Department Of Corrections Approval To File Petition For Determination Of Eligibility For The Substance Abuse Program {CR-264}

For Official Use STATE OF WISCONSIN, CIRCUIT COURT, Amended COUNTY State of Wisconsin -vs, Defendant Name Department of Corrections Approval to File Petition for Determination of Eligibility for the Substance Abuse Program §302.05(3)(e) Case No. Date of Birth 1. The petitioner is presently serving the confinement portion of a bifurcated sentence. The petitioner was not convicted of a crime specified in chapter 940 or §§948.02, 948.025, 948.03, 948.05, 948.055, 948.06, 948.07, 948.075, 948.08 or 948.095, Wis. Stats. 2. The court has not yet determined if the petitioner is eligible or ineligible to participate in the Substance Abuse Program. 3. The Department of Corrections approves filing of the Petition for Determination of Eligibility for the Substance Abuse Program. State of County of Subscribed and sworn to before me on Department of Corrections Representative Name Typed or Printed Notary Public/Court Official Date Name Printed or Typed My commission/term expires: DISTRIBUTION: 1. Court ­ Original 2. Department of Corrections CR-264, 08/11 Department of Corrections Approval to File Petition for Determination of Eligibility for the Substance Abuse Program DOC-2251 §302.05(3)(e), Wis. Stats. American LegalNet, Inc. www.FormsWorkFlow.com This form shall not be modified. It may be supplemented with additional material.