Fill and Sign the Persons Phone Number Form

GF-165, 10/05 Bench W arrant Civil §§785.04, 857.09, 880.252, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Case Caption: Bench Warrant Civil Case No. For Official Use Name of Person Person’s Address Person’s Phone Number ( ) Person’s Date of Birth Sex Race Driver’s License Number Height Weight Eye Color Hair Color Other Identifying Characteristics TO ANY LAW ENFORCEMENT OFFICER: Arrest and deliver to the sheriff the above named person because this person: failed to appear in court as required: Date of court appearance: Type of court appearance: failed to: . This person may be released upon completion of any all of the following conditions: Completing the attached Order for Financial Disclosure and Financial Disclosure Statement, SC-506. Agreeing to appear at a future supplementary examination at a time and place to be determined by the judgment creditor. Paying the amount owed on the judgment $ . Paying the statutory sheriff’s fees. Paying other costs $ . Performing the following conditions as authorized by the court: (All conditions under this section must be specifically authorized by the court.) Other: If the person posts the total amount due and is released, the law enforcement agency shall inform the court and district attorney of any new court date. BY THE COURT: Circuit Court Judge/Court Commissioner Name Printed or Typed Geographic restriction: Statewide Within county of ORI Within adjacent counties of ORI Other: ____________________ Date