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JD-1747, 02/10 Dispositional Order - Civil Law/Ordinance Violation §§938.342, 938.343, 938.344, 938.37, Wisconsin Statutes This form shall not be modified. It may be suppleme nted with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Dispositional Order - Civil Law/ Ordinance Violation D ate of Birth Case No. For Official Use THE COURT FINDS: 1. A dispositional hearing was held on (Date) 2. The child has violated a civil law or ordinance: 3a. The child alone is financially able to pay res titution of $ and/or a forfeiture of $ . 3b. The child is physically able to perform servic es for the victim and the victim agrees to accept such services. 3c. The custodial parent is financially able to pa y reasonable restitution of $ and/or forfeiture of $ . 4. The violation is related to the use or abuse of alcoholic beverages or controlled substances: 5. Other: THE COURT ORDERS AS A DISPOSITION IN THIS MATTER TH E FOLLOWING: 1. Counseling: 2. Restitution: $ , to be paid: See restitution supplement. Make repairs or provide services agreeable to the victim: 3. Forfeiture of $ to be paid: 4. Costs of (age 14 and over) $ , to be paid: Failure to pay forfeiture/costs shall result in a suspension of the following license for Motor vehicle operating privilege DNR, Ch. 29 license 5. Supervised work program: 6. Safety course or program: 7. DNR, Ch. 29 license suspension for: 8. Alcohol/drug abuse (AODA) dispositions: AODA assessment and, if recommended, an outpatient AODA program. Facility: Date completed by: AODA education program by: Dispositional Order - Civil Law/ Ordinance Violation Page 2 of 2 Case No. JD-1747, 02/10 Dispositional Order - Civil Law/ Ordinance Violation §§938.342, 938.343, 938.344, 938.37, Wisconsin Statutes This form shall not be modified. It may be suppleme nted with additional material. Page 2 of 2 9. Truancy disposition (in addition to any of the above) : Operating privilege suspension: days Community service: Supervised work program: Home detention: 10. Other: • Person/agency responsible for services: • Order effective date of hearing; expiration date: THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL IF SIG NED BY A CIRCUIT COURT JUDGE. BY THE COURT: Circuit Court Judge Circuit Court Commissioner Name Printed or Typed Date