Wis JI-Criminal 2302A

We, the undersigned jurors, find as follows:

1. Is there probable cause to believe that the death of (name of deceased) was

caused under circumstances constituting (name of offense submitted to the jury),

contrary to section _________ of the Wisconsin Statutes? 1

Yes _____ No _____

Answer question 2 only if you answer question 1 "yes."

2. Is there probable cause to believe that the following person committed the

offense of (name of offense submitted to the jury), contrary to section _________ of the

Wisconsin Statutes, in causing the death of (name of deceased) ? 2

(Name person).

Yes _____ No _____

Answer question 3 only if you answer question 1 "no."

3. Is there probable cause to believe that the death of (name of deceased) was a

result of [natural causes] [an accident] [suicide] [an act privileged by law]? 3

Yes _____ No _____

We, the undersigned jurors, state that we are unanimous as to each question in the

verdict, and the verdict is signed by each of us. Dated at ______________________,

Wisconsin, this _____ day of _______________, 20__.

__________________________ ________________________

__________________________ ________________________

__________________________ ________________________

Validated and signed this ______ day of

_______________, 20__.

________________________________________

(Name of judge), Circuit Court Judge