Fill and Sign the Motion for Certificate and Order of Form

Motion for Certificate and Order of Discharge/ (MT CORD , MCORD PN) - Page 1 of 3 and Petition for Issuance of Separate No -Contact Order WPF CR 08.0600 ( 07/2019 ) RCW 9.94A.637 Superior Court of Washington County of State of Washington , Plaintiff, vs. __ __________________________ , Defendant. SID: If no SID, use DOB: Criminal Case No .:__________________ Civil Case No .:_____________________ [ ] Motion for Certi ficate and Order of Discharge (MTCORD ) [ ] Motion for Certificate and Order of Discharge and Petition for Issuance of a Separate No -Contact Order (MCORDPN ) Clerk’s Action Required : [ ] Filing fee received for civil case number Note to defendant : A Certificate and Order of Discharge does not remove a criminal Conviction from your record. It does not remove any restrictions on the ownership, possession or control of firearms/ammunition under state /federal law. A Certificate and Order of Discharge do es not terminate your obligation to comply with a no -contact order that excludes or prohibits you from having contact with a specified person or coming within a set dis tance of any specified location , or your obligation to register as a sex or kidnapping offender. I, ______________________ _____________ (name of defendant ) ask the court for a Certificate and Order of Discharge [ ] and petition for Issuance of a Separate No -Contact Order under RCW 9.94A.637. As provided in the Confirmation of Court -Ordered Requirements on page 3: 1. [ ] On __________________________ (date), I completed all of the sentencing conditions imposed on me by the court in the Judgment and Sentence in this case, including the payment of any and all legal financial obligations. RC W 9.94A.637(3). 2. [ ] I have verified that I completed all nonfinancial sentencing conditions imposed by the court in the Judgment and Sentence in this case. RCW 9.94A.637(4). or Motion for Certificate and Order of Discharge/ (MT CORD , MCORD PN) - Page 2 of 3 and Petition for Issuance of Separate No -Contact Order WPF CR 08.0600 ( 07/2019 ) RCW 9.94A.637 [ ] I cannot verify I completed all nonfinancial sentencing conditions imposed by the court in the Judgment and Sentence in this case, and the court should waive the verification requirement because: (RCW 9.94A.637(4)) If I am subject to a no -contact order that was written as part of and included in the judgment and sentence , I petition the court to reissue the no -contact order separately for the remaining term and under the same conditions as contained in the judgment and sentence . I understand that I must pay the filing fee for the separate no -contact order. I declare 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 ). ____________________________ ________ Signature of D efendant Print or Type Name Motion for Certificate and Order of Discharge/ (MT CORD , MCORD PN) - Page 3 of 3 and Petition for Issuance of Separate No -Contact Order WPF CR 08.0600 ( 07/2019 ) RCW 9.94A.637 ----------------------------------------------------------------------------------------------------------------------------- -- Confirmation of Court -ordered Requirements : I have check ed the Department of Corrections records and the records show that the defendant [ ] has [ ] has not satisfactorily completed all court -ordered sentencing conditions . [ ] Community custody was completed on ________ ________ (date) or if not ordered, full and partial confinement was completed on __________ _______ (date). I declare 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) _________________. ______________________ __ ____________ _________________________ _______ Signature of Community Corrections Officer Print Name OR I am submitting the following materials to show that I have completed the conditions in the Judgment and Sentence, such as community service hours and substance evaluation/treatment (include dates): _________________________________________________________________________ ___ _________________________________________________________________________ ___ . (attach copies to this document.) [ ] I complete d community custody on ________________ (date) [ ] or if not ordered, I completed full and partial confinement on _________________ (date). I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and corre ct. Signed at (city) ________________________, (state) ________ on (date) ________________. __________________________ _________________ ______________________________ Signature of Defendant Pro Se/ Print Name Attorney for Defendant/WSBA No. ------------- ------------------------------------------------------------------------------------------------------------------ And Confirmation of Legal Financial Obligations : I have check ed the Clerk ’s financial records and the records show that the defendant : [ ] has not paid any and all legal financial obligations. [ ] has paid any and all legal financial obligations. [ ] Any and all legal financial obligations were satisfied on ____________________ (date). I declare 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) _______________. ____________________________________ ________________________________ Signature of (Deputy ) Clerk - Finance section Print Name