Fill and Sign the Fines 497430966 Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use Case Caption:       Judgment for Unpaid Fines, Forfeitures and Other Financial Obligations Case No.       THE COURT FINDS: 1. The name and address of the debtor: Name:       DOB:       Address:       City/State/Zip Code:       2. The name and address of the creditor: Name:       Address:       City/State/Zip Code:       3. The debtor was ordered to pay a fine, forfeiture, court costs, assessments, guardian ad litem fees, court appointed attorney fees, surcharges or DNR restitution (if applicable). The total obligation was not paid and the amount owed is: $       . THE COURT ORDERS: 1. Judgment is granted in favor of the creditor and against the defendant/debtor for the amount owed. Twelve percent (12%) interest will be added from the date of entry of judgment. 2. This judgment shall be entered in the judgment and lien docket. 3. No docketing fee shall be charged. Distribution: 1. Court – Original 2. Defendant/Debtor BY THE COURT: Court Official       Name Printed or Typed       Date Please note: Even when you pay this debt in full, the judgment entered in the judgment and lien docket may remain unsatisfied until you pay the $5 fee to have it satisfied. An unsatisfied debt could adversely affect your credit rating and, consequently, your ability to obtain a loan. GF-171 , 04/07 Judgment for Unpaid Fines, Forfeitures and Other Financial Obligations §§48.235(8), 54.46(3), 55.075(4), 55.18(3), 345.47, 345.49, 767.045(6), 778.30, 785.04, 815(8), 938.235(8) and 973.05(4), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.