Fill and Sign the Fillable Online Sacred Heart of Mary Girls School Fax Form

Judgment and Sentence Form (JS) - Page 1 of 3 CrRLJ 07.0110 (1/29/2018) CrRLJ 7.2, 7.3 Court of Washington for No. Plaintiff , vs. Defendant. Judgment and Sentence (JS) Clerk’s Action Required: DOL notice The defendant pled guilty, or pled not guilty and the verdict of the jury was guilty, or the finding of the court was guilty of: Count Crime RCW or Ordinance (with subsection) 1. 2. GV For the crime(s) charged in count(s) _________________, domestic violence – intimate partner was pled and proved. RCW 9A.36.041(4). GV For the crime(s) charged in count(s) _________________, domestic violence (other) was pled and proved. RCW 10.99.020. Therefore, the defendant is adjudged guilty and sentenced as follows: Sentence is suspended (susp.)/deferred (def.) for months/years on the following conditions: Count 1)_____ days of jail, susp./def. ______ days; and a fine of $__________ with $ ___________ susp./def. Count 2)_____ days of jail, susp./def. ______ days; and a fine of $__________ with $ ___________ susp./def. Serve a total of ___________ days in jail with credit for ____________ days served, and serve a total of ________ days of electronic monitoring home detention/electronic monitoring with credit for ______ days served. Other alternative means of confinement ___________________________________________ Jail sentences are concurrent/consecutive with all other commitments . This crime is an offense which requires sex or kidnapping offender registration, or is one of the following offenses , assault in the fourth degree domestic violence, assault in t he fourth degree with sexual motivation, communication with a minor for immoral purposes, custodial sexual misconduct in the second degree, failure to register, harassment, patronizing a prostitute, sexual misconduct with a minor in the second degree, stalking, or violation of a sexual assault protection order granted under chapter 7.90 RCW. Therefore, the defendant shall have a biological sample collected for purposes of DNA identification analysis. This paragraph does not appl y if it is established that the Washington State Patrol crime laboratory already has a sample from defendant for a qualifying offense . RCW 43.43.754. Defendant shall pay to the clerk of this court: fine $_____________ BAC fee $____________ assessments $_____________ criminal traffic fee $____________ costs $_____________ probation/monitoring fee $____________ bench warrant fee $_____________ booking fee $____________ jail recoupment fee $_____________ public defender recoupment $____________ DNA fee (RCW 43.43.7541) $_____________ domestic violence assessment $____________ PPIA (RCW 9A.88.120) $_____________ criminal conviction fee $____________ other ________________ $_____________ violation of RCW 26.50 DVPO $____________ restitution to:_____________________________ DPR fee (RCW 26.50.110) $ 30.75 Judgment and Sentence Form (JS) - Page 2 of 3 CrRLJ 07.0110 (1/29/2018) CrRLJ 7.2, 7.3 Total:$____________ $ ___________ of this total is converted to ________ hours of community restitution (service) which must be completed by ______________________. Proof of completion shall be provided to the court/probation department . The defendant is ordered to reimburse __________________________________________________ (name of electronic monitoring agency) at ______________________________________________, for the cost of pretrial electronic monitoring in the amount of $_________________________. Additional Conditions of Sentence : No criminal violations of law or alcohol related infractions. Not drive a motor vehicle without a valid license and proof of insurance. Probation for _________ months. Supervised probation for ______________ months, with probation department and abide by all rules and regulations of probation department. Pay a $________ pre- sentence fee and a $_______ monthly probation fee unless the fee is reduced by the probation department. Supervised probation to end upon completion of Certified domestic violence treatment and/or . Begin the following within ________days and complete within ____________ days and file proof of timely enrollment. Certified Domestic Violence Program Anger Management Consumer Awareness (theft) Other________________________________________________________. Obtain an alcohol/drug evaluation from a Washington State-approved agency a psycho-sexual evaluation from a state certified provider a mental health evaluation from a state licensed mental health provider, and file a copy of the evaluation within ________ days. Begin any recommended treatment or education within________ days and file proof of timely enrollment and completion. Begin the following within __________ days and complete within ___________ months, and file proof of timely enrollment and completion: DUI Victim’s Panel Alcohol/Drug Information School One Year Alcohol/Drug Treatment Two Year Alcohol/Drug Treatment Alcohol/Drug Treatment for the period of ___________________ Driver Improvement School. Use no alcoholic beverages or non-prescribed controlled drugs. Attend Alcoholics Anonymous Narcotics Anonymous Other self-help program (_________________) meetings _____ times a week for _____ months or as recommended by treatment provider . Do not go upon the property of and have no contact with __________________________________ _______________________________________________________________________________. Other: __________________________________________________________________________. This crime involves a sex offense, or a kidnapping offense involving a minor, as d efined in RCW 9A.44.130. The defendant is required to register with the county sheriff as described in the “Offender Registration” Attachment. Department of Licensing Notice – Violation of RCW 9.41.270. Count ________ is (a) a violation of RCW 9.41.270 (unlawful carrying or handling of weapons), a gross misdemeanor for which the penalty includes loss of the defendant’s concealed pistol license, if any. Clerk’s Action –The clerk shall forward a Notice of Revocation of Concealed Pistol License to DOL. 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 Judgment and Sentence Form (JS) - Page 3 of 3 CrRLJ 07.0110 (1/29/2018) CrRLJ 7.2, 7.3 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. Return for a review hearing: _____________________. Bail or Bond is Exonerated Forfeited. I have read the rights, conditions and warnings. Dated: _________________________________ ______________________________________________ ______________________________________ Defendant’s Signature Date of Birth Judge/Commissioner/Pro Tem Prosecuting Attorney WSBA No. Defendant’s Address and Telephone Defense Attorney WSBA No. Written Waiver of Counsel is filed.