Felony Judgment and Sentence (FJS) (Jail One Year or Less)) Page 1 of 12
(Sex Offense and Kidnapping of a Minor )
(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 --
Jail One Year or Less
(Sex Offense and Kidnapping of a Minor)
(FJS)
[ ] Clerk’s Action Required, 2.1, 4.1, 4.3a, 4.3b, 4.8,
5.2, 5.3, 5.5a, 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 de fendant, 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) ____________:
Class: FA (Felony -A), FB (Felony -B), FC (Felony -C),
Count Crime RCW Class Date of
(w/subsection) Crime
(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 par tner 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 member was
pled and proved. RCW 26.50.010(6) .
[ ] The defendant used a deadl y weapon other than a firearm in committing the offense in Count ________
_______________________. RCW 9.94A.825 and RCW 9.94A.533.
Felony Judgment and Sentence (FJS) (Jail One Year or Less)) Page 2 of 12
(Sex Offense and Kidnapping of a Minor )
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] In count _____________ an internet advertisement in which the victim of the crime was described or depicted
was inst rumental in facilitating the commission of the crime. RCW 9.68A.100, RCW 9.68A.101, or
RCW 9.68A.102, Laws of 2013, ch. 9, §1.
[ ] This case involves kidnapping in the second degree, or 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.
[ ] In count ___________ the defendant committed a robbery of a pharmacy as defined in RCW 18.64.011(21),
RCW 9.94A.____.
[ ] The defendant has a chemical dependency that ha s 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
[ ] Count ____ ____________ is a criminal street gang -related felony offense in which the defendant
compensated, threatened, or solicited a minor in order to involve that minor in the commission of the offense.
RCW 9.94A.833.
[ ] Count ____________ is the crime of unlawful possession of a firearm and the defendant was a criminal
street gang member or associate when the defendant committed the crime. RCW 9.94A.702, RCW 9.94A.829.
GY [ ] In Count _______, the defendant had (number of) ______ passenger(s) under the age of 16 in the vehicle.
RCW 9.94A.533.
[ ] Count ________ is a felony in the commission of which the defendant used a motor vehicle . RCW46.20.285.
[ ] Counts __________________ encompass the same criminal conduct and count as one crime in determi ning the
offender score (RCW 9.94A.589).
[ ] Other current convictions listed under different cause numbers used in calculating the offender score are :
Crime Cause Number Court (county & state) DV*
Yes
1.
2.
* DV: Domestic Violence was p led and proved.
[ ] Additional current convictions listed under different cause numbers used in calculating the offender score are
attached in Appendix 2.1b.
2.2 Criminal History :
Crime Date of
Crime
Date of
Sentence
Sentencing Court
(County & State)
A or J
Adult,
Juv.
Type
of
Crime
DV*
Yes
1.
2.
3.
4.
5.
*DV: Domestic Violence was pled and proved.
[ ] Additional criminal history is attached in Appendix 2.2.
Felony Judgment and Sentence (FJS) (Jail One Year or Less)) Page 3 of 12
(Sex Offense and Kidnapping of a Minor )
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] The defendant committed a current off ense while on community placement/community custody (adds one point
to score). RCW 9.94A.525.
[ ] The prior convictions listed as numbers ____________, above, or in appendix 2.2, are one offense for purposes
of determining the offender score (RCW 9.94A. 525).
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
(D) Other deadly weapons, ( RPh) Robbery of a pharmacy, (CSG) Criminal street gang involving minor,
(P16) Passenger(s) under age 16.
[ ] Additional current offense sentencing data is attached in Appendix 2.3.
2.4 [ ] Exceptional Sentence . The court finds substantial and compell ing reasons that justify an
exceptional sentence:
[ ] below the standard range for Count(s) _______________.
[ ] above the standard range for Count(s) _______________.
[ ] The defendant and state stipulate that justice is best served by imposit ion of the exceptional sentence
above the standard range and the court finds the exceptional sentence furthers and is consistent with
the interests of justice and the purposes of the sentencing reform act.
[ ] Aggravating factors were [ ] stipulated b y the defendant, [ ] found by the court after the defendant
waived jury trial, [ ] found by jury, by special interrogatory.
[ ] within the standard range for Count(s) _________, but served consecutively to Count(s) ____________.
Findings of fact and conclusions of law are attached in Appendix 2.4. [ ] Jury’s special interrogatory is
attached. The Prosecuting Attorney [ ] did [ ] did not recommend a similar sentence.
2.5 Legal Financial Obligations/Restitution . The court has considered the tot al 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 findings:
[ ] The defendant is indigent as defined in RCW 10.101.010(3)(a) -(c) because th e 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 defendant has the pre sent means to pay costs of incarceration. RCW 9.94A.760.
[ ] (Name of agenc y) ___________________________ ’ s costs for its emergency response are
reasonble. RCW 38.52.430 (effective August 1, 2012).
2.6 [ ] Felony Firearm Offender Registration . The de fendant committed a felony firearm offense as
defined in RCW 9.41.010, and:
[ ] The defendant should register as a felony firearm offender. The court considered the following factors
in making this determination:
Felony Judgment and Sentence (FJS) (Jail One Year or Less)) Page 4 of 12
(Sex Offense and Kidnapping of a Minor )
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] 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 offense 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. Sente nce and Order
It is ordered :
4.1 Confinement . The court sentences the defendant as follows:
(a) Confinement . RCW 9.94A.589. A term of total confinement in the custody of :
[ ] ________________________________ the county jail:
[ ] The defendant was und er 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 on Count months on Count
months on Count months on Count
months on Count months on Count
Actual number of months of total confinement ordered is: _____________________________________.
All counts shall be served concurrently, except for the following which shall be served consecutively:
_______________________________________________________ __________________________.
This sentence shall run consecutively with the sentence in the following cause number(s) (see
RCW 9.94A.589(3)): _________________________________________________________________.
Confinement shall commence immediately unl ess otherwise set forth here:________________________
_________________________________________________________________________________.
[ ] Partial Confinement . The defendant may serve the sentence, if eligible and approved, in partial
confinement in the following programs, subject to the following conditions:________________________
________________________________ ________________________________ ____________________
_________________________________________________________________________________.
[ ] work crew RCW 9.94A.725 [ ] home detention RCW 9.94A.731, .190
[ ] work release RCW 9.94A.731 [ ] electronic monitoring RCW 9.94A.030
[ ] Conversion of Jail Confinement (Use only for unlawful imprisonment. This is not available
for violent or sex offenses ). RCW 9.94A.680(3). The county jail is authorized to con vert jail confinement
to an available county supervised community option, to reduce the time spent in the community option by
earned release credit consistent with local correctional facility standards, and may require the offender to
perform affirmative c onduct pursuant to RCW 9.94A.
[ ] The defendant shall receive credit for time served in an available county supervised community
option prior to sentencing. The jail shall compute time served.
Felony Judgment and Sentence (FJS) (Jail One Year or Less)) Page 5 of 12
(Sex Offense and Kidnapping of a Minor )
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] Alternative Conversion . RCW 9.94A.680. ____________ ___ days of total confinement ordered
above are hereby converted to ________________ hours of community restitution (service) (8 hours = 1
day, nonviolent offenders only, 30 days maximum) under the supervision of the Department of Corrections
(DOC) to be c ompleted on a schedule established by the defendant's community corrections officer but not
less than ______________ hours per month.
[ ] Alternatives to total confinement were not used because of: ______________________________
[ ] criminal history [ ] failure to appear (finding required for nonviolent offenders only RCW
9.94A.680 ).
(b) Credit for Time Served : The defendant shall receive credit for eligible time served prior to sentencing if
that confinement was solely under this cause number. R CW 9.94A.505. The jail shall compute time
served.
4.2 Community Custody . RCW 9.94A.505, .702.
(A) The defendant shall serve ___________________ months in community custody.
The court may order community custody under the jurisdiction of DOC for up to 12 months if the defendant is
convicted of a sex offense, a violent offense, a crime against a person under RCW 9.94A.411, or felony
violation of chapter 69.50 or 69.52 RCW or an attempt, conspiracy or solicitation to commit such a crime. For
offenses comm itted on or after June 7, 2006, the court shall impose a term of community custody under RCW
9.94A.701 if the offender is guilty of failure to register (second or subsequent offense) under RCW
9A.44.130(11)(a) and for offenses after June 12, 2008 for unlaw ful possession of a firearm with a finding that
the defendant was a member or associate of a criminal street gang.
The defendant shall report to DOC, not later than 72 hours after release from custody at the address provided in
open court or by separate do cument.
(B) While on community custody, the defendant shall: (1) report to and be available for contact with the
assigned community corrections officer as directed; (2) work at DOC -approved education, employment and/or
community restitution (service); (3) notify DOC of any change in defendant’s address or employment; (4) not
consume controlled substances except pursuant to lawfully issued prescriptions; (5) not unlawfully possess
controlled substances while on community custody; (6) not own, use, or posses s firearms or ammunition;
(7) pay supervision fees as determined by DOC; (8) perform affirmative acts as required by DOC to confirm
compliance with the orders of the court; (9) for sex offenses, submit to electronic monitoring if imposed by
DOC; and (10) abide by any additional conditions imposed by DOC under RCW 9.94A.704 and .706. The
defendant’s residence location and living arrangements are subject to the prior approval of DOC while on
community custody. For sex offenders sentenced under RCW 9.94A.70 9, the court may extend community
custody up to the statutory maximum term of the sentence.
The court orders that during the period of supervision the defendant shall:
[ ] not possess or consume alcohol.
[ ] not possess or consume controlled substances , including marijuana, without a valid prescription.
[ ] have no contact with: ________________________________ ________________________________ ____ .
[ ] remain [ ] within [ ] outside of a specified geographical boundary, to wit:
________________________________ ________________________________ _____________________
________________________________ ________________________________ _____________________
[ ] not reside within 880 feet of the facilities or grounds of a public or pr ivate school (community protection
zone). RCW 9.94A.030.
[ ] participate in an education program about the negative costs of prostitution.
[ ] participate in the following crime -related treatment or counseling services:
___________________________ __________________________ _______________________________ .
[ ] undergo an evaluation for, and fully comply with treatment for [ ] domestic violence [ ] substance use
disorder [ ] mental health [ ] anger management.
[ ] comply with the following cr ime -related prohibitions:_________________________________________
___________________________________________________________________________________.
Felony Judgment and Sentence (FJS) (Jail One Year or Less)) Page 6 of 12
(Sex Offense and Kidnapping of a Minor )
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] Other conditions:
________________________________ ________________________________ ____________________
________________________________ ________________________________ ____________________
(C) The conditions of community custody shall begin immediately upon releas e from confinement 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 releas e treatment information to DOC for the duration of
incarceration and supervision. RCW 9.94A.562.
4.3a 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
Cri minal filing fee $ 200 FRC
Witness costs $ WFR
Sheriff 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
CLF 3212 $ Crime lab fee [ ] suspended due to indigency RCW 43.43.690
$ 100 DNA collection fee [ ] suspended . DNA previ ously collected RCW 43.43.7541
FPV 3335 $ Specialized Forest Products RCW 76.48.171
PPI 3405 $ Trafficking/Promoting prostitution/Commercial sexual abuse of minor fee (may be
reduced by no more than two thirds upon a finding of inability to pay.)
RCW 9 A.40.100, 9A.88.120, 9.68A.105
EXM 3233 $ Fee for possession of depictions of a minor engaged in sexually explicit conduct
($1,000 for each separate conviction) RCW 9.68A.070
$ Other fines or costs for:
DEF 3506 $ Emergency response costs ($1,000 maximum, $2,500 max. effective Aug. 1,
2012). RCW 38.52.430
Agency: ______________________________________________________
$ 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
Felony Judgment and Sentence (FJS) (Jail One Year or Less)) Page 7 of 12
(Sex Offense and Kidnapping of a Minor )
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] The above total does not includ e 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 Nu mber (Victim’s name) (Amount -$)
RJN ________________________________ ________________________________ ___________________
________________________________ ________________________________ ___________________ .
[ ] 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 wi th 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 unde r RCW 72.09.111 and 72.09.480.)
The restitution 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 obligatio ns
imposed in this judgment. RCW 10.82.090. An award of costs on appeal against the defendant may be added
to the total legal financial obligations. RCW 10.73.160.
4.3b [ ] Electronic Monitoring Reimbursement . The defendant is ordered to reimburse
__ _______________________________________________________ (name of electronic monitoring
agency) at _________________________________________________________, for the cost of pretrial
electronic monitoring in the amount of $______________________.
4.4 DNA Te sting . The defendant shall have a biological sample collected for purposes of DNA identification
analysis and the defendant shall fully cooperate in the testing. RCW 43.43.754. 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 10.73.160.
The facility where the defendant serves the term of confinement shall be responsible for obtaining the sample as
part of the defendant ’s intake proce ss 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 provid e a biological sample is a gross misdemeanor. [ ] HIV Testing . The defendant shall
submit to HIV testing. RCW 70.24.340.
4.5 No Contact :
[ ] The defendant shall not have contact with _________________________________________________
___________________ _______________________________________ (name) including, but not limited
to, personal, verbal, telephonic, written or contact through a third party until _________________ (which
does not exceed the maximum statutory sentence).
Felony Judgment and Sentence (FJS) (Jail One Year or Less)) Page 8 of 12
(Sex Offense and Kidnapping of a Minor )
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] The defendant is excl uded 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 ma ximum 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 Off -Limits Order . (Known drug trafficker). RCW 10.66.020. The following areas are off limits to the
defendant while under the supervision of the county jail or Department of Correcti ons:_________________
______________________________________________________________________________________.
4.8 Exoneration : The Court hereby exonerates any bail, bond and/or personal recognizance conditions.
V. Notices and Signatures
5.1 Collateral At tack 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, m otion 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 financial
obligati ons 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 financial obliga tions, 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 time while you re main 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
deduction 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 amoun t 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 Community Custody Violation .
If you are subject to a violation hearing and DOC finds that you committe d the violation, you may receive a
sanction of up to 30 days of confinement. RCW 9.94A.633(1).
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 cour t in which you are convicted or the superior
court in Washington State where you live, and 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.
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5.5b [ ] Felony Firearm Offender Registration . The defendant is required to register as a felon y firearm
offender. The specific registration requirements are in the “Felony Firearm Offender Registration” attachment.
5.6 Sex and Kidnapping Offender Registration . RCW 9A.44.128, 9A.44.130, 10.01.200.
1. General Applicability and Requirements : Because this crime involves a sex offense or
kidnapping offense involving a minor as defined in RCW 9A.44.128 , you are required to register.
If you are a resident of Washington, you must register with the sheriff of the county of the state of
Washington whe re you reside. You must register within three business days of being sentenced unless you
are in custody, in which case you must register at the time of your release with the person designated by the
agency that has jurisdiction over you. You must also r egister within three business days of your release with
the sheriff of the county of the state of Washington where you will be residing.
While in custody, if you are approved for partial confinement, you must register when you transfer to partial
confineme nt with the person designated by the agency that has jurisdiction over you. You must also register
within three business days from the end of partial confinement or release from confinement with the sheriff of
the county where you reside.
If you are not a resident of Washington, but you are a student in Washington or you are employed in
Washington or you carry on a vocation in Washington, you must register with the sheriff of the county of your
school, place of employment, or vocation. You must register within three business days of being sentenced
unless you are in custody, in which case you must register at the time of your release with the person designated
by the agency that has jurisdiction over you. You must also register within three business day s of your release
with the sheriff of the county of your school, where you are employed, or where you carry on a vocation.
2. Offenders Who Are New Residents, Temporary Residents, or Returning Washington
Residents : If you move to Washington or if you leave this state following your sentencing or release from
custody but later move back to Washington, you must register within three business days after moving to this
state. If you leave this state following your sentencing or release from custody but lat er while not a resident of
Washington you become employed in Washington, carry on a vocation in Washington, or attend school in
Washington, you must register within three business days after starting school in this state or becoming
employed or carrying ou t a vocation in this state. If you are visiting and intend to reside or be present 10 or
more days in Washington, then you must register the location where you plan to stay or your temporary
address with the sheriff of each county where you will be stayin g within three business days of your arrival.
3. Change of Residence Within State : If you change your residence within a county, you must provide,
by certified mail, with return receipt requested or in person, signed written notice of your change of res idence to
the sheriff within three business days of moving. If you change your residence to a new county within this state,
you must register with the sheriff of the new county within three business days of moving. Also within three
business days, you mu st provide, by certified mail, with return receipt requested or in person, signed written
notice of your change of address to the sheriff of the county where you last registered.
4. Leaving the State or Moving to Another State : If you move to another state, or if you work,
carry on a vocation, or attend school in another state you must register a new address, fingerprints, and
photograph with the new state within three business days after establishing residence, or after beginning to
work, carry on a vocation, or attend school in the new state. If you move out of the state, you must also send
written notice within three business days of moving to the new state or to a foreign country to the county
sheriff with whom you last registered in Washington St ate.
5. Travel Outside the United States : If you intend to travel outside the United States, you must
provide signed written notice of the details of your plan to travel out of the country to the sheriff of the
county where you are registered. Notice must be provided at least 21 days before you travel. Notice may be
provided to the sheriff by certified mail, with return receipt requested, or in person.
If you cancel or postpone this travel, you must notify the sheriff within three days of canceling or postponing
your travel or on the departure date you provide in your notice, whichever is earlier.
If you travel routinely across international borders for work, or if you must travel unexpectedly due to a
family or work emergency, you must personally no tify the sheriff at least 24 hours before you travel. You
Felony Judgment and Sentence (FJS) (Jail One Year or Less)) Page 10 of 12
(Sex Offense and Kidnapping of a Minor )
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must explain to the sheriff in writing why it is impractical for you to comply with the notice required by
RCW 9A.44.130(3).
6. Notification Requirement When Enrolling in or Employed by a Public or Private
Institution of Higher Education or Common School (K -12) : You must give notice to the sheriff of
the county where you are registered within three business days:
i) before arriving at a school or institution of higher education to attend classes ;
ii) before starting work at an institution of higher education; or
iii) after any termination of enrollment or employment at a school or institution of higher education.
7. Registration by a Person Who Does Not Have a Fixed Residence : Even if you do not have a
fixed residence, you are required to register. Registration must occur within three business days of release in
the county where you are being supervised if you do not have a residence at the time of your release from
custody. Within three b usiness days after losing your fixed residence, you must send signed written notice to
the sheriff of the county where you last registered. If you enter a different county and stay there for more than
24 hours, you will be required to register with the sh eriff of the new county not more than three business days
after entering the new county. You must also report weekly in person to the sheriff of the county where you are
registered. The weekly report shall be on a day specified by the county sheriff's off ice, and shall occur during
normal business hours. You must keep an accurate accounting of where you stay during the week and provide it
to the county sheriff upon request. The lack of a fixed residence is a factor that may be considered in
determining an offender’s risk level and shall make the offender subject to disclosure of information to the
public at large pursuant to RCW 4.24.550.
8. Application for a Name Change : If you apply for a name change, you must submit a copy of the
application to th e county sheriff of the county of your residence and to the state patrol not fewer than five days
before the entry of an order granting the name change. If you receive an order changing your name, you must
submit a copy of the order to the county sheriff of the county of your residence and to the state patrol within
three business days of the entry of the order. RCW 9A.44.130(7).
5.7 [ ] Department of Licensing Notice : The court finds that Count ________ is a felony in the
commission of which a motor ve hicle was used. 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 46.20.285.
Findings for DUI, Physical Control, Felony DUI or Physical Control, Vehicular Assault, or Vehicular
Homicide (ACR information) :
[ ] Within two hours after driving or being in physical control of a vehicle, the defendant had an alcohol
concentration of breath or blood (BAC) of ____ .
[ ] No BAC test result.
[ ] BAC Refused. The defenda nt refused to take a test offered pursuant to RCW 46.20.308.
[ ] Drug Related. The defendant was under the influence of or affected 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 Passenger Veh. [ ] Hazmat Veh.
5.8 [ ] Department of Licensing Notice – Defendant under age 21 only.
Count ________ is (a) a vio lation 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) (Jail One Year or Less)) Page 11 of 12
(Sex Offense and Kidnapping of a Minor )
(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 provisionally 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 obligation s 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 or der 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 t he 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 interpr eter, or the court has found me otherwise qualified to interpret, in the
_________________________________ language, which the defendant understands. I interpreted this 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) (Jail One Year or Less)) Page 12 of 12
(Sex Offense and Kidnapping of a Minor )
(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 Applicant 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 Pacific Islander [ ] Non -Hispanic [ ] Female
[ ] Refused [ ] White [ ] Unavailable [ ] Refuse d
[ ] 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
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Right
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Right four fingers taken simultaneously
