Fill and Sign the Order and Notice of Hearing Petition on Summary Assignment Form

GN-4 02 0, 1 0/0 6 O rd er a nd N otic e fo r H earin g o n T em pora ry P ro te ctiv e P la ce m ent §55 .1 3 5, W is co nsin S ta tu te s T h is f o rm s h all n ot b e m odif ie d . It m ay b e s u pple m en te d w it h a d dit io nal m ate ria l. S TA TE O F W IS C O NSIN , C IR CUIT C O URT, C O UNTY IN T H E M ATTE R O F A m en ded O rd er a n d N otic e f o r H earin g o n T em pora ry P ro te ctiv e P la cem en t D ate o f B ir th C ase N o. For O ff ic ia l U se A S ta te m ent o f E m erg ency P ro te ctiv e P la ce m ent h as b een f il e d b y (n am e) : A p e tit io n h as b ee n f ile d b y (n am e) : re questin g: p ro te ctiv e p la ce m ent o f th e in div id ua l. g uard ia nsh ip a n d p ro te ctiv e p la ce m ent o f th e in d iv id u al. T H E C O URT O RDER S: A p re lim in ary h earin g s h all b e h eld b efo re , C ourt O ffic ia l, o n (d ate ) a t (tim e) o r w he n s ch ed ule d th ere a fte r a t (lo ca tio n a nd a ddre ss ) : , W is co nsin , R oom , N otic e o f t im e a n d p la c e o f t h e p re lim in ary h earin g s h all b e g iv en o ra ll y a n d in w rit in g t o t h e in d iv id ual. I f y o u n eed h elp in t h is m atte r b ec au se o f a d is ab ilit y , p le a se c all: BY T H E C O URT: P le ase c h ec k w it h a tto rn ey b elo w f o r e xa ct t im e a n d d ate . N am e o f A tto rn ey A ddre ss C ir c u it C ourt J u d ge /C ourt C om mis sio n er N am e P rin te d o r T yp ed D ate T ele ph on e N um ber B ar N um ber