CONFIDENTIAL COURT RECORD ME-945, 02/16 Evaluation, Recommendation, and Petition for Extension of Commitment 24751.20(13)(g)2r. and 3., Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE CONDITION OF Name of Subject Individual Date of Birth Amended Evaluation, Recommendation, and Petition for Recommitment Case No. DEPARTMENT EVALUATION/RECOMMENDATION: 1. The subject individual, who resides at [Address] , [Phone Number] is currently under an order of commitment, entered in [County] , which is due to expire on [Date] . 2. The subject individual is mentally ill, developmentally disabled or drug dependent, and a proper subject for treatment. 3. treatment record, that the subject individual would be a proper subject for commitment if treatment is withdrawn. 4. A recommitment of the subject individual is is not recommended by this department for the protection of society, the subject individual, or both. 5. In support of the above conclusions, the following treatment summary and mental evaluation of the subject individual is provided: See attached PETITION: the undersigned petitions the Court for a hearing for recommitment of the subject individual. Location of Hearing: Date of Hearing: Time of Hearing: a.m . p.m. Date to be set by Court. The following people will be available to testify to the basis for the recommitment: Name Phone Number Program and/or Agency or Facility and Address Corporation Counsel/Department Representative Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com