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CR-263, 08/11 Petition for Determination of Eligibility for the Substance Abuse Program §302.05(3)(e), W isconsin Statutes DOC-2251A This form shall not be modified. It may be supplemented with additional mater ial. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY State of W isconsin -vs - , Defendant Name Date of Birth Amended Petition for Determination of Eligibility for the Substance Abuse Program §302.05(3)(e), Wis. Stats. Case No. 1. I am presently serving the confinement portion of a bifurcated sentence. 2. I was not convicted of a crime specified in chapter 940 or §§948.02, 948.025, 948.03, 948.05, 948.05 5, 948.06, 948.07, 948.075, 948.08 or 948.095, W is. Stat s. 3. My sentence was imposed A. before July 26, 2003, the effective date of the Substance Abuse Program. OR B. on or after July 26, 2003, and the sentencing court did not determine if I was eligible or inel igible to participate in the Substance Abuse Program. 4. Attached is form CR-264, Department of Corrections Approval to File Petition for Determination of Eligibility for the Substance Abuse Program. 5. A copy of this petition is being served on the district attorney in the county of conviction. The district attorney may file a written response. I request the sentencing court to determine if I am eligible or ineligible to participate in the Subs tance Abuse Program within 90 days after the filing of this petition. DISTRIBUTION: 1. Court 2. Inmate 3. District Attorney ► Petitioner Name Printed or Typed Date

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