Fill and Sign the Enter the Name of the for Official Use State of Wisconsin Form

GF-182, 01/09 Petition, Affidavit and Order Concerning Removal of Defendant’s Name from Online Records Because of Identity Thef t or Mistaken Identity This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 - - Enter the name of the county in which the case is filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter the name of the plaintiff in the original case file. Plaintiff : First name Middle name Last name -vs- Petition, Affidavit and Order Concerning Removal of Defendant’s Name from Online Records Because of Identity Theft or Mistaken Identity Case No. Enter the name of the defendant in the original case file. Defendant : First name Middle name Last name Enter the case n umber. Please Note: The mere fact that a case is dismissed or a person is found “not guilty” is not sufficient to file this petition. This petition can only be filed when the charge was a bona fide case of either identity theft or a true mistake in cha rging the wrong person. Check 1. if you have a prosecuting attorney’s certification (GF -185) or 2. if you do not. Indicate the reason why the prosecuting attorney would not sign the document. UNDER OATH I STATE: I am the defendant in the case named ab ove. I am requesting that my name be removed from the online records of the Wisconsin Circuit Court Access website. I understand that the actual physical record of this case will remain as a public record in the office of the Clerk of Court . The reaso n for my request is that the Prosecuting Attorney agrees that charging me with this offense was a mistake because of either a stolen identity or mistaken identity in charging. 1. I have attached a certification from the prosecuting atto rney certifying to these facts. 2. On [Date] , I requested a certification and the prosecuting attorney has not signed it. The prosecuting attorney has not signed it because: Therefore, I ask that the court enter an order directing the Clerk of Court to remove my name from the online record of this case on the Wisconsin Circuit Court Access website. STOP! Take this document to a No tary Public BEFORE you sign it. After a Notary Public has sworn you, sign and print your name and date the document in front of the Notary Public. Authorized Signature Print or Type Name Date After you have signed the document while under oath, have the Notary Public sign, date, and seal the document. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Petition, Affidavit and Order Concerning Removal of Defendant’s Name from Online Records Because of Iden tity Theft or Mistaken Identity Page 2 of 2 Case No. ___________ GF-182, 01/09 Petition, Affidavit and Order Concerning Removal of Defendant’s Name from Online Records Because of Identity Theft or Mist aken Identity This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 IT IS ORDERED : 1. The Petitio n is GRANTED. The Clerk is directed to remove this defendant’s name from the online records of the Wisconsin Circuit Court Access website. The actual physical record of this case shall remain as a public record in the office of the Clerk of Circuit Court . 2. The Petition is DENIED because: A. The petitioner has failed to provide the certification of the Prosecuting Attorney and has shown no good cause for not obtaining the certification. B. This was NOT a case of stolen identity or a mistake in charging. For Court Use Only . 3. The Court needs further information before deciding whether the Petition should be granted or denied. The Petition is to be scheduled for a hearin g as follows: Before: Circuit Court Judge/Circuit Court Commissioner Location: Date: Time: a.m. p.m. BY THE COURT: Circu it Court Judge/Circuit Court Commissioner Title (Print or Type Name if not eSigned) Date