Fill and Sign the Public Defender Wisconsin Form

For Official Use STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY IN THE INTEREST OF       Name Public Defender Response/ Order Concerning Recoupment       Date of Birth Case No.       PUBLIC DEFENDER RESPONSE 1. The child/juvenile was provided legal services through the Office of the State Public Defender, either as appointed or staff counsel. The court has ordered the parent(s) of this person to reimburse the State of Wisconsin for the cost of those services in the total amount of $       . The court ordered this sum to be paid: jointly by parents. totally by one parent: father. mother. split between the parents as follows: father: $       mother: $       2. The following parent has requested an indigency review: father: (name)       mother: (name)       this is an intact family; both parents(named above) have jointly requested review. 3. The Public Defender reviewed the ability of the requesting person(s) to pay the sums ordered and reports to the court that: a. The parent(s) requesting review is indigent . That parent has no obligation for reimbursement and the original Order for Recoupment should be amended. b. The parent(s) requesting review is partially indigent. The original Order for Recoupment of Costs and Legal Services should be amended to indicate that the parent(s) is able to pay $       . c. The parent(s) requesting review is not indigent . The original Order for Recoupment of Costs of Legal Services should not be modified. d. The parent(s) request was untimely. The original Order for Recoupment of Costs of Legal Services should not be modified. Signature Title Date AMENDED REIMBURSEMENT ORDER Based on the response of the State Public Defender, IT IS ORDERED: 1a. The parent(s) requesting review is indigent. The original Order for Recoupment, as it affects the parent(s) requesting review, is amended to provide that there is no obligation by that parent(s) to reimburse the State of Wisconsin. 1b. The parent(s) requesting review is partially indigent. The original Order for Recoupment of Costs of Legal Services, is amended to provide that the obligation by that parent(s) is the amount indicated in 3b above. 1c. The parent(s) requesting review is not indigent. The original Order for Recoupment of Costs of Legal Services, as it affects the parent(s) requesting review, shall remain in effect, including the payment schedule. 2. Any failure by the parent(s) to comply with this order shall subject that party to 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 – Court 2. Parent(s) requesting Review 3. State Public Defender BY THE COURT: Signature of Circuit Judge       Name Printed or Typed       Date JD-1763, 11/99 Public Defender Response/Order Concerning Recoupment §§48.275 and 938.275(2), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.