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DUI Judgment and Sentence Form (DUIJS) - Page 1 of 3CrRLJ 07.0100 (07/2017) CrRLJ 7.2, 7.3; RCW 46.20.720, 46.61.5055 Court of Washington For No.Plaintiff, vs.Defendant.Judgment and Sentence for:1) Driving Under The Influence Physical Control 2) Reckless Driving (RCW 46.61.500(3) Negligent Driving - 1st
Degree
(RCW 46.61.5249(4))3) ___________________________________ (DUIJS) The defendant is adjudged guilty based upon a guilty plea, jury verdict, or bench trial. The court verified
the defendant’s criminal history and driving record and made findings as follows: (check all that apply):
GY Passenger under age 16, BAC _____, No Test, Refusal, Drug related, THC_____,
CDL Vehicle Information: Hazmat vehicle, Commercial vehicle, 16 Passenger vehicle, and
____________________________________________________________________________________
____________________________________________________________________________________ ; therefore, the defendant is sentenced as follows:Sentence is suspended for a period of months/years on the following conditions:Count 1) ____ days of jail and suspends____ days; and a fine of $________ with $ _______ suspendedCount 2) ____ days of jail and suspends____ days; and a fine of $_________ with $ ______ suspendedCount 3) ____ days of jail and suspends____ days; and a fine of $_________ with $ ______ suspendedJail: Serve a total of ____________ days in jail with credit for ___________ days served, and
serve a total of _______ days of electronic home monitoring with credit for ______ days served. other alternative means of confinement: _________________________________________.Jail sentences are concurrent/consecutive with all other commitments _____________________.Pay: fine of $____________ Alcohol violator fee DUC $___________ assessments $____________ criminal traffic fee $___________ costs $____________ probation/monitoring fee $___________ bench warrant fee $____________ booking fee $___________ jail recoupment fee $____________ public defender recoupment $___________ other __________ $ criminal conviction fee $ Passenger under 16 fine $ DUI emergency response reimbursement to (agency): ___________________ $ restitution to: $ (All payments shall be made through the clerk of this court, including restitution.) 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.Mandatory Conditions of Sentence - DUI/Physical Control (a) The defendant shall not drive a motor vehicle without a valid license. (b) The defendant shall not
drive a motor vehicle without proof of liability insurance or other financial responsibility. (c) The
defendant shall not drive or be in physical control of a motor vehicle with an alcohol concentration of
.08 or more or a THC concentration of 5.00 nanograms per milliliter of whole blood or higher, within
two hours after driving. (d) The defendant shall submit to a breath or blood alcohol test upon the
reasonable request of a law enforcement officer. (e) The defendant shall not drive a motor vehicle
without a functioning ignition interlock device as required by the Department of Licensing. For each
violation of the above mandatory conditions, the court shall order your confinement for a minimum of
DUI Judgment and Sentence Form (DUIJS) - Page 2 of 3CrRLJ 07.0100 (07/2017) CrRLJ 7.2, 7.3; RCW 46.20.720, 46.61.5055 30 days, which may not be suspended or deferred. For each incident involving a violation, the court
shall suspend your license for 30 days. No criminal violations of law or alcohol related infractions.Comply with the rules and requirements of the Department of Licensing regarding the installation and
use of a functioning ignition interlock device. Comply with the requirement to install an ignition interlock device for 6 months in addition to any other
ignition interlock device requirements imposed by the Department of Licensing or the court.
(Passenger under 16, RCW 46.61.5055(6).)The court has ordered the defendant to refrain from consuming any alcohol. The defendant must
comply with alcohol monitoring as authorized by law. The defendant shall pay the cost of
monitoring. The cost of monitoring shall be paid by __________________________________.
(RCW 46.61.5055(5)).
Conditions of Sentence – Reckless Driving/Negligent Driving – 1st
Degree (a) The defendant shall not drive a motor vehicle without a valid license and proof of liability insurance
or other financial responsibility. (b) The defendant shall not drive or be in physical control of a motor
vehicle with an alcohol concentration of .08 or more or a THC concentration of 5.00 nanograms per
milliliter of whole blood or higher, within two hours after driving. The defendant shall submit to a breath or blood alcohol test upon the reasonable request of a law
enforcement officer.No criminal violations of law or alcohol related infractions.Comply with mandatory ignition interlock device requirements as imposed by the Department of
Licensing. Additional Conditions of Sentence – 24/7 Sobriety Program/Discretionary Ignition Interlock 24/7 Sobriety Program is available. For 6 months ____ days/months: comply with the 24/7 Sobriety Program (RCW 46.61.5055(1) – (3).) do not drive any motor vehicle unless it is equipped with an ignition interlock device (this does not
authorize you to drive without a valid license).Comply with discretionary ignition interlock device requirements. RCW 46.20.720(1)(e): For a period of _________ years or for _______ months drive only a motor vehicle equipped
with a functioning ignition interlock device, which is in addition to any ignition interlock device
restriction imposed by DOL. Unless otherwise stated, the calibration level for any ignition interlock requirement imposed under this
order shall be .025% _______.
Employer exemption : When the defendant provides an Employer Exemption declaration to the
Department of Licensing, this order shall not apply to vehicles owned, leased, or rented by defendant’s
employer or to those vehicles whose care and/or maintenance is the temporary responsibility of the
employer and driven at the direction of the defendant’s employer as a requirement of employment during
working hours. Except that, the employer exemption does not apply when the employer’s vehicle is
assigned exclusively to the defendant and used solely to commute to and from employment.Additional Conditions of Sentence 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 as set by the probation department. Obtain a substance use disorder evaluation expanded alcohol assessment from a Washington
State approved agency and file a copy of the evaluation/assessment within ________ days. Begin
any recommended/appropriate substance use disorder treatment or education within ______ days and
file proof of timely enrollment and completion.
DUI Judgment and Sentence Form (DUIJS) - Page 3 of 3CrRLJ 07.0100 (07/2017) CrRLJ 7.2, 7.3; RCW 46.20.720, 46.61.5055 Begin the following within ________days, complete within ______________ days, and file proof of
timely enrollment and completion: DUI Victim’s Panel Alcohol/Drug Information School One
Year Substance Use Disorder Treatment Two Year Substance Use Disorder Treatment
Substance Use Disorder Treatment for a period of ______________ Driver Improvement School
Other _________________________.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.Other: ___________________________________________________________________________. Department of Licensing Notice – DUI, Physical Control, Reckless Driving, Negligent Driving 1st
. 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
suspend/revoke the Defendant’s driver’s license. Return for a review hearing: . Bail or Bond is Exonerated
Forfeited.
Dated: I have read the rights, conditions, and warnings .Defendant’s Signature Date of Birth Judge/Court Commissioner/Pro TemProsecuting Attorney WSBA No. Defendant’s Address and Telephone Defense Attorney WSBA No.Written Waiver of Counsel is filed.
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