Felony Judgment and Sentence (FJS) (Jail One Year or Less) Page 1 of 10
(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
(FJS)
[ ] Clerk’s Action Required, 2.1, 4.1, 4.3, 4.8, 5.2,
5.3, 5.5, 5.7, and 5.8
[ ] Defendant Used Motor Vehicle
[ ] Juvenile Decline [ ] Mandatory [ ] D iscretionary
I. Hearing
1.1 The court conducted a sentencing hearing this date; the defendant, the defendant's lawyer, and the (deput y)
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 member was
pled and proved. RCW 26.50.010(6) .
[ ] The defendant used a firearm in the commission of the offense in Count _______ _______. RCW 9.94A.825,
RCW 9.94A.533.
Felony Judgment and Sentence (FJS) (Jail One Year or Less) Page 2 of 10
(RCW 9.94A.500, .505)(WPF CR 84.0400 (07/201 9))
[ ] The defendant used a deadly weapon other than a firearm in committing the offense in Count ________
_______________________. RCW 9.94A.825, 9.94A.533.
[ ] In count ___________ the defendant committed a robbe ry of a pharmacy as defined in RCW 18.64.011(21),
RCW 9.94A.____
[ ] 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 commis sion 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, 9.94A.829.
[ ] The def endant has a chemical dependency that 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 o ffense. RCW 9.94B.080
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 . RCW46.2 0.285.
[ ] Counts __________________ 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 offense 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 of fender 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: Dom estic 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 10
(RCW 9.94A.500, .505)(WPF CR 84.0400 (07/201 9))
[ ] The defendant committed a current offense while on community placement/community custody (adds one point
to score). RCW 9.94A.525.
[ ] The prior conv ictions 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
* (F) Firearm, (D) Other deadly weapons, (RPh) Robbery of a pharmacy, (CSG) Criminal street gang involving minor,
(P16) Passenger(s) under ag e 16.
[ ] Additional current offense sentencing data is attached in Appendix 2.3.
2.4 [ ] Exceptional Sentence . The court finds substantial and compelling 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 imposition 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 by the defendant, [ ] found by the court after the defendant
waived jury trial, [ ] found by jury, b y 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. Th e Prosecuting Attorney [ ] did [ ] did not recommend a similar sentence.
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 im pose. (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 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 re stitution inappropriate (RCW
9.94A.753):
________________________________ ________________________________ ________________ .
[ ] The defendant has the present means to pay the costs of incarceration. RCW 9.94A.760.
[ ] (Name of agency) ___________________________‘s costs for its emergency response are reasonble.
RCW 38.52.430 (effec tive August 1, 2012).
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 firearm offender. The court considered the following fa ctors
in making this determination:
[ ] the defendant’s criminal history.
Felony Judgment and Sentence (FJS) (Jail One Year or Less) Page 4 of 10
(RCW 9.94A.500, .505)(WPF CR 84.0400 (07/201 9))
[ ] 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 viol ence 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 comm itted 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 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 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 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)): _________________________________________________________________.
Confine ment shall commence immediately unless 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 (Nonviolent and Nonsex Offenses) . RCW 9.94A.680(3). The
county jail is authorized to convert jail confinem ent 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 conduct pursuant t o 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.
[ ] Alternative Conversion . RCW 9.94A.680. _______________ days of tot al 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 completed on a s chedule established by the defendant's community corrections officer but not
less than ______________ hours per month.
Felony Judgment and Sentence (FJS) (Jail One Year or Less) Page 5 of 10
(RCW 9.94A.500, .505)(WPF CR 84.0400 (07/201 9))
[ ] 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. RCW 9.94A.505. The jail shall compute time
served.
4.2 Community Custody . RCW 9.94A.505, .702.
(A) The defendant shall serve _________________________ months (up to 12 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 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 committed
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 unlawful poss ession 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 document.
(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 D OC 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 possess firearm s 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; and (9) abide by any additional conditions imposed by DOC under
RCW 9.94A.704 and .706. Th e defendant’s residence location and living arrangements are subject to the prior
approval of DOC while on community custody.
The court orders that during the period of supevision the defendant shall:
[ ] not possess or consume alcohol.
[ ] not poss ess or consume controlled substances, including marijuana, without a valid prescription.
[ ] have no contact with: __________________________________________________________________.
[ ] remain [ ] within [ ] outside of a specified geographical bo undary, to wit:
________________________________ ________________________________ ______________________
______________________________________________________________________________________.
[ ] 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 crime -related prohibitions:_____ ____________________________________
______________________________________________________________________________________.
[ ] Other conditions:
____________________________________________________________________________________
__________________ __________________________________________________________________
____________________________________________________________________________________.
(C) The conditions of community custody shall begin immediately upon release from confinement unless ot herwise
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 rele ase treatment information to DOC for the duration of
incarceration and supervision. RCW 9.94A.562.
Felony Judgment and Sentence (FJS) (Jail One Year or Less) Page 6 of 10
(RCW 9.94A.500, .505)(WPF CR 84.0400 (07/201 9))
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
Cri minal filing fee $200.00 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 32 31 $ Court appointed defense expert and other defense costs RCW 9.94A.760
$____________ DUI fines, fees and assessments
CLF 3212 $ Crime lab fee [ ] suspended due to indigency RCW 43.43.690
$ 100 DNA collection fee [ ] suspended . DNA previously collected RCW 43.43.7541
FPV 3335 $ Specialized forest products RCW 76.48.140
$ 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
[ ] The above total does not include all restitution or other legal financial obl igations, 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 pre sent 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 -$)
RJN ________________________________ ________________________________ ____________________
Felony Judgment and Sentence (FJS) (Jail One Year or Less) Page 7 of 10
(RCW 9.94A.500, .505)(WPF CR 84.0400 (07/201 9))
[ ] 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 t o 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 restitu tion 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 10.82.090. An award of costs on appeal against the defendant may be added
to the total legal financial obligations. RCW 10.73.160.
4.4 DNA Testing . The defendant shall have a biological sample collected for purposes of DNA identification
analysis and the defendan t 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 defendant 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 Contact :
[ ] The defendant shall not have contact with _________________________________________________
__________________________________________________________ (name/s) including, but not
limited to, personal, verbal, telephonic, written or contact through 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, Stalking No -Contact Order, or Antiharassment No -
Contact Or der is filed concurrent with this Judgment and Sentence.
4.6 Other : ________________________________________________________________________________
________________________________________________________________________________________
_________________ _______________________________________________________________________
_______________________________________________________________________________________.
Felony Judgment and Sentence (FJS) (Jail One Year or Less) Page 8 of 10
(RCW 9.94A.500, .505)(WPF CR 84.0400 (07/201 9))
4.7 Off -Limits Order . (Known drug trafficker). RCW 10.66.020. The following areas are off lim its to the
defendant while under the supervision of the county jail or Department of Corrections: ___________________
_______________________________________________________________________________________.
4.8 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 10.73.1 00.
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 sentenc e or release from confinement, whichever is longer, to assure payment of all legal financial
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 financial obligations, until you have completely satisfied your obligation, regardless
of the statutory maximum for the crime. RCW 9.94A.760, RCW 9.94A.505(5). The clerk of the court has
authority to collect unpaid legal financial obligations at any time while you remain under the jurisdiction of the
court for purposes of your legal financial obligations. RCW 9.94A.760(4), RCW 9.94A.753(4).
5.3 Notice of Income -Withho lding 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 ar e 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 Commun ity Custody Violation .
(a) If you are subject to a violation hearing and DOC finds that you committed the violation, you may receive a
sanction of up to 30 days of confinement. RCW 9.94A.633(1).
(b) If you have not completed your maximum term of total con finement and you are subject to a violation hearing
and DOC finds that you committed the violation, DOC may return you to a state correctional facility to serve
up to the remaining portion of your sentence. RCW 9.94A.633(2)(a).
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, 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.
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 Offender 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 Record (ACR) to the DOL, which must revoke the Defendant’s driver’s license. RCW 46.20.285.
Felony Judgment and Sentence (FJS) (Jail One Year or Less) Page 9 of 10
(RCW 9.94A.500, .505)(WPF CR 84.0400 (07/201 9))
Findings for DUI, Physical Control, Felony DUI or Physical Control, Vehicular Assault, or
Vehicular Homicide (ACR information) (Check all that apply) :
[ ] 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 defendant refused to take a test offered pursuant to RCW 46.20.308.
[ ] Drug Related. The defen dant 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 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 [Alc ohol], 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 chapt er 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 .
5.9 Other :__________________________________________________ _______________________.
Done in Open Court and in the presence of the defendant on 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 felon y 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 obligations or an agreement for the payment of legal financial obl igations.
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: ______________________________________________ ___
Felony Judgment and Sentence (FJS) (Jail One Year or Less) Page 10 of 10
(RCW 9.94A.500, .505)(WPF CR 84.0400 (07/201 9))
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 this Judgment
and Sentence for the defendant into that language.
I declare under penalty of perjury under the laws of the state of Washington th at the foregoing is true and correct.
Signed at (city) ____________________, (state) _______________, on (date) ______________________.
___________________________________ _____________________________________
Interpreter Print Name
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 Indi an or Alaska Native [ ] Hispanic [ ] Male
[ ] Multiracial [ ] Native Hawaiian or Other Pacific 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 fou r fingers taken simultaneously
Left
Thumb
Right
Thumb
Right four fingers taken simultaneously
