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Fill and Sign the Cr 265 Order on Petition for Determination of Eligibility for Form

Fill and Sign the Cr 265 Order on Petition for Determination of Eligibility for Form

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CR-264, 08/11 Department of Corrections Approval to File Petition for Determ ination of Eligibility for the Substance Abuse Program §302.05(3)(e), W isconsin Statutes DOC-2251 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 Department of Corrections Approval to File Petition for Determination of Eligibility for the Substance Abuse Program §302.05(3)(e), Wis. Stats. Case No. 1. The petitioner is presently serving the confinement portion of a bifurcated sentence. The peti tioner was not convicted of a crime specified in chapter 940 or §§948.02, 948.025, 948.03, 948.05, 948.055, 948.06 , 948.07, 948.075, 948.08 or 948.095, W is. Stat s. 2. The court has not yet determined if the petitioner is eligible or ineligible to partic ipate in the Substance Abuse Program. 3. The Department of Corrections approves filing of the Petition for Determination of Eligibility for the Sub stance Ab use Program. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Department of Corrections Representative Name Typed or Printed Date DISTRIBUTION: 1. Court 2. Department of Corrections

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