DEPARTMENT OF HEALTH SERVICES Division of Mental Health and Substance Abuse Services F-25206 (07/2008)
STATE OF WISCONSIN S.971.17(3)(e) Wisconsin Statutes Administrative Rule HFS 98.22
CIRCUIT COURT STATE OF WISCONSIN
STATE OF WISCONSIN, Plaintiff
vs
COUNTY
PETITION FOR
CAPIAS
Defendant
Court Case Number
Date of Birth
Client Number
Date the Defendant was committed by this court
Offense(s):
Date the defendant was released on conditions by the court and placed under supervision:
Date the defendant violated conditions and / or DHS rules of supervision for persons on conditional release:
Alleged violations:
Therefore, the Department of Health Services petitions the court seeking a capias commanding the detaining law enforcement agency to take the named individual into custody pending further order of this court.
SIGNATURE DHS Representative
Date Signed
DISTRIBUTION: COPIES - Releasing Court, DHS/DMHSAS Forensic Specialist