Fill and Sign the District Court of Vermont Form

Form No. 369A State of Vermont District Court of Vermont Notice of Plea Agreement NOTICE OF PLEA AGREEMENT Date Defendant State of Vermont vs. The State of Vermont and the Defendant named above enter into the following agreement: Charge: Charge: Charge: Docket Number: Docket Number: Docket Number: Amended: Amended Section No: Amended Section No: Amended Section No: SENTENCE: SENTENCE: SENTENCE: & Surcharge $ FINE $ FINE $ & Surcharge $ FINE $ & Surcharge $ Mo. Days Yr. (Min.) Days (Min.) Mo. Yr. Yr. Mo. (Min.) Days Mo. Days Yr. (Max.) Days Mo. (Max.) Yr. Mo. Yr. (Max.) Days Suspended with Probation: Treatment Credit: All Suspended except Total FINE & Surcharges: $ TOTAL SENTENCE: Special Probation Conditions: Cases to be Dismissed by State: Docket # Charge: Docket # Charge: Docket # Charge: Charge: Docket #Docket # Charge: Report Date: Forthwith: PSI Ordered? Defendant already on probation? (See Reverse for General Conditions) Other: This is a binding Rule 11 Agreement. I have reviewed this agreement and understand it. Defendant Date Prosecutor Date Date Defense Attorney Judge Date Guardian ad Litem Date Rev. 12/06 SML The parties hereby stipulate that this conviction is a violation of the Defendant's probation and, as part of this Plea Agreement, waive further notice, separate hearing, and agree that the Court impose the following: Amended: Amended: Suspended with Probation: Suspended with Probation: Distribution: 1st Copy ~ Court; 2nd Copy ~ Computer Operator; 3rd Copy ~ State's Attorney; 4th Copy ~ Defendant; 5th Copy ~ Defense Attorney Out-of-State Credit: Treatment Credit: All Suspended except Out-of-State Credit: Treatment Credit: All Suspended except Out-of-State Credit: In addition to any credit to which defendant is entitled by law, the parties agree defendant shallreceive credit for treatment, out-of-state, andlocal lockup as shown above. Amended Charge Code: Amended Charge Code: Amended Charge Code: Days Days Days Days Days Days Local Lock-up Credit: Days Local Lock-up Credit: Days Local Lock-up Credit: Days Yes No Guilty Nolo Contendre Concurrent Consecutive YesNo days months yrs Yes No Guilty Nolo Contendre Concurrent Consecutive YesNo days months yrs Yes No Guilty Nolo Contendre Concurrent Consecutive YesNo days months yrs Yes No YesNo You shall notify your probation officer within 48 hours if you are arrested or given a A. citation for a new offense. You must not be convicted of another crime. You must regularly work at a job or look for work, if your probation officer tells you todo so. You must get job training if your probation officer tells you to do so. You must regularly work at a community service job if the court orders you to do so. B. C. D. You must support your dependents and meet other family responsibilities. E. You must meet with your probation officer or designee whenever he/she tells you to do F. so. If you change your address or move, you must tell your probation officer within two G. days. If you change or lose your job, you must tell your probation officer within two days You cannot leave the state without written permission from your probation officer. Upon request, and without delay, you must allow the probation officer to visit you H. I. J. wherever your are staying. If the probation officer or the court orders you to go to any counseling or training program, you must do so. You must participate to the satisfaction of your probation K. officer. You must not buy, have or use any regulated drugs unless they are prescribed by a doctor.Your probation officer or any other person authorized by your probation officer can L. require you to have random urinalysis testing. M. Violent or threatening behavior is not allowed at any time.You shall not operate, try to operate or be in actual physical control of a motor vehicle on a public highway unless in possession of a valid Vermont operator's license. You shall not drink alcoholic beverages to the extent they interfere with your employmentor the welfare of your family, yourself or any other person. You must submit to any alco- sensor test or any other alcohol test when your probation officer or their designee tells N. 0. you to do so. P. The execution of the sentence is suspended and the defendant is placed on probation in the care and custody of the Commissioner of Corrections until (date) orfurther order of the court under the following standard conditions: NOTICE: Under the Federal Gun Control Act, any person who has been convicted of a felony may not lawfully own, use, or possess a firearm. Rev. 12/06 SML If restitution is ordered, you must cooperate fully with the Restitution Unit.