Fill and Sign the Waiver of Stayed Delinquency Form

JD-1750, 08/06 W aiver of Stayed Delinquency Dispositional Order and Order Lifting Stay §938.34(16), W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Waiver of Stayed Delinquency Dispositional Order and Order Lifting Stay D ate of Birth Case No. For Official Use 1. I am the juvenile found delinquent in this case. The court has imposed and stayed: the entire dispositional order. a portion of the dispositional order. 2. The case worker and I agree that imposing the st ayed conditions will not move me from an in home to an out of home placement. 3. I agree that: • a hearing is not necessary because I admit I vi olated the disposition order. • the condition(s) of the dispositional order I v iolated were explained to me prior to my violation. • I do not object to the court imposing the condit ion(s) of the original dispositional order. • I am making this decision of my own free will. 4. Although I understand that the court is not boun d by this request and may impose the entire terms o f the dispositional order, the caseworker and I are reque sting the following conditions be imposed: Signature of Caseworker Signature of Juvenile Date Date ORDER LIFTING STAY The court has reviewed and approved the above waive r by the juvenile. THE COURT ORDERS: 1. The juvenile shall not be moved from an in home placement to an out of home placement without a hearing. 2. The stay of the condition(s) of the disposition al order is lifted as to: The conditions set forth in paragraph 4 above. That portion of the dispositional order as follows : BY THE COURT: Circuit Court Judge Name Printed or Typed Distribution: 1. Original - Court 2. Caseworker 3. Juvenile Date