Fill and Sign the Application for Judicial Assignment Justiaforms

This form is only available from the CCAP system used by the circuit courts. Type of Case Indicate one Civil Forfeiture Probate Small Claims Family Juvenile Felony (Charge): Misdemeanor (Charge): Traffic Criminal Traffic Class Code for Civil, Small Claims, Family: Class Code -Description Case Status Information Last Activity inCase Scheduled Activity Description Date MM-DD-YYYY Next Scheduled (ortobescheduled) Activity Scheduled Activity Description Date MM-DD-YYYY Jury Trial Post Judgment Other: Description ofCase Status Information helpful tochief judge and judge assigned (e.g., time limits ineffect, defendant incustody, other judges already substituted ordisqualified, other attorneys): Additional information entered from the Print dialog window. Attorney Information Attorney forPlaintiff/Petitioner _ Attorney Name Firm Name Primary Address City, WI 54321-1234 123-456-7890_ _ _ _ fullNamefirmprimAddrcity, state zip phone_ Attorney forDefendant/Respondent _ Attorney Name Firm Name Primary Address City, WI 54321-1234 123-456-7890_ _ Attorney Name Firm Name Primary Address City, WI 54321-1234 123-456-7890_ Reason for Assignment Application 1. Substitution request, dated: Date by plaintiff defendant 2. Disqualification -Wis. Stats: Reason: 3. On Assignment 4. Congestion 5. Vacation 6. Family Medical Leave 7. Judicial Education: 8. Expedite Litigation: 9. Vacancy 10. Mentoring 11. Meeting: 12. Chief Judge Duties 13. Military Service 14. Jury Duty 15. Disciplinary Action 16. Other: STATE OF WISCONSIN CIRCUIT COURT SAMPLE COUNTY Send "Chief Judge" and "Assigned Judge" copies toyour District Court Administrator * Application for Judicial Assignment Specific General Case Number(s) 2003CV123456 Case Caption (General Assignment, Dates -Times) Case Caption County Sample Code 99 Date Case Filed MM-DD-YYYY Current Court Official C.O. Name Code 1590 Branch No. 5 District No. 4 GF-168(CCAP) 04/02 Application forJudicial Assignment Page 1of2 This form may not bemodified. Itmay besupplemented with additional material. Current Court Official Approval __________________________________________ Application Prepared By Name __________________________________________ Approved Denied (Explain):_____________________________________________ _______________________________________________________________ By: ___________________________________________ ______________ Current Court Official Date Chief Judge/Deputy Chief Judge/DCA Approval __________________________________________ Approved Denied (Explain):_____________________________________________ _______________________________________________________________ By: _____________________________ _________ Chief Judge/Deputy Chief Judge/DCA Date __________________________________________ Assigned Judge:_________________________________________________ STATE OF WISCONSIN CIRCUIT COURT SAMPLE COUNTY Send "Chief Judge" and "Assigned Judge" copies toyour District Court Administrator * Application for Judicial Assignment Specific General Case Number(s) 2003CV123456 Case Caption (General Assignment, Dates -Times) Case Caption County Sample Code 99 Date Case Filed MM-DD-YYYY Current Court Official C.O. Name Code 1590 Branch No. 5 District No. 4 GF-168(CCAP) 04/02 Application forJudicial Assignment Page 2of2 This form may not bemodified. Itmay besupplemented with additional material.