Fill and Sign the Judgment and Disposition Order Form

Defendant’s full name: Page ___ of ___ JUDGMENT AND DISPOSITION ORDER IN THE CIRCUIT COURT OF _______________, ARKANSAS _____DISTRICT _____ DIVISION On _________________________ the Defendant appeared before the Court, was advised of the nature of the charge(s), of constitutional and legal rights, of the effect of a guilty plea upon those rights, and of the right to make a statement before sentencing. The Court made the following findings: DEFENDANT'S FULL NAME: DATE OF BIRTH: RACE: SEX: SID #: DEFENDANT'S ATTORNEY: PROSECUTING ATTORNEY OR DEPUTY: Defendant was represented by ___ private counsel ___ appointed counsel ___ public defender ___ himself/herself Defendant made a voluntary, knowing and intelligent waiver of the right to counsel: ___ Yes ___ No There being no legal cause shown by the Defendant, as requested, why judgment should not be pronounced, a judgment is hereby entered against the Defendant on each charge enumerated, fines levied, and court costs assessed. Defendant was advised of the conditions of the sentence and/or placement on probation and understands the consequences of violating those conditions. The Court retains jurisdiction during the period of probation/suspension and may change or set aside the conditions of probation/suspension for violations or failure to satisfy Department of Community Correction rules and regulations. -------------------------------------------------------------------------------------------------------------------------------------------------------------- TOTAL NUMBER OF COUNTS: -------------------------------------------------------------------------------------------------------------------------------------------------------------- Offense # 1 Docket #: Arrest Tracking #: A.C.A. # of Offense: Name of Offense: Seriousness Level of Offense: Criminal History Score: Presumptive Sentence: Sentence is a departure from the sentencing grid. ___ Yes ___ No Offense is a ___felony ___misdemeanor. Classification of offense: ___A ___B ___C ___D ___U ___Y Period of Confinement: ___ months Suspended imposition of sentence: ___ months Period of Probation: ___ months Defendant is assigned to ___ county jail ___ Department of Community Correction and/or probation ___ confinement under special conditions. Special conditions of confinement are attached. ___ Yes ___ No Defendant ___attempted ___solicited ___conspired to commit the offense. Offense date: Number of counts: Commitment on this offense is a result of the revocation of Defendant's probation or suspended imposition of sentence. ___ Yes ___ No Age of the victim of the offense if he or she was under 18 years of age at the time the offense occurred ______________ Defendant voluntarily, intelligently, and knowingly entered a ___ negotiated plea of guilty or nolo contendere. ___ plea directly to the court of guilty or nolo contendere. Defendant ___ entered a plea as shown above and was sentenced by a jury. ___ was found guilty of said charge(s) by the court, and sentenced by ___the court ___a jury. ___ was found guilty at a jury trial, and sentenced by ___the court ___a jury. ___ Defendant committed a target offense and was sentenced under the Community Punishment Act. Upon successful completion of the conditions of probation/S.I.S., Defendant shall be eligible to have his/her records sealed. Defendant was sentenced pursuant to the First Offender Act (A.C.A. § 16-93-301 et seq.) ___ Yes ___ No Defendant’s full name: Page ___ of ___ Offense # Docket #: Arrest Tracking #: A.C.A. # of Offense: Name of Offense: Seriousness Level of Offense: Criminal History Score: Presumptive Sentence: Sentence is a departure from the sentencing grid. ___ Yes ___ No Offense is a ___felony ___misdemeanor. Classification of offense: ___A ___B ___C ___D ___U ___Y Period of Confinement: ___ months Suspended imposition of sentence: ___ months Period of Probation: ___ months Defendant is assigned to ___ county jail ___ Department of Community Correction and/or probation ___ confinement under special conditions. Special conditions of confinement are attached. ___ Yes ___ No Defendant ___attempted ___solicited ___conspired to commit the offense. Offense date: Number of counts: Commitment on this offense is a result of the revocation of Defendant's probation or suspended imposition of sentence. ___ Yes ___ No Age of the victim of the offense if he or she was under 18 years of age at the time the offense occurred ______________ Defendant voluntarily, intelligently, and knowingly entered a ___ negotiated plea of guilty or nolo contendere. ___ plea directly to the court of guilty or nolo contendere. Defendant ___ entered a plea as shown above and was sentenced by a jury. ___ was found guilty of said charge(s) by the court, and sentenced by ___the court ___a jury. ___ was found guilty at a jury trial, and sentenced by ___the court ___a jury. ___ Defendant committed a target offense and was sentenced under the Community Punishment Act. Upon successful completion of the conditions of probation/S.I.S., Defendant shall be eligible to have his/her records sealed. Defendant was sentenced pursuant to the First Offender Act (A.C.A. § 16-93-301 et seq.) ___ Yes ___ No. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Offense # Docket #: Arrest Tracking #: A.C.A. # of Offense: Name of Offense: Seriousness Level of Offense: Criminal History Score: Presumptive Sentence: Sentence is a departure from the sentencing grid. ___ Yes ___ No Offense is a ___felony ___misdemeanor. Classification of offense: ___A ___B ___C ___D ___U ___Y Period of Confinement: ___ months Suspended imposition of sentence: ___ months Period of Probation: ___ months Defendant is assigned to ___ county jail ___ Department of Community Correction and/or probation ___ confinement under special conditions. Special conditions of confinement are attached. ___ Yes ___ No Defendant ___attempted ___solicited ___conspired to commit the offense. Offense date: Number of counts: Commitment on this offense is a result of the revocation of Defendant's probation or suspended imposition of sentence. ___ Yes ___ No Age of the victim of the offense if he or she was under 18 years of age at the time the offense occurred ______________ Defendant voluntarily, intelligently, and knowingly entered a ___ negotiated plea of guilty or nolo contendere. ___ plea directly to the court of guilty or nolo contendere. Defendant ___ entered a plea as shown above and was sentenced by a jury. ___ was found guilty of said charge(s) by the court, and sentenced by ___the court ___a jury. ___ was found guilty at a jury trial, and sentenced by ___the court ___a jury. ___ Defendant committed a target offense and was sentenced under the Community Punishment Act. Upon successful completion of the conditions of probation/S.I.S., Defendant shall be eligible to have his/her records sealed. Defendant’s full name: Page ___ of ___ Defendant was sentenced pursuant to the First Offender Act (A.C.A. § 16-93-301 et seq.) ___ Yes ___ No ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- Jail Time Credit: ______ days Conditions of disposition or probation are attached. ___ Yes ___ No A copy of the presentence investigation on sentencing information, including but not limited to criminal history elements is attached. ___ Yes ___ No Fines $ Court Costs $ DNA Sample Fee (A.C.A. § 12-12-1118) $ Drug Crime Special Assessment (A.C.A. § 12-17-106) $ Booking and Admin. Fee (A.C.A. § 12-41-505) $ Public Defender User Fee (A.C.A. § 16-87-213) $ A judgment of restitution is hereby entered against the Defendant in the amount and terms as shown below: Amount $ ___ Due immediately ___ Installments of: Payment to be made to: If multiple beneficiaries, give names and show payment priority: Defendant was convicted of, or has entered a plea of guilty or nolo contendere to, a “drug crime,” as defined by A.C.A. § 12-17-101. __Yes __No Defendant has been adjudicated guilty of an offense requiring registration as a sex offender, and is ordered to complete the Sex Offender Registration Form. ___ Yes ___ No Defendant, who was adjudicated guilty of an offense requiring registration as a sex offender, has been adjudicated guilty of a prior sex offense under a separate case number. Yes ____ No. If yes, list prior case number(s): _________________________ Defendant is alleged to be a Sexually Violent Predator, and is ordered to undergo an evaluation at a facility designated by the Department of Correction pursuant to A.C.A. § 12-12-918. ___ Yes ___ No. Defendant has committed an aggravated sex offense, as defined in A.C.A. § 12-12-903. ___ Yes ___ No Defendant was adjudicated guilty of a “qualifying offense” or a “repeat offense,” as defined in A.C.A. § 12-12-1103, and is ordered to have a DNA sample drawn at: ___ a D.C.C. facility ___ the A.D.C. or _____________ (other): ___ Yes ___ No Defendant was adjudicated guilty of a domestic-violence related offense. ___ Yes ___ No If yes, identify the relationship of the victim to the Defendant. ______________ If no, was Defendant originally charged with a domestic-violence related offense? ___ Yes ___ No If yes, state the name of the offense. ____________________ Defendant was informed of the right to appeal: ___ Yes ___ No. Appeal Bond: $ The County Sheriff is hereby ordered to ___ transport the Defendant to the County Jail or ___ take custody of the Defendant for referral to a Regional Punishment Facility. Defendant shall report to the probation officer for assignment of a reporting date to a Regional Punishment Facility. ____Yes ___No ---------------------------------------------------------------------------------------------- Date: Circuit Judge: Signature:_____________________ I certify this is a true and correct record of this Court. Date: Circuit Clerk/Deputy:____________________________________ (Seal) Form Revised 05/2010