Felony Judgment and Sentence (FJS) (Persistent Offender) Page 1 of 11
(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 --
Persistent Offender
(FJS)
[ ] Clerk’s Action Required, para 2.1, 4.1, 4.3, 4.7,
5.2 5.3, 5.5, 5.7, and 5.8
[ ] 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.
GV [ ] Fo r 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 me mber was
pled and proved. RCW 26.50.010(6) .
[ ] Count ____________________ is a most serious offense and the defendant has been convicted on at least two
separate occasions of most serious offense felonies, at least one of which occurred before the com mission of the
other most serious offense for which the defendant was previously convicted.
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(RCW 9.94A.500, .505)(WPF CR 84 .0400 ( 07/201 9))
[ ] Count ____________________ is a crime listed in RCW 9.94A.030(37)(b)(i) e.g., rape in the first degree, rape
of a child in the first degree (when the offen der was 16 years of age or older when the offender committed the
offense), child molestation in the first degree, rape in the second degree, rape of a child in the second degree
(when the offender was 18 years of age or older when the offender committed th e offense), or indecent liberties
by forcible compulsion; or any of the following offenses with a finding of sexual motivation: murder in the first
degree, murder in the second degree, homicide by abuse, kidnapping in the first degree, kidnapping in the
second degree, assault in the first degree, assault in the second degree, assault of a child in the first degree,
assault of a child in the second degree, or burglary in the first degree; or an attempt to commit any crime listed
in RCW 9.94A.030(37)(b)(i)), and that the defendant has been convicted on at least one separate occasion,
whether in this state or elsewhere, of a crime listed in RCW 9.94A.030(37)(b)(i) or any federal or out -of-state
offense or offense under prior Washington law that is comparable to the offenses listed in
RCW 9.94A.030(37)(b)(i).
The jury returned a special verdict or the court made a special finding with regard to the following:
[ ] The defendant used a firearm in the commission of the offense in Count ______________. RCW 9.94A .825,
9.94A.533.
[ ] The defendant used a deadly weapon other than a firearm in committing the offense in Count ____________
_______________________. RCW 9.94A.825 and RCW 9.94A.533.
[ ] The defendant engaged, agreed, offered, attempted, solicited a nother, or conspired to engage a victim of child
rape or child molestation in sexual conduct in return for a fee in the commission of the offense in Count _____.
RCW 9.94A.839.
[ ] In count _____________ an internet advertisement in which the victim of the crime was described or depicted
was instrumental 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.
[ ] The offense was predatory as to Count ______________. RCW 9.94A.836.
[ ] The victim was under 15 years of age at the time of the offense in Count ________________ RCW 9.94A.837.
[ ] The victim was developmentally disabled, mentally disordered, or a frail elder or vulnerable adult at the time of
the offense in Count ________ ________. RCW 9.94A.838 and RCW 9A.44.010.
[ ] The defendant acted with sexual motivation in committing the offense in Count_________. RCW 9.94A.835.
[ ] This case involves kidnapping in the first degree, kidnapping in the second degree, or unlawfu l 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._ ___.
[ ] 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, 9.94A.829.
[ ] The defendant committed [ ] vehicular homicide [ ] vehicular assault proximately caused by driving a
vehicle while under the influence of intoxicating liquor or drug or by operating a vehicle in a reckless manner.
The offense is, therefore, deemed a violent offense. RCW 9.94A.030.
GY [ ] In Count _______, the de fendant had (number of) ______ passenger(s) under the age of 16 in the vehicle.
RCW 9.94A.533.
[ ] Count __________ involves attempting to elude a police vehicle and during the commission of the crime the
defendant endangered one or more persons other than the defendant or the pursuing law enforcement officer.
RCW 9.94A.834.
[ ] In Count ______________ the defendant has been convicted of assaulting a law enforcement officer or other
employee of a law enforcement agency who was performing his or her o fficial duties at the time of the assault,
as provided under RCW 9A.36.031, and the defendant intentionally committed the assault with what appeared to
be a firearm . RCW 9.94A.831, 9.94A.533.
[ ] Counts __________________ encompass the same criminal c onduct and count as one crime in determining the
offender score (RCW 9.94A.589).
Felony Judgment and Sentence (FJS) (Persistent Offender) Page 3 of 11
(RCW 9.94A.500, .505)(WPF CR 84 .0400 ( 07/201 9))
[ ] Other current convictions listed under different cause numbers used in calculating the offender score are
(list offense and cause number):
Crime Cause Number Court (co unty & state) DV*
Yes
1.
2.
* DV: Domestic Violence was pleaded and proven.
(If the crime is a drug offense, include the type of drug in the second column.)
[ ] Additional current convictions listed under different cause numbers used in calculating the offender score are
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
4
5
* DV: Domestic Violence was pleaded and proven.
[ ] Additional criminal history is attached in Appendix 2.2.
[ ] The defendant committed a current offense while on community placement/community custody (adds one point
to score). R CW 9.94A.525.
[ ] The prior offenses listed as number(s) _______________ above, or in appendix 2.2, require that the defendant
be sentenced as a Persistent Offender (RCW 9.94A.570).
[ ] The prior convictions listed as number(s) ____________ above, or i n appendix 2.2, are one offense for purposes
of determining the offender score (RCW 9.94A.525).
[ ] The prior convictions listed as number(s) __________ above, or in appendix 2.2, are not counted as points but
as enhancements pursuant to RCW 46.61.520.
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(RCW 9.94A.500, .505)(WPF CR 84 .0400 ( 07/201 9))
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, (VH) Veh. Hom, see RCW
9.94A.533(7), (SM) Sexual motivation, RCW 9.94A.533(8), (SCF) Sexual conduct with a child for a fee, RCW
9.94A.533(9), (CSG) Criminal street gang involving minor, (AE) Endangerment while attempti ng to elude.
(ALF) Assault law enforcement with firearm, RCW 9.94A.533(12), (P16) Passenger(s) under age 16.
[ ] Additional current offense sentencing data is attached in Appendix 2.3.
For violent offenses, most serious offenses, or armed offenders, rec ommended sentencing agreements or plea
agreements are [ ] attached [ ] as follows: ______________________________________________________
2.4 Reserved.
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 findings:
[ ] The defendant is indigent as defined in RCW 10.101.010(3)(a) -(c) because the defendant:
[ ] rece ives public assistance [ ] is i nvoluntarily committed to a public mental health facility [ ] receives
an a nnual income 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 present means to pay costs of incarceration. RCW 9.94A.760.
[ ] (Name of agency) ___________________________ ‘s costs for its emergency response are
reasonble. RCW 38.52.430 (effective 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 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 beca use 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.
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(RCW 9.94A.500, .505)(WPF CR 84 .0400 ( 07/201 9))
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 . RCW 9.94A.570. The court sentences the defendant to the following term of total
confinement in the custody of the Department of Corrections:
Life without the possibility of early release on Count .
months on Count
months on Count
months on Count
Actual number of months of total confinement ordered is: l ife without the possibility of early release.
All counts shall be served concurrently, except for the portion of those counts for which there is an
enhancement for firearm, other deadly weapon, sexual motivation, sexual conduct with a child for a fee,
passenger(s) under age 16, or impaired driving as set forth above at Section 2.3, and except for the
following counts 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 unless otherwise set forth here:__________________________
Court Ordered Treatment: If the defendant is currently undergoing court ordered mental health or substance
use disorder treatment, the defendant must notify DOC and must release treatment information to DOC.
RCW 9.94A.562.
4.2 Other :
4.3 Legal Financial Obligations : The defendant shall pay to the clerk of th is 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
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(RCW 9.94A.500, .505)(WPF CR 84 .0400 ( 07/201 9))
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
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 collected RCW 43.43.7541
FPV 3335 $ Specialized forest products RCW 76.48.171
$ 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 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 -$)
RJN ________________________________ ________________________________ ____________________
________________________________ ________________________________ ____________________
________________________________ ________________________________ ____________________
[ ] The Department of Corrections (DOC) or clerk of the court shall immediately issue a Notice of Payroll
Deduction. RCW 9.94 A.7602, RCW 9.94A.760(8).
[ ] 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 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 obligations
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(RCW 9.94A.500, .505)(WPF CR 84 .0400 ( 07/201 9))
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 col lected for purposes of DNA identification
analysis and the defendant 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 q ualifying
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 .
[ ] HIV Testing . The defendant shall subm it 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).
[ ] 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 recogn izance 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 petitio n, 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 Su pervision . 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, whichev er 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 and RCW 9.94A.505(5). The clerk of the court has
authority to coll ect 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) and RCW 9.94A.753(4).
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(RCW 9.94A.500, .505)(WPF CR 84 .0400 ( 07/201 9))
5.3 Notice of Income -Withholding Action . If the court has no t 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 mo nthly
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 Reserved.
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 commit ment.) 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.
Delete or cross off if not applicable :
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 where you reside. You must register within three business days of being sentenced un less you
are in custody, in which case you must register at the time of your release wth the person designated by the
agency that has jurisdiction over you. You must also register within three business days of your release with
the sheriff of the county o f 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
confinement with the person designated by the agency that has jurisdiction over you. You mu st 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 i n 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 c ase 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 days of your release with the sheriff
of the county of your school, where you are emplo yed, 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 ba ck 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 later 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 out 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 staying within three business days of your arrival.
3. Change of Residence Within Sta te: If you change your residence within a county, you must
provide, by certified mail, with return receipt requested or in peson, signed written notice of your change of
residence to the sheriff within three business days of moving. If you change your re sidence 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 must 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.
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(RCW 9.94A.500, .505)(WPF CR 84 .0400 ( 07/201 9))
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 mu st 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 State.
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 th e 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, whic hever 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 notify the sheriff at least 24 hours before you travel. You
must explain to the sh eriff 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 business days after losing your fixed residence, you must send signed written n otice 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 sheriff of the new county not more than three business days
after entering the n ew 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 office, and shall occur during
normal business hours. You must keep an accurate a ccounting 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 inf ormation 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 the county sheriff of the county of your residence and to the state patrol not fe wer 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 d ays 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 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.
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 o f 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 Relate d. The defendant was under the influence of or affected by any drug.
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(RCW 9.94A.500, .505)(WPF CR 84 .0400 ( 07/201 9))
[ ] 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
[Imitati on 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 chap ter 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 viol ation
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
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 f elony 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 t o 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 o bligations.
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.84.6 60. 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 this Judgment
and Sentence for the defendant into that language.
I certify 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
Felony Judgment and Sentence (FJS) (Persistent Offender) Page 11 of 11
(RCW 9.94A.500, .505)(WPF CR 84 .0400 ( 07/201 9))
VI. I dentification 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 [ ] Refused
[ ] Unknown [ ] Other: [ ] Unknown
Fin gerprints : 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
