Fill and Sign the Petition and Stipulation to Waive Appearance and Hearing and Order Judgment Wisconsin Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use State of Wisconsin, Plaintiff -vs-       , Defendant Name Petition and Stipulation to Waive Appearance and Hearing, and Order Extending Probation Judgment for Restitution Judgment for Court Ordered Financial Obligations DOC No.       Case No.       I am the defendant in this case and inform the court that: 1. My address is       . My occupation is       . My date of birth is       . 2. I was convicted on (mo/day/yr)       . (mo/day/yr) • for committing the offense(s) of       . • violating statute number(s)       . 3. I was placed on probation for       years,       months. This probation expires on       . 4. I have failed to complete the following conditions of probation: (mo/day/yr) Restitution: (Indicate below, name and address of victim, and amount unpaid.) See attached listing of victims. Name Address Amount unpaid                                     Court ordered financial obligations. Amount unpaid: $       . Other:       5. I understand that the Dept. of Corrections believes I have not made a good faith effort to pay and is asking the court to: Extend my probation for       years,       months. Terminate my probation and have a civil judgment entered against me for the unpaid restitution. have a civil judgment entered against me for unpaid court ordered financial obligations. waive my remaining court-ordered financial obligations. 6. I also understand that I have the rights listed on the back of this form. 7. I wish to waive my right to a hearing. 8. I ask the court to grant the request of the Department. 9. By signing this document, I certify that this waiver is made freely and voluntarily, without promises or threats. Signature of Defendant       Date Signature of Agent Number of Agent COURT ORDER / JUDGMENT The court finds, orders, and adjudges that: 1. The defendant has waived a hearing. This waiver is free and voluntary and is a stipulation to grant the relief requested. 2. The Department's request is justified . The relief requested is in the best interests of the defendant and the community. 3. The defendant's probation is extended for       years,       months, from (current discharge date)       to (new discharge date)       ; or until all court obligations are completed, whichever comes first. This extension will serve the purposes for which probation was imposed. 4. Judgment is granted against the defendant in favor of the victim(s) listed in paragraph 4 above for the amount unpaid. The clerk is directed to enter this judgment on the judgment and lien docket without fee. 5a. Judgment is granted against the defendant for unpaid court ordered financial obligations in the amount of $       . The clerk is directed to enter this judgment on the judgment and lien docket without fee. Twelve percent (12%) interest will be added from the date of entry of judgment. 5b. All remaining court ordered financial obligations of the defendant are waived. CR-208, 01/06 Petition and Stipulation to Waive Appearance and Hearing, and Order Extending Probation / Chapter 806, §973.09(3)(b), Wisconsin Statutes . DOC-101, 01/06 Judgment for Restitution/Judgment for Court Ordered Financial Obligations This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 Petition and Stipulation to Waive Page 2 of 2 Case No. Appearance and Hearing, and Order Extending Probation / Judgment for Restitution/Judgment for Court Ordered Financial Obligations Distribution: 1. Court – Original BY THE COURT:       Name Printed or Typed       Date Circuit Court Judge Rights Being Waived • I have a right to a hearing before the court on whether the Department's request should be granted. • I have a right to be represented by an attorney and, if I cannot afford an attorney, one will be appointed for me. • At a hearing, the Department would have to show that I have the ability to pay and that an extension will further my rehabilitation as well as the interests of the community. • If I waive these rights, the court can enter an order extending my probation or enter a judgment against me. Please initial that you have read your rights. CR-208, 01/06 Petition and Stipulation to Waive Appearance and Hearing, and Order Extending Probation / Chapter 806, §973.09(3)(b), Wisconsin Statutes . DOC-101, 01/06 Judgment for Restitution/Judgment for Court Ordered Financial Obligations This form shall not be modified. It may be supplemented with additional material. Page 2 of 2