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Fill and Sign the Order for Change of Placement Out of Home to Out of Home Placement Only Wisconsin Form

Fill and Sign the Order for Change of Placement Out of Home to Out of Home Placement Only Wisconsin Form

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STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE INTEREST OF       Name Order for Change of Placement (Out of Home to Out of Home Placement Only)       Date of Birth Case No.       THE COURT FINDS: 1. A notice of change of placement has been filed and no objection to the change in placement has been received. 2. A request for a hearing on change of placement has been filed and the hearing was held on (date)       . As to the department or agency recommendation: a. The placement location recommended by the department or agency is adopted. OR b. After giving bona fide consideration to the recommendations of the department or agency and all parties, the placement location recommended is not adopted. THE COURT ORDERS: 1. The placement of the child/juvenile is changed to       remains at       2. Transportation to the new placement shall be provided by:       3. All provisions of the dispositional order not changed by this order remain in full force and effect. 4. The parents have been advised of the applicable grounds for termination of parental rights and the conditions that are necessary for a safe return to the home or a restoration of visitation rights. Written TPR Warnings are attached. 5. The parent(s) shall contribute toward the expenses of custody/services in the amount of: $       to be determined by (agency):       6. The amount of support to be paid by the parent(s), guardian or trustee for the out of home placement is: $       or       % of gross income payable by wage assessment. to be set by the child support agency. The support obligation begins on the date of placement. 7. Other:       Distribution: 1. Original - Court 2. Child/Juvenile/Attorney/Guardian ad Litem 3. Parents/Guardian 4. Legal and/or Physical Custodian/Attorney (if any) 5. Social Worker 6. Foster Home/Treatment Foster Home (if any) 7. District Attorney/Corporation Counsel 8. Other       BY THE COURT: Circuit Court Judge       Name Printed or Typed       Date JD-1790 , 08/06 Order for Change of Placement (Out of Home to Out of Home Placement Only) §§48.357, 48.363, 48.365, 938.357, 938.363 and 938.365, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

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