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Fill and Sign the Referral by Department of Corrections to Sentencing Court Section 3021139g Geriatric Terminal Wisconsin Form

Fill and Sign the Referral by Department of Corrections to Sentencing Court Section 3021139g Geriatric Terminal Wisconsin Form

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STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use State of Wisconsin -vs-       , Defendant Name Referral by Department of Corrections to Sentencing Court §302.113(9g) (Geriatric/Terminal)       Date of Birth Case No.       1. Attached is the inmate’s Petition to Modify Bifurcated Sentence. The Program Review Committee has approved this petition for referral to the sentencing court. The Program Review Committee has determined that the public interest would be served by a modification of the inmate’s bifurcated sentence in the manner provided in §302.113(9g)(f) (see attached decision of Program Review Committee). The Department of Corrections requests that the court conduct a hearing on this petition. 2. The inmate is eligible under §302.113(9g)(i). 3. The inmate is 65 years of age or older and has served at least 5 years of the term of confinement in prison. OR The inmate is 60 years of age or older and has served at least 10 years of the term of confinement in prison; OR The inmate has a terminal condition, and has attached and incorporated into the petition affidavits from two (2) physicians. Distribution: 1. Original - Court 2. Copy - Department of Corrections Department of Corrections: Signature       Name Printed or Typed       Date CR-255 , 03/04 Referral by Department of Corrections to Sentencing Court §302.113(9g) §302.113(9g), Wisconsin Statutes DOC-2253 This form shall not be modified. It may be supplemented with additional material.

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