Fill and Sign the I Am the District Attorney for Form

CR-210, 11/99 Appointment of 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 Appointment of Special Prosecutor under Chapter 978 For Official Use I am the district attorney for County and request the appointment of a special prosecutor under §978.045, Wisconsin Statutes. Signature of District Attorney Name Printed or Typed Date The court on its own motion is appointing a special prosecutor under §978.045, Wisconsin Statutes . APPOINTMENT ORDER THE COURT FINDS AND ORDERS: 1.Attorney is appointed special prosecutor for: The period to , plus reasonable preparation time . The matter of: State of Wisconsin Other: vs. , Case No. . 2. The reason for the appointment: There is no district attorney for the county. The district attorney is absent from the county. The district attorney is physically unable to attend to duties or has a mental incapacity that impairs ability to perform duties. The district attorney has a conflict of interest under statute: . The district attorney is serving in the U.S. armed forces. The district attorney is charged with a crime and the governor has not acted under §17.11, Wisconsin Statutes. Other statutory reason: . Cite statute: 3.Compensation is set at the following rate: No compensation is to be paid because this person is from another prosecutorial unit or an assistant attorney general. Hourly rate specified in §977.08(4m)(b), Wisconsin Statutes. Other: 4.Disbursements shall be submitted to County for payment, if incurred. 5. The Department of Administration shall pay the com pensation ordered by the court. > Send a copy of this Appointment to: BY THE COURT: Signature of Circuit Judge Name Printed or Typed 1. Director State Prosecutor’s OfficeDepartment of Administration P.O. Box 7869 Madison, WI 53707-7869Telephone: (608)267-2700 2. County Clerk of countyresponsible for payingdisbursements. Date OATH AND CONSENT TO SERVE I accept this appointment and (swear) or (affirm) that I will support the constitutions of the United States and the State of Wisconsin, and will faithfully discharge the duties of this office to the best of my ability. Signature of AttorneyTelephone Number Name Printed or Typed Bar Number Subscribed and sworn to before me on Notary Public, State of Wisconsin My commission expires: Address of Principal Office