Child Welfare Act 24724748.32 and 938.32, 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 Stipulation for Consent Decree (Out - of - Home Placement Only) Indian Child Welfare Act Case No. The parties stipulate and agree that the court may order a consent decree an amended consent decree placing the child/juvenile under supervision, consistent with these terms and conditions. 1. A. The case shall be held open for days/ months. [Chapter 48, up to six months; Chapter 938, up to one year.] B. The consent decree shall be amended. The original expiration date is . 2. Placement shall be in . 3. No referrals to intake and/or violations of federal, state, or local laws. 4. Restitution. $ [Under age 14, $250 limit], payable to . Payment terms: Make repairs or provide services agreeable to the victim [Under age 14, 40 hour limit] See attached 5. Community service/supervised work program [Under age 14, 40 hour limit] Amount: hours. Terms: 6. Counseling. 7. Other: [Include payment for services under 24724748.36, 938.36, and 938.361, Wis. Stats.] See attached 8. The court may extend this decree for an additional 6 months upon notice and motion. Unless an objection is made, no hearing will be held. SIGNED BY DATE SIGNED BY DATE Child/Juvenile Mother Father Indian Custodian Prosecuting Attorney Case Worker Notice: During the period of this consent decree, the child/juvenile may object to its continuation and the hearing under which the child/juvenile was placed on supervision may be continued as if the consent decree had never been entered. American LegalNet, Inc. www.FormsWorkFlow.com