Wisconsin > Statewide > Circuit Court > Juvenile
Court Referral Child Juvenile Law Enforcement Referral JD-1701 - Wisconsin
|Court Referral Child Juvenile Law Enforcement Referral Form. This is a Wisconsin form and can be used in Juvenile Circuit Court Statewide .||
|Get this form for FREE as a print-only pdf|
FORM SUMMARY Name of Form: Form Number: Statutory Reference: Benchbook Reference: Purpose of Form: Court Referral - Child/Juvenile (Law Enforcement Referral) JD-1701 §§48.24 and 938.24, Wisconsin Statutes JV 2 To refer a child/juvenile to intake, who may be delinquent, in need of protection or services or in violation of a civil law or ordinance, and to record the decision of the intake worker. Top portion completed by law enforcement and bottom portion completed by intake worker. Original to intake file, copies to district attorney/corporation counsel and referring agency. Police report (including all accompanying statements), warrants/capias, restitution information, supporting documentation. Modification, last update 5/00. Changed the race codes to match CCAP codes. None. This form was developed by the Wisconsin Juvenile Court Intake Forms Committee. It has been approved by the Wisconsin Records Management Committee, a committee of the Director of State Courts Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Who Completes It: Distribution of Form: Accompanying Forms: New Form/Modification: Modifications: Comments: About this Form: Date: 08/07/2007 Page 1 American LegalNet, Inc. www.FormsWorkflow.com State of Wisconsin, Circuit Court, 1. Intake Case Number County Court Referral Child/Juvenile (Law Enforcement Referral) 4. Alias/Nickname 5. Age 2. Court Case Number 3. Child's/Juvenile's Name (Last, First, Middle) 6. Date of Birth 7. Sex Male 8. Child's/Juvenile's Street Address City State Zip Code 9. County of Residence 10. Race 1. African American 2. Asian or Pacific Islander 3. American Indian or Alaskan Native 4. Hispanic Female 5. Caucasian 6. Unknown 7. Other 11. Home Telephone 12. School Attended/Place of Employment 13. Grade/Occupation 14. Legal Father's Name Address Marital Status 15. Legal Mother's Name Address Marital Status 16. Guardian/Legal Custodian/Supervising Agency Address Marital Status T E L E P H O N E Work: Home: Work: Home: Work: Home: 17. Name of Referring Agency 18. Office Telephone 19. File/Case Number 20. Prior Record with Referring Agency: If yes, describe manner of handling: Yes No Additional information attached. 21. Name of Referring Officer 22. Alleged Offenses: Additional information attached. Statute Number(s) Offense Date(s) 23. Name of Accomplice(s) Address Sex Birth Date Mo/Day/Yr Referred to Court/Cited M F Yes No M F Yes No M F Yes No 24. Name of Victim and Address 25. Parent(s) Notified: No 26. Date of Referral to Intake Office Yes 27. Property loss or medical bills: No Yes Estimate $ INTAKE INQUIRY RECOMMENDATION 29. Interview Date and Time: 30. Present at Interview: 28. Date Received 31. Custody Authorization: 32. Prior Referrals to Intake: Released Detained Date: Nonsecure: Time: No Yes How Many? If juvenile alleged "Delinquent" under §938.12, attach prior referrals/disposition report to D.A.'s copy. Secure: 33. Intake Recommendation - Check all appropriate boxes. A. Case Closed Dismissed - lacks jurisdiction Counseled Referred to Other County Other: (Specify) B. Deferred Prosecution/Informal Disposition Agreement Expires: Restitution: $ hrs. Supervised Work Program: Informal Supervision Other: (Specify) C. Formal Petition Requested Ordinance Violation - Civil Traffic Offense Delinquency Waiver In Need of Protection/Services under ch. 48 In Need of Protection/Services under ch. 938 34. Comments: 35. Name of Intake Worker/Agency 36. Signature 37. Telephone 38. Date Recommended JD-1701, 08/07 Court Referral - Child/Juvenile (Law Enforcement Referral) §§48.24 and 938.24, Wisconsin Statutes. American LegalNet, Inc. www.FormsWorkflow.com This form shall not be modified. It may be supplemented with additional material.