ME-909A, 12/02 Statement of Noncompliance with Settlement Agreement 24751.20(8)(bm), 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 Date of Birth Statement of Noncompliance with Settlement Agreement Case No. UNDER OATH I STATE: 1. A Settlement Agreement approved by the court is still in effect. 2. Upon information and belief, the subject has failed to comply with the Settlement Agreement as follows: I REQUEST THE COURT: 1. Schedule a hearing as follows: A. Probable Cause Hearing (within 72 hours of detention if detained or within a reasonable time if not). B. Final hearing (within 14 days of detention if detained or 30 days if not detained). 2. Order the detention of the subject at [Name of Detention Facility] pending further disposition. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expi res: Corporation Counsel Name Printed or Typed Date Telephone Number D ISTRIBUTION: 1. Court 2. Subject 4. Corporation Counsel 5. County Dept. Monitoring Agreement 6. Treatment Facility/Provider 7. Detention Facility (if different) American LegalNet, Inc. www.FormsWorkFlow.com