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Felony Judgment and Sentence (FJS) Page 1 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9)) Superior Court of Washington County of State of Washington , Plaintiff, vs. ______________________________________, Defendant. DOB PCN: SID: No . Felony Judgment and Sentence -- Parenting Sentencing Alternative (FJS) [ ] Clerk’s Action R equired, 2.1, 4.1, 4.3, 4.7, 5.2, 5.3, 5.5, 5.7, and 5.8 [ ] Defendant Used Motor Vehicle [ ] Juvenile Decline [ ] Mandatory [ ] Discretionary I. Hearing 1.1 The court conducted a sentencing hearing this date; the defendant, the defendant's lawyer, and the (deputy) prosecuting attorney were present. II. Findings 2.1 Current Offenses : The defendant is guilty of the following offenses, based upon [ ] guilty plea (date) ____________ [ ] jury -verdict (date) ____________ [ ] bench trial (date) ____ _______: Count Crime RCW Class Date of (w/subsection) Crime Class: FA (Felony -A), FB (Felony -B), FC (Felony -C) (If the crime is a drug offense, include the type of drug in the second column.) [ ] Additional current offenses are attached in Appendix 2.1a. The jury returned a special verdict or the court made a special finding with regard to the following: GV [ ] For the crime(s) charged in Count ____________, domestic violence – intimate partner as defined in RCW 9A.36.041(4 ) and RCW 26.50.010(7) was pled and proved . GV [ ] For the crime(s) charged in Count ____________, domestic violence - family or household was pled and proved. RCW 26.50.010(6) . [ ] This case involves unlawful imprisonment as defined in chapter 9A.40 RCW, where the victim is a minor and the offender is not the minor’s parent. RCW 9A.44.130. Felony Judgment and Sentence (FJS) Page 2 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9)) [ ] Count ________ is a felony in the commission of which the defendant used a motor vehicle . RCW46.20.285. [ ] The defendant has a chemical dependency tha t has contributed to the offense(s). RCW 9.94A.607. [ ] Reasonable grounds exist to believe the defendant is a mentally ill person as defined in RCW 71.24.025, and that this condition is likely to have influenced the offense. RCW 9.94B.080 [ ] Coun ts __________________ encompass the same criminal conduct and count as one crime in determining the offender score (RCW 9.94A.589). [ ] Other current convictions listed under different cause numbers used in calculating the offender score are (list offen se and cause number): Crime Cause Number Court (county & state) DV* Yes 1. 2. * DV: Domestic Violence was pled and proved. [ ] Additional current convictions listed under different cause numbers used in calculating the offender score a re attached in Appendix 2.1b. 2.2 Criminal History (RCW 9.94A.525) : Crime Date of Crime Date of Sentence Sentencing Court (County & State) A or J Adult, Juv. Type of Crime DV* Yes 1. 2. 3. * DV: Domestic Violence was pled and proved. 2.3 Sentencing Data : Count No . Offender Score Serious - ness Level Standard Range (not including enhancements) Plus Enhancements* Total Standard Range (including enhancements) Maximum Term N/A N/A N/A [ ] Additio nal current offense sentencing data is attached in Appendix 2.3. 2.4 Parenting Sentencing Alternative . The court finds that the defendant is eligible for the parenting sentencing alternative and this alternative is appropriate and should be imposed. RCW 9.94A.655. Felony Judgment and Sentence (FJS) Page 3 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9)) 2.5 Legal Financial Obligations/Restitution . The court has considered the total amount owing, the defendant's financial resources and the nature of the burden that payment will impose. (RCW 10.01.160). The court makes the following specific f indings: [ ] The defendant is indigent as defined in RCW 10.101.010(3)(a) -(c) because the defendant: [ ] receives public assistance [ ] is i nvoluntarily committed to a public mental health facility [ ] receives an a nnual income , after taxes, of 125 percent or less of the current federal poverty level. [ ] The defendant is not indigent as definied in RCW 10.101.010(3)(a) -(c). [ ] The following extraordinary circumstances exist that make restitution inappropriate (RCW 9.94A.753): ________________________________ ________________________________ ________________ . [ ] The defendan t has the present means to pay costs of incarceration. RCW 9.94A.760. 2.6 [ ] Felony Firearm Offender Registration . The defendant committed a felony firearm offense as defined in RCW 9.41.010, and: [ ] The defendant should register as a felony firea rm offender. The court considered the following factors in making this determination: [ ] the defendant’s criminal history. [ ] whether the defendant has previously been found not guilty by reason of insanity of any offense in this state or elsewhere. [ ] evidence of the defendant’s propensity for violence that would likely endanger persons. [ ] other:_______________________________________________________________________. [ ] The defendant must register as a felony firearm offender because the offen se was committed in conjunction with an offense committed against a person under the age of 18, or a serious violent offense or offense involving sexual motivation as defined in RCW 9.94A.030. III. Judgment 3.1 The defendant is guilty of the Counts and Charges listed in Paragraph 2.1 and Appendix 2.1. 3.2 [ ] The court dismisses Counts in the charging document. IV. Sentence and Order It is ordered : 4.1 Parenting Sentencing Alternative . RCW 9.94A.030, RCW 9.94A.655. The defendant is eligible for the parenting sentencing alternative. The court waives imposition of a sentence within the standard sentence range and imposes the following sentence: (a) Community Custody . The defendant shall serve, under the charge of DOC . [ ] The defendant was under 18 at the time of the offense and shall be initially placed in the custody of the Department of Children, Youth, and Families (DCYF) : _____________________ months in community custody on Count ________________. _____________________ months in community cu stody on Count ________________. _____________________ months in community custody on Count ________________. The defendant shall comply with the community custody conditions in paragraph 4.2. (b) [ ] Review Hearing . The defendant shall appear at review hearing as follows _________________ ______________________________________________________________________________. (c) Credit for Time Served : If the court orders the defendant to serve a term of total confinement, the defendant shall receive credit for any time previously served in confinement under RCW 9.94A.655. Felony Judgment and Sentence (FJS) Page 4 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9)) 4.2 Community Custody Conditions . RCW 9.94A.655. The defendant shall report to the DOC not later than 72 hours after sentencing or release from custody at the address provided in open court or by separate document. The defendant shall comply with the instructions, rules and regulations of DOC for the conduct of the defendant during the period of community custody. The defendant shall obey all laws, perform affirmative acts as required by DO C to confirm compliance with the orders of the court. The defendant shall inform DOC of court -ordered treatment upon the request of DOC. The defendant shall comply with any other conditions of community custody stated in this Judgment and Sentence or impos ed by DOC under RCW 9.94A.704 during community custody. While under supervision, the defendant shall not own, use, or possess firearms or ammunition. The court orders that during the period of supervision the defendant shall: [ ] pay all court -ordered l egal financial obligations. [ ] notify the community corrections officer in advance of any change in defendant’s address or employment. [ ] not possess or consume controlled substances, including marijuana, without valid prescription. [ ] not possess or consume alcohol. [ ] report as directed to a community corrections officer. [ ] remain within prescribed geographical boundaries. [ ] devote time to specific employment or occupation. [ ] obtain prior approval from DOC of residence location and livi ng arrangements. [ ] obtain a mental health evaluation and comply with recommended treatment. [ ] obtain a substance use disorder evaluation and comply with recommended treatment. Other conditions: _________________________________________________ ________________________ ________________________________________________________________________________________ . The conditions of community custody shall begin immediately unless otherwise set forth here:_____________________________________________ ______________________________________. Court -Ordered Treatment: If any court orders mental health or substance use disorder treatment, the defendant must notify DOC and the defendant must release treatment information to DOC for the duration of incarcer ation and supervision. RCW 9.94A.562. 4.3 Legal Financial Obligations : The defendant shall pay to the clerk of this court: JASS/Odyssey CODE PCV 310 5 $ 500 Victim assessment RCW 7.68.035 PDV 3102 $_____________Domestic Violence (DV) assessment RCW 10.99.080 $ Violation of a DV protection order ($15 mandatory fine) RCW 26.50.110 CRC 3403 $ Court costs, including RCW 9.94A.760, 9.94A.505, 10.01.160, 10.46.190 Criminal filing fee $200.00 FRC Witness costs $ WFR Sher iff service fees $ SFR/SFS/SFW/WRF Jury demand fee $ JFR Extradition costs $ EXT Other $ PUB 3225 $ Fees for court appointed attorney RCW 9.94A.760 WFR 3231 $ Court appointed defense expert and other defense costs RCW 9.94A.760 FCM 3303 $ Fine RCW 9A.20.021; [ ] VUCSA chapter 69.50 RCW, [ ] VUCSA MTH 3337 additionalfine deferred due to indigency RCW 69.50.430 Felony Judgment and Sentence (FJS) Page 5 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9)) CDF 3302 $ Drug enforcement fund of ____________________ RCW 9.94A.760 LDI 3308/FCD 3363 NTF 3338/SAD 3365/SDI 3307 CLF 3212 $ Crime lab fee [ ] suspended due to indigency RCW 43.43.690 $ 100 DNA collection fee [ ] suspended . DNA previously collecte d RCW 43.43.7541 FPV 3335 $ Specialized forest products RCW 76.48.171 $ Other fines or costs for: $ Restitution to: RTN/RJN 3801 $ Restitution to: $ Restitution to: (Name and Address --address may be withheld and provided confidentially to Clerk of the Court’s office.) $ Total RCW 9.94A.760 [ ] The above total does not include all restitution or other legal financial obligations, which may be set by later order of the court. An agreed restitution order may be entered. RCW 9.94A.753. A restitution hearing: [ ] shall be set by the prosecutor. [ ] is scheduled for (date). [ ] The defendant waives any right to be present at any restitution hearing (sign initials):_____________. [ ] Restitution Schedule attached. [ ] Restitution ordered above shall be paid jointly and severally with: Name of other defendant Cause Number (Victim’s name) (Amount -$) RJ N ________________________________ ________________________________ ____________________ ________________________________ ________________________________ ____________________ [ ] The Department of Corrections (DOC) or clerk of the court shall immediately issue a Notice of Payroll Deduction. RCW 9.94A.7602, RCW 9.94A.760(8). [ ] All payments shall be made in accordance with the policies of the clerk of the court and on a schedule established by DOC or the clerk of the court, commencing immediately, unless the court specifically sets forth the rate here: Not less than $_____ per month commencing_______________________________. RCW 9.94A.760. (Restitution payments must begin immediately. RCW 9.4A.750(1).) The defendant shall report to the clerk of the court or as directed by the clerk of the court to provide financial and other information as requested. RCW 9.94A.760(7)(b). [ ] The court orders the defendant to pay costs of incarceration at the rate of $______________ per day (actual costs not to exceed $100 per day). ( JLR ) RCW 9.94A.760. (This provision does not apply to costs of incarceration collected by DOC under RCW 72.09.111 and 72.09.480.) The res titution obligations imposed in this judgment shall bear interest from the date of the judgment until payment in full, at the rate applicable to civil judgments. No interest shall accrue on non -restitution obligations imposed in this judgment. RCW 10.82.0 90. An award of costs on appeal against the defendant may be added to the total legal financial obligations. RCW 10.73.160. Felony Judgment and Sentence (FJS) Page 6 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9)) 4.4 DNA Testing . The defendant shall have a biological sample collected for purposes of DNA identification analysis and the defe ndant shall fully cooperate in the testing. This paragraph does not apply if it is established that the Washington State Patrol crime laboratory already has a sample from the defendant for a qualifying offense. RCW 43.43.754. The facility where the defen dant serves the term of confinement shall be responsible for obtaining the sample as part of the defendant ’s intake process or as soon as practicable . If further c onfinement is not ordered, t he defendant shall report to ____________________________________ (law enforcement agency) by _____________________________ (date/time) to provide a biological sample. Failure to provide a biological sample is a gross misdemeanor. [ ] HIV Testing . The defendant shall submit to HIV testing. RCW 70.24.340. 4.5 No Co ntact : [ ] The defendant shall not have contact with _________________________________________________ __________________________________________________________ (name) including, but not limited to, personal, verbal, telephonic, written or contact thro ugh a third party until ___________________ (which does not exceed the maximum statutory sentence). [ ] The defendant is excluded or prohibited from coming within ______________________ (distance) of: [ ] _______________________________________________( name of protected person(s))’s [ ] home/ residence [ ] work place [ ] school [ ] (other location(s)) ______________________________________ _________________________________________________________________________________, or [ ] other location ______ ______________________________________________________________, until _______________________ (which does not exceed the maximum statutory sentence). [ ] A separate Domestic Violence No -Contact Order, Antiharassment No -Contact Order, Stalking No -Contact Order, or Sexual Assault Protection Order is filed concurrent with this Judgment and Sentence. 4.6 Other : . 4.7 Exoneration : The Court hereby exonerates any bail, bond and/or personal recognizance conditions. V. Notices and Signatures 5.1 Collateral Attack on Judgment . If you wish to petition or move for collateral attack on this Judgment and Sentence, including but not limited to any personal restraint petition, state habeas corpus petition, motion to vacate judgment, motion to withdraw guilty plea, motion for new trial or motion to arrest judgment, you must do so within one year of the final judgment in this matter, except as provided for in RCW 10.73.100. RCW 10.73.090. 5.2 Length of Supervision . If you committed your offense prior to July 1, 2000, you shall remain under the court's jurisdiction and the supervision of the Department of Corrections for a period up to 10 years from the date of sentence or release from confinement, whichever is longer, to assure payment of all legal fin ancial Felony Judgment and Sentence (FJS) Page 7 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9)) obligations unless the court extends the criminal judgment an additional 10 years. If you committed your offense on or after July 1, 2000, the court shall retain jurisdiction over you, for the purpose of your compliance with payment of the legal f inancial obligations, until you have completely satisfied your obligation, regardless of the statutory maximum for the crime. RCW 9.94A.760 and RCW 9.94A.505(5). The clerk of the court has authority to collect unpaid legal financial obligations at any ti me while you remain under the jurisdiction of the court for purposes of your legal financial obligations. RCW 9.94A.760(4) and RCW 9.94A.753(4). 5.3 Notice of Income -Withholding Action . If the court has not ordered an immediate notice of payroll deducti on in Section 4.1, you are notified that the Department of Corrections (DOC) or the clerk of the court may issue a notice of payroll deduction without notice to you if you are more than 30 days past due in monthly payments in an amount equal to or greater than the amount payable for one month. RCW 9.94A.7602. Other income -withholding action under RCW 9.94A.760 may be taken without further notice. RCW 9.94A.7606. 5.4 Parental Sentencing Alternative Sanctions At any time during the period of community cust ody, the court may bring you back into court to evaluate your progress in treatment, or to determine if you have violated the conditions of the sentence. The court may modify the conditions of community custody or impose sanctions. If the court finds th at you have violated the conditions or requirements of sentence or if you have failed to make satisfactory progress in treatment, the court may impose sanctions and order you to serve a term of total confinement within the standard range of your current of fense. 5.5a Firearms . You may not own, use or possess any firearm, and under federal law any firearm or ammunition, unless your right to do so is restored by the court in which you are convicted or the superior court in Washington State where you live, an d by a federal court if required. You must immediately surrender any concealed pistol license. (The clerk of the court shall forward a copy of the defendant's driver's license, identicard, or comparable identification to the Department of Licensing along with the date of conviction or commitment.) RCW 9.41.040, 9.41.047. 5.5b [ ] Felony Firearm Offender Registration . The defendant is required to register as a felony firearm offender. The specific registration requirements are in the “Felony Firearm Off ender Registration” attachment. 5.6 Reserved. 5.7 [ ] Department of Licensing Notice : The court finds that Count ________ is a felony in the commission of which a motor vehicle was used. Clerk’s Action –The clerk shall forward an Abstract of Court Recor d (ACR) to the DOL, which must revoke the Defendant’s driver’s license. RCW 46.20.285. Findings for DUI, Physical Control, Felony DUI or Physical Control (ACR information) : [ ] Within two hours after driving or being in physical control of a vehicle, th e defendant had an alcohol concentration of breath or blood (BAC) of ____. [ ] No BAC test result. [ ] BAC Refused. The defendant refused to take a test offered pursuant to RCW 46.20.308. [ ] Drug Related. The defendant was under the influence of or a ffected by any drug. [ ] THC level was _____ within two hours after driving. [ ] Passenger under age 16. The defendant committed the offense while a passenger under the age of sixteen was in the vehicle. Vehicle Info .: [ ] Commercial Veh.; [ ] 16 Pas senger Veh.; [ ] Hazmat Veh.. 5.8 [ ] Department of Licensing Notice – Defendant under age 21 only. Count ________ is (a) a violation of RCW chapter 69.41 [Legend drug], 69.50 [VUCSA], or 69.52 [Imitation drugs], and the defendant was under 21 years of age at the time of the offense OR (b) a violation under RCW 9.41.040 [unlawful possession of firearm], and the defendant was under the age of 18 at the time of the offense OR (c) a violation under RCW chapter 66.44 [Alcohol], and the defendant was under the age of 18 at the time of the offense, AND the court finds that the defendant previously committed an offense while armed with a firearm, an unlawful possession of a firearm offense, or an offense in violation of chapter 66.44, 69.41, 69.50, or 69.52 RCW. Clerk’s Action –The clerk shall forward an Abstract of Court Record (ACR) to the DOL, which must revoke the Defendant’s driver’s license. RCW 46.20.265 Felony Judgment and Sentence (FJS) Page 8 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9)) 5.9 Other : ________________________________ ________________________________ _______________ . Done in Open Court and in the presence of the defendant this date:________________ ______________. _______________________________________________ Judge /Print Name: _____________________________ ____________________________ _____________________________ Deputy Prosecuting Attorney Attorney for Defendant Defendant WSBA No. WSBA No. Print Name: Print Name: Print Name: Voting Rights Statement : I acknowledge that I have lost my right to vote because of this felony conviction. If I am registered to vote, my voter registration will be cancelled. My right to vote is provisio nally restored as long as I am not under the authority of DOC (not serving a sentence of confinement in the custody of DOC and not subject to community custody as defined in RCW 9.94A.030). I must re - register before voting. The provisional right to vote may be revoked if I fail to comply with all the terms of my legal financial obligations or an agreement for the payment of legal financial obligations. My right to vote may be permanently restored by one of the following for each felony conviction: a) a certificate of discharge issued by the sentencing court, RCW 9.94A.637; b) a court order issued by the sentencing court restoring the right, RCW 9.92.066; c) a final order of discharge issued by the indeterminate sentence review board, RCW 9.96.050; or d ) a certificate of restoration issued by the governor, RCW 9.96.020. Voting before the right is restored is a class C felony, RCW 29A.84.660. Registering to vote before the right is restored is a class C felony, RCW 29A.84.140. Defendant’s signature: ______________________________________________ I am a certified or registered interpreter , or the court has found me otherwise qualified to interpret, in the _________________________________ language, which the defendant understands. I interpreted thi s Judgment and Sentence for the defendant into that language. I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at (city) ____________________, (state) _______________, on (date) _ _____________________. _______________________________________ ____________________________________________ Interpreter Print Name Felony Judgment and Sentence (FJS) Page 9 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9)) VI. Identification of the Defendant SID No. ______________________________________ (If no SID complete a separate A pplicant card (Form FD -258) for State Patrol) Date of Birth __________________________ FBI No. __________________________________ Local ID No. __________________________ PCN No. __________________________________ Other ________________________________ Alias name, DOB: ___________________________________________________________________ Race : Ethnicity : Sex : [ ] Asian [ ] Black [ ] Indian -American Indian or Alaska Native [ ] Hispanic [ ] Male [ ] Multiracial [ ] Native Hawaiian or Other Pacifi c Islander [ ] Non -Hispanic [ ] Female [ ] Refused [ ] White [ ] Unavailable [ ] Refused [ ] Unknown [ ] Other: [ ] Unknown Fingerprints : I attest that I saw the defendant who appeared in court affix his or her fingerprints and signature on this document. Clerk of the Court, Deputy Clerk, _______________________________ Dated:_________________ The defendant’s signature : Left four fingers taken simultaneously Left Thumb Right Thumb Right four fingers taken simultaneously