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Fill and Sign the Petition and Order Directing Compensation for Special Prosecutor Wisconsin Form

Fill and Sign the Petition and Order Directing Compensation for Special Prosecutor Wisconsin Form

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STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use Petition and Order Directing Compensation for Special Prosecutor (Print or type information. Submit an original and two copies of this petition to the court.) Under oath I state: 1. I was appointed special prosecutor for: State of Wisconsin Other:       vs.       , Case No.       . The period       to       . 2. A complete and truthful itemization on form DOA–5186, issued by the Department of Administration, of the time involved in completing this appointment is attached. This is an interim request for compensation. The duties of special prosecutor have not yet been completed. This is a final billing. All duties must have been completed. 3. I request payment by the Department of Administration for these services. 4. An itemization of disbursements is attached, for which I request payment by the county. Payment should be sent to: Name of Special Prosecutor       Complete Mailing Address       Telephone Number       Bar Number       Social Security No. or Taxpayer ID No. (for income tax purposes)       Subscribed and sworn to before me on       Notary Public, State of Wisconsin My commission expires:       Signature of Special Prosecutor       Date ORDER DIRECTING COMPENSATION IT IS ORDERED: 1. The Secretary of the Department and Administration pay the total sum of $       as compensation for the special prosecutor. 2.       County pay disbursements in the amount of $       . > Submit this order and itemization to: BY THE COURT: 1. Director State Prosecutor’s Office Department of Administration P.O. Box 7869 Madison, WI 53707-7869 Telephone: (608)267-2700 2. County Clerk of county responsible for paying disbursements, if ordered under #2. Signature of Circuit Judge       Name Printed or Typed       Date       Telephone Number CR-211, 11/99 Petition and Order Directing Compensation for Special Prosecutor §978.045, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.

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