Fill and Sign the Order for Recoupment of Form

JD-1762, 02/18 Order for Recoupment of Costs of Legal Services §§48.275 and 938.275(2), W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY For Official Use IN THE INTEREST OF Name Amended Order for Recoupment of Costs of Legal Services Date of Birth Case No. THE COURT FINDS: 1. The child/juvenile has been adjudicated delinquent. adjudicated in violation of a civil law or ordinance. adjudicated in need of protection or services. released with no adjudication. the subject of a request for revision/extension/change of placement/permanency plan review. 2. The State Public Defender Office established that the amount of reimbursement shall be $480 in felony matters and $240 for all other cases. 3. The parents were not the complaining or petitioning party and the interests of the child/juvenile and parents are such that reimbursement would not be unfair. The parents are financially able to reim burse costs. THE COURT ORDERS: 1. The parents shall reimburse the State of Wisconsin for attorney services in the total amount of: Felony: $480.00 Other cases: $240.00 Name of Parent 1 : Date of Birth Address: Name of Parent 2: Date o f Birth Address: This amount will apply unless the parent meets with the Office of the State Public Defender within 30 days of this order to complete a Statement of Income, Assets, and Living Expenses, and is f ound to be indigent. The State Public Defender shall complete and send to the court the Public Defender response/order concerning recoupment form for each such parent. Notice to parents: You must have a copy of this order available when you contact the State Public Defender Office. 2. The reimbursement shall be paid as follows: jointly by parents (intact household) in the amount of $ per month. as a lump sum. totally by one parent: Parent 1 Parent 2 in the amount of $ per month. as a lump sum. split betwe en the parents (divorced or separated household) in the amount of: for Parent 1 : $ per month . as a lump sum. for Parent 2 : $ per month. as a lump sum. 3. All payments shall be made to The first payment shall be due on . Any remaining payment shall be made beginning 30 days after initial payment and each month on that same date until paid in full. 4. Failure by the parents to comply with this order may result in penalties for contempt of court, including incarceration in th e county jail for up to 6 months, forfeitures of up to $2,000 per day for each day of noncompliance, and any other order necessary to ensure compliance with this order. THIS IS A FINAL OR DER FOR PURPOSE OF APPEAL. DISTRIBUTION: 1. Juvenile Clerk for filing 2. Clerk of Court (for payme nt record) 3. Parents 4. State Public Defender Office BY THE COURT: Circuit Court Judge Name Printed or Typed Date