State of wisconsin, circuit court,   county




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STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY

For Official Use




Appointment of Special Prosecutor under Chapter 978





 I am the district attorney for       County and request the appointment of a special prosecutor under §978.045, Wisconsin Statutes.


Signature of District Attorney

Name Printed or Typed

     


Date

     

 The court on its own motion is appointing a special prosecutor under §978.045, Wisconsin Statutes.

APPOINTMENT ORDER

THE COURT FINDS AND ORDERS:


1. Attorney       is appointed special prosecutor for:

 The period       to       , plus reasonable preparation time.

 The matter of: State of Wisconsin  Other:      

vs.       , Case No.       .

2. The reason for the appointment:

 There is no district attorney for the county.

 The district attorney is absent from the county.

 The district attorney is physically unable to attend to duties or has a mental incapacity that impairs ability to perform duties.

 The district attorney has a conflict of interest under statute:       .

 The district attorney is serving in the U.S. armed forces.

 The district attorney is charged with a crime and the governor has not acted under §17.11, Wisconsin Statutes.

 Other statutory reason:       . Cite statute:      

3. Compensation is set at the following rate:

 No compensation is to be paid because this person is from another prosecutorial unit or an assistant attorney general.

 Hourly rate specified in §977.08(4m)(b), Wisconsin Statutes.

 Other:      

4. Disbursements shall be submitted to       County for payment, if incurred.

5. The Department of Administration shall pay the compensation ordered by the court.




> Send a copy of this Appointment to:




BY THE COURT:

1. Director


State Prosecutor’s Office
Department of Administration
P.O. Box 7869
Madison, WI 53707-7869
Telephone: (608)267-2700

2. Agency responsible for paying disbursements.






Circuit Court Judge

     

Name Printed or Typed

     

Date








OATH AND CONSENT TO SERVE

I accept this appointment and (swear) or (affirm) that I will support the constitutions of the United States and the State of Wisconsin, and will faithfully discharge the duties of this office to the best of my ability.




Subscribed and sworn to before me

on      




Notary Public, State of Wisconsin

My commission expires:      






Signature of Attorney


Telephone Number

     


Name Printed or Typed

     


Bar Number

     


Address of Principal Office

     





CR-210, 10/09 Appointment of Special Prosecutor under Chapter 978 §978.045, Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material.

Page of


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