Judgment and Disposition Order

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.

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.

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 if under 18:

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 # 2

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:

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. 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

I certify this is a true and correct record of this Court.

(Seal)

Form Revised 05/2010