Fill and Sign the Directing Compensation for Form

CR-211, 11/99 Petition and Order Directing Compensation for Special Prosecutor§978.045, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Petition and Order Directing Compensation for Special Prosecutor For Official Use (Print or type information. Submit an original and two copies of this petition to the court.) Under oath I state:1.I was appointed special prosecutor for: State of Wisconsin Other: vs. , Case No. . The period to . 2. A complete and truthful itemization on form DOA–5186, issued by the Department of Administration, of the time involved in completing this appointment is attached. This is an interim request for compensation. The duties o f special prosecutor have not yet been completed. This is a final billing. All duties must have been completed. 3. I request payment by the Department of Administration for these services. 4.An itemization of disburseme nts is attached, for which I request payment by the county. Name of Special Prosecutor Complete Mailing Address Telephone Number Bar Number Payment should be sent to: Social Security No. or Taxpayer ID No. (for income tax purposes) Signature of Special Prosecutor Date Subscribed and sworn to before me on Notary Public, State of Wisconsin My commission expires: ORDER DIRECTING COMPENSATION IT IS ORDERED: 1.The Secretary of the Department and Administration pay the total sum of $ as compensation for the special prosecutor. 2. County pay disbursements in the amount of $ . > Submit this order and itemization to: BY THE COURT: Signature of Circuit Judge Name Printed or Typed 1. Director State Prosecutor’s Office Department of AdministrationP.O. Box 7869 Madison, WI 53707-7869 Telephone: (608)267-2700 2. County Clerk of county responsible for paying disbursements, ifordered under #2. Date Telephone Number