SC-5500VA, 05/18 Petition for Stay of Eviction Based on s Application for Emergency Assistance (Small Claims) 247799.40(4), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials. Enter the name of the county in which this case was filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter the Plaintiff( s ) name . Plaintiff(s): - vs - Defendant(s): Enter the Defendant( s ) name . Enter the eviction case number. Amended Petitio n for Stay of Eviction Based on Defendant Application for Emergency Assistance (Small Claims) Case No. Attach proof of application. UNDER OATH, I STATE: 1. I am the defendant in this case and I have applied for emergency assistance , pursuant to 24749.138, Wis. Stats . 2. No writ of restitution has been issued. 3 . I am asking the court to stay the eviction proceedings , pursuant to 247799.40(4), Wis. Stats. 4 . Proof of my application for emergency assistance is attached. STOP! Take this document to a Notary Public BEFORE you sign it. After you have been sworn by a Notary Public, sign and print your name, add your address and date the document in front of the Notary Public. Signature Print or Type Name Address Dat e Have the Notary Public sign and date the document. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: American LegalNet, Inc. www.FormsWorkFlow.com