Fill and Sign the Order for Recoupment of Costs of Legal Services Wisconsin Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE INTEREST OF       Name 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 reimburse 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 Father:       Date of Birth       Address:       Name of Mother:       Date of 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 found 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: father mother in the amount of $       per month. as a lump sum. split between the parents (divorced or separated household) in the amount of: for the father: $       per month. as a lump sum. for the mother: $       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 the 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. Distribution: 1. Original – Juvenile Clerk for filing 2. Clerk of Court (for payment record) 3. Parents BY THE COURT: Circuit Court Judge       Name Printed or Typed       Date JD-1762 , 08/06 Order for Recoupment of Costs of Legal Services §§48.275 and 938.275(2), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1