Fill and Sign the Wa Judgment Form

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 the 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 apply 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 Total : $____________ Judgment and Sentence Form (JS) - Page 1 of 3 CrRLJ 07.0110 (1/29/2018) CrRLJ 7.2, 7.3 $ ___________ 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 defined in RCW 9A.44.130. The defendant is required to register with the county sheriff as described in the “Offender Registration” Attachment. D epartment 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. D epartment 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 Judgment and Sentence Form (JS) - Page 2 of 3 CrRLJ 07.0110 (1/29/2018) CrRLJ 7.2, 7.3 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 Defendant’s Address and Telephone Prosecuting Attorney WSBA No. Defense Attorney WSBA No. Written Waiver of Counsel is filed. Judgment and Sentence Form (JS) - Page 3 of 3 CrRLJ 07.0110 (1/29/2018) CrRLJ 7.2, 7.3