Fill and Sign the Wisconsin Delinquency Dispositional Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE INTEREST OF       Name Waiver of Stayed Delinquency Dispositional Order and Order Lifting Stay       Date of Birth Case No.       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 stayed 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 violated the disposition order. • the condition(s) of the dispositional order I violated were explained to me prior to my violation. • I do not object to the court imposing the condition(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 bound by this request and may impose the entire terms of the dispositional order, the caseworker and I are requesting the following conditions be imposed:       Signature of Caseworker Signature of Juvenile       Date       Date ORDER LIFTING STAY The court has reviewed and approved the above waiver 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 dispositional order is lifted as to: The conditions set forth in paragraph 4 above. That portion of the dispositional order as follows:       Distribution: 1. Original - Court 2. Caseworker 3. Juvenile BY THE COURT: Circuit Court Judge       Name Printed or Typed       Date JD-1750, 08/06 Waiver of Stayed Delinquency Dispositional Order and Order Lifting Stay §938.34(16), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.