Felony Judgment and Sentence (FJS) (Prison) Page 1 of 14
(Sex Offense an d Kidnapping of a Minor Offense)
(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 -- Prison
[ ] RCW 9.94A.507 Prison Confinement
(Sex Offense and Kidnapping of a Minor)
(FJS)
[ ] Clerk’s Action Required, para 2,1, 4.1, 4.3a, 4.3b,
4.8, 5.2, 5.3, 5.5, 5.7, and 5.8
[ ] Defendant Used Motor Vehicle
[ ] Juvenile Decline [ ] Mandatory [ ] Discretionary
I. Hearing
1.1 The court conducted a senten cing 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 d rug in the second column.)
[ ] Additional current offenses are attached in Appendix 2.1a.
[ ] The defendant is a sex offender subject to indeterminate sentencing under RCW 9.94A.507 .
The jury returned a special verdict or the court made a special fin ding 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).
Felony Judgment and Sentence (FJS) (Prison) Page 2 of 14
(Sex Offense an d Kidnapping of a Minor Offense)
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] The defendant used a firearm in the commission of the offense in Count ______________. RCW 9.94A.825,
RCW 9.94A.533.
[ ] The defendant used a deadly weapon other than a firearm in committing the offense in Count ____________
____________________RCW 9.94A.825, 9.94A.533.
[ ] Count ______________________, is aggravated murder in the first degree committed while the defendant was
[ ] under 16 years of age [ ] 16 or 17 years of age when the offense was committed.
[ ] Count ______________________, was committed while the defendant was under 18 years of age and the time
of confinement is over 20 years.
[ ] The defendant engaged, agreed, offered, attempted, solicited another, 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 of fense in Count ________________. RCW 9.94A.838, 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 de gree, 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(2 1),
RCW 9.94A.____.
[ ] Count _______________________, Violation of the Uniform Controlled Substances Act (VUCSA) , RCW
69.50.401 and RCW 69.50.435, took place in a school, school bus, within 1000 feet of the perimeter of a school
grounds or within 1000 feet of a school bus route stop designated by the school district; or in a public park,
public transit vehicle, or public transit stop shelter; or in, or within 1000 feet of the perimeter of a civic center
designated as a drug -free zone by a local governme nt authority, or in a public housing project designated by a
local governing authority as a drug -free zone.
[ ] The defendant committed a crime involving the manufacture of methamphetamine, including its salts, isomers,
and salts of isomers, when a juve nile was present in or upon the premises of manufacture in Count
_____________________________. RCW 9.94A.605, RCW 69.50.401, RCW 69.50.440.
[ ] 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 w hen 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 operatin g a vehicle in a reckless manner.
The offense is, therefore, deemed a violent offense. RCW 9.94A.030.
GY [ ] In Count _______, the defendant 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 official duties at the time of the assault,
as provided under RCW 9A.36.031, and the defendant intentionally committed th e assault with what appeared to
be a firearm . RCW 9.94A.831, 9.94A.533.
[ ] Count ________ is a felony in the commission of which the defendant used a motor vehicle . RCW46.20.285.
[ ] The defendant has a chemical dependency that has contributed to the offense(s). RCW 9.94A.607.
Felony Judgment and Sentence (FJS) (Prison) Page 3 of 14
(Sex Offense an d Kidnapping of a Minor Offense)
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] 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
[ ] In Count ______, assau lt in the 1 st degree (RCW 9A.36.011) or assault of a child in the 1 st degree (RCW
9A.36.120), the offender used force or means likely to result in death or intended to kill the victim and shall be
subject to a mandatory minimum term of 5 years (RCW 9.94A.5 40).
[ ] 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 off ender 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 pled and proved.
[ ] 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). RCW 9.94A.525.
[ ] The prior convictions listed as number(s) ___________, above, or in 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 co unted as points
but as enhancements pursuant to RCW 46.61.520.
Felony Judgment and Sentence (FJS) (Prison) Page 4 of 14
(Sex Offense an d Kidnapping of a Minor Offense)
(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, (V) VUCSA in a protected zone, (RPh) Robbery of a pharmacy,
(VH) Veh. Hom, see RCW 9.94A.533(7), (JP) Juvenile present, (SM) Sexual motivation, RCW 9.94A.533(8),
(SCF) Sexual conduct w ith a child for a fee, RCW 9.94A.533(9), (CSG) Criminal street gang involving minor,
(AE) Endangerment while attempting to elude, (ALF) Assault law enforcement with firearm, RCW
9.94A.533(12), (P16) Passenger(s) under age 16.
[ ] Additional current offen se sentencing data is attached in Appendix 2.3.
For violent offenses, most serious offenses, or armed offenders, recommended sentencing agreements or plea
agreements are [ ] attached [ ] as follows: ______________________________________________________ .
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, 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 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:
[ ] 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 presen t 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).
Felony Judgment and Sentence (FJS) (Prison) Page 5 of 14
(Sex Offense an d Kidnapping of a Minor Offense)
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
2.6 [ ] Felony Firearm Offender Registration . The def endant 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 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. Sentenc e and Order
It is ordered :
4.1 Confinement . The court sentences the defendant to total confinement as follows:
(a) Confinement . RCW 9.94A.589. A term of total confinement in the custody of the Department of
Corrections (DOC) :
[ ] The defendant was un der 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
[ ] The confinement time on Count(s)___________ contain(s) a mandatory minimum term of __________.
[ ] The confinement time on Count __________________________ includes _____________ months as
enhancement for [ ] firearm [ ] deadly weapon [ ] sexu al motivation [ ] VUCSA in a protected zone
[ ] manufacture of methamphetamine with juvenile present [ ] sexual conduct with a child for a fee
[ ] impaired driving.
Actual number of months of total confinement ordered is: _________________________ ____________
All counts shall be served concurrently, except for the portion of those counts for which there is an
enhancement 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 commen ce immediately unless otherwise set forth here: __________________________
(b) Confinement . RCW 9.94A.507 (Sex Offenses only): The court orders the following term of confinement
in the custody of the DOC:
Count minimum term: maximum term: Statutory Maximum
Count minimum t erm: maximum term: Statutory Maximum
Felony Judgment and Sentence (FJS) (Prison) Page 6 of 14
(Sex Offense an d Kidnapping of a Minor Offense)
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
(c) Confinement . RCW 10.95.030 (Aggravated murder and under age 18.) The court orders the following:
Count minimum term: maximum term: Life
Count minimum term: maximum term: Life
(d) 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.
(e) [ ] Work Ethic Program . RCW 9.94A.690, RCW 72.09.410. The court finds that the defendant is
eligible and is likely to qualify for work ethic program. The court recommends that the defendant serve the
sentence at a work ethic program. Upon completion of work ethic program, the defendant shall be released
on commu nity custody for any remaining time of total confinement, subject to the conditions in Section
4.2. Violation of the conditions of community custody may result in a return to total confinement for
remaining time of confinement.
4.2 Community Custody . (To determine which offenses are eligible for or required for community custody
see RCW 9.94A.701, RCW 10.95.030(3))
(A) The defendant shall be on community custody for:
Count(s) _____________ 36 months Sex Offenses
Count(s) _____________ 36 months for S erious Violent Offenses
Count(s) _____________ 18 months for Violent Offenses
Count(s) _____________ 12 months (for crimes against a person, drug offenses, or offenses involving the
unlawful possession of a firearm by a street gang member or
associate)
(Sex offenses, only) For count(s) ___________________, sentenced under RCW 9.94A.507, for any period
of time the defendant is released from total confinement before the expiration of the statutory maximum.
(B) While on community custody, the defendant shal l: (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 employ ment; (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 firearms or ammunition;
(7) pay supervision fees as det ermined 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 RC W 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.709, the court may extend community
custody up to the statut ory 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 res ide within 880 feet of the facilities or grounds of a public or private school (community protection
zone). RCW 9.94A.030.
[ ] participate in an education program about the negative costs of prostitution.
[ ] participate in the following crime -relat ed treatment or counseling services:
_________________________________________________________________________________
Felony Judgment and Sentence (FJS) (Prison) Page 7 of 14
(Sex Offense an d Kidnapping of a Minor Offense)
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] undergo an evaluation for treatment for [ ] domestic violence [ ] substance use disorder [ ] mental health
[ ] anger manag ement, and fully comply with all recommended treatment.
[ ] comply with the following crime -related prohibitions : ________________________________ __________
________________________________ ________________________________ _____________________
[ ] Other conditions:
________________________________ ________________________________ _____________________
________________________________ ________________________________ _____________________
________________________________ ________________________________ _____________________
(C) For sentences imposed under RCW 9.94A.507, the Indeterminate Sentence Review Board may impose
other con ditions (including electronic monitoring if DOC so recommends). In an emergency, DOC may
impose other conditions for a period not to exceed seven working days.
Court Ordered Treatment: If any court orders mental health or substance use disorder treatment , the defendant
must notify DOC and the defendant must release treatment information to DOC for the duration of
incarceration and supervision. RCW 9.94A.562.
(D) If the defendant committed the above crime(s) while under age 18 and is sentenced to more tha n 20 years
of confinement:
(i) As long as the defendant’s conviction is not for aggravated first degree murder or certain sex
crimes, and the defendant has not been convicted of a crime committed after he or she turned 18 or
committed a disqualifying serious i nfraction as defined by DOC in the 12 months before the
petition is filed, the defendant may petition the Indeterminate Sentence Review Board (Board) for
early release after the defendant has served 20 years.
(ii) If the defendant is released early because th e petition was granted or by other action of the Sentence
Review Board, the defendant will be subject to community custody under the supervision of the DOC
for a period of time determined by the Board, up to the length of the court -imposed term of
incarcer ation. The defendant will be required to comply with any conditions imposed by the Board.
(iii) If the defendant violates the conditions of community custody, the Board may return the defendant to
confinement for up to the remainder of the court -imposed term of incarceration .
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
$ Violat ion 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
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 co sts RCW 9.94A.760
FCM 3303 $ Fine RCW 9A.20.021; [ ] VUCSA chapter 69.50 RCW, [ ] VUCSA additional
MTH 3337 fine deferred due to indigency RCW 69.50.430
Felony Judgment and Sentence (FJS) (Prison) Page 8 of 14
(Sex Offense an d Kidnapping of a Minor Offense)
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
CDF 3302 $ Drug enforcement fund of ___________ _________ RCW 9.94A.760
LDI 3308/FCD 3363
NTF 3338 /SAD 3365 /SDI 3307
CLF 3212 $ Crime lab fee [ ] suspended due to indigency RCW 43.43.690
$ 100 DNA collection fee [ ] suspended . DNA previously 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 9A.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 fee 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: ______________________________________________________
RTN/RJN 3801 $ 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 restituti on 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):_____________
[ ] Restitu tion 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 9.94A.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 imme diately, 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 t he 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).
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(Sex Offense an d Kidnapping of a Minor Offense)
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
[ ] 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
imposed in this judgment. RCW 10.82.090. An award of costs on appeal against the defendant may be added
to the tota l 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 Testing . The defendant shall have a biological sample collected 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 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 .
[ ] 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).
[ ] 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 Protec tion 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 Depa rtment 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 Ju dgment
and Sentence, including but not limited to any personal restraint petition, state habeas corpus petition, motion to
Felony Judgment and Sentence (FJS) (Prison) Page 10 of 14
(Sex Offense an d Kidnapping of a Minor Offense)
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
vacate judgment, motion to withdraw guilty plea, motion for new trial or motion to arrest judgment, you must
do so within one year of the final judgment in this matter, except as provided for in RCW 10.73.100.
RCW 10.73.090.
5.2 Length of Supervision . If you committed your offense prior to July 1, 2000, you shall remain under the
court's jurisdiction and the supervision of the Depart ment 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
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 statu tory 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 remain under the jurisdiction of the
court for purposes of your legal financial obli gations. 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 c ourt
may issue a notice of payroll deduction without notice to you if you are more than 30 days past due in monthly
payments in an amount equal to or greater than the amount payable for one month. RCW 9.94A.7602. Other
income -withholding action under RCW 9.94A.760 may be taken without further notice. RCW 9.94A.7606.
5.4 Community 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. RC W 9.94A.633(1).
(b) If you have not completed your maximum term of total confinement 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 co urt
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 identific ation to the Department of Licensing along with the date of conviction or
commitment.) RCW 9.41.040 and RCW 9.41.047.
5.5b [ ] Felony Firearm Offender Registration . The defendant is required to register as a felony firearm
offender. The specific registr ation 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 where 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 register within three business days of you r 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
confinement with the person designated by the agen cy 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 stu dent 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 sentenc ed 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 days of your release with the sheriff
of the co unty of your school, where you are employed, or where you carry on a vocation.
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(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
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 r elease 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 later while not a resident of
Washington you becom e 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 visitin g 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 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 residence 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 must provide, by certified mail, with return recei pt 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 att end 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 yo u 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 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 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 notify the sheriff at least 24 hours before you travel . You
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 highe r 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 regist er. 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 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 sheriff of the new county not more than three business day s
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 office, and shall occur during
normal business hours. You m ust 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 subje ct to disclosure of information to the
public at large pursuant to RCW 4.24.550.
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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 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 with in
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 vehicle was used. Clerk’s Action –The clerk shall forward a n 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 tw o 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 46.20.30 8.
[ ] 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
wa s 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 [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
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:
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(Sex Offense an d Kidnapping of a Minor Offense)
(RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/201 9))
Voting Rights Statement : I acknowledge that I have lost my right to vot e 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 obligations or an agreement for the paymen t of legal financial obligations.
My right to vote may be permanently restored by one of the following for each felony conviction: a) a certificate of
discharge issued by the sentencing court, RCW 9.94A.637; b) a court order issued by the sentencing cou rt restoring
the right, RCW 9.92.066; c) a final order of discharge issued by the indeterminate sentence review board, RCW
9.96.050; or d) a certificate of restoration issued by the governor, RCW 9.96.020. Voting before the right is restored
is a class C felony, RCW 29A.84.660. Registering to vote before the right is restored is a class C felony,
RCW 29A.84.140.
Defendant’s signature: ______________________________________________
I am a certified or registered interpreter, or the court has found me otherwise qualified to interpret, in the
_________________________________ language, which the defendant understands. I interpreted 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) ______________________.
_______________________________________ ____________________________________________
Interpre ter Print Name
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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 [ ] Refused
[ ] Unknown [ ] Othe r: [ ] 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 d efendant’s signature :
Left four fingers taken simultaneously
Left
Thumb
Right
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Right four fingers taken simultaneously
