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Felony Judgment and Sentence (FJS) Page 1 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/2019 )) Superior Court of Washington County of State of Washington , Plaintiff, vs. ______________________________________, Defendant. DOB PCN: SID: No . Felony Judgment and Sentence -- Theft or Taking of a Motor Vehicle (FJS) [ ] Clerk’s Actio n Required, 2.1, 4.1, 4.3, 4.7, 5.2, 5.3, 5.5, 5.7, and 5.8 I. Hearing 1.1 The court conducted a sentencing hearing this date; the defendant, the defendant's lawyer, and the (deputy) prosecuting attorney were present. II. Findings 2.1 Current Offenses : The defendant is guilty of the following offenses, based upon [ ] guilty plea (date) ____________ [ ] jury -verdict (date) ____________ [ ] bench trial (date) ___________: Count Crime RCW Class Date of (w/subsection) Crime Class: FA (Felony -A), FB (Felony -B), FC (Felony -C) [ ] Additional current offenses are attached in Appendix 2.1a. The jury returned a special verdict or the court made a special finding with regard to the following: GV [ ] For the crime(s) charged in Count ____________, domestic violence – intimate partner as defined in RCW 9A.36.041(4) and RCW 26.50.010(7) was pled and proved . GV [ ] For the crime(s) charged in Count ____________, domestic violence – family or household was pled and proved. RCW 26.50.010(6) . [ ] Count ________ is a felony in the commission of which the defendant used a motor vehicle . RCW46.20.285. [ ] The defendant has a chemical dependency that has contributed to the offense(s). RCW 9.94A.607. [ ] Reasonable grounds exist to believe the defendant is a mentally ill person as defined in RCW 71.24.025, and that this condition is likely to have influenced the offense. RCW 9.94B.080 Felony Judgment and Sentence (FJS) Page 2 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/2019 )) [ ] Counts __________________ encompass the same criminal conduct and count as one crim e in determining the offender score (RCW 9.94A.589). [ ] Other current convictions listed under different cause numbers used in calculating the offender score are (list offense and cause number): Crime Cause Number Court (county & state) DV* Yes 1. 2. * DV: Domestic Violence was pled and proved. [ ] Additional current convictions listed under different cause numbers used in calculating the offender score are attached in Appendix 2.1b. 2.2 Criminal History (RCW 9.94A.525) : Crime Date of Crime Date of Sentence Sentencing Court (County & State) A or J Adult, Juv. Type of Crime DV* Yes 1. 2. 3. * DV: Domestic Violence was pled and proved. 2.3 Sentencing Data : Count No . Offender Score Serious - ness Level Standard Range (not including enhancements) Plus Enhancements* Total Standard Range (including enhancements) Maximum Term [ ] Additional current offense sentencing data is attached in Appendix 2.3. 2.4 Theft or taking of a motor vehicle sentence : For counts _______________, the midpoint of the standard sentence range is greater than one year and the defendant is sentenced for one of the following crimes that makes the defendant eli gible for the theft or taking of a motor vehicle sentence under Laws of 2019, ch. 191, §1:  Theft of a motor vehicle (RCW 9A.56.065) or an attempt;  Possession of a stolen vehicle (RCW 9A.56.068) or an attempt;  Taking a motor vehicle without permission in the first degree (RCW 9A.56.070); or  Taki ng a motor vehicle without permission in the second degree (RCW 9A.56.075). Felony Judgment and Sentence (FJS) Page 3 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/2019 )) 2.5 Legal Financial Obligations/Restitution . The court has considered the total amount owing, the defendant's financial resources and the nature of the burden that payment will i mpose. (RCW 10.01.160). The court makes the following specific findings: [ ] The defendant is indigent as defined in RCW 10.101.010(3)(a) -(c) because the defendant: [ ] receives public assistance [ ] is i nvoluntarily committed to a public mental healt h facility [ ] receives an a nnual income , after taxes, of 125 percent or less of the current federal poverty level. [ ] The defendant is not indigent as definied in RCW 10.101.010(3)(a) -(c). [ ] The following extraordinary circumstances exist that make restitution inappropriate (RCW 9.94A.753): ________________________________ ________________________________ _______________ . [ ] The defendant has the present means to pay costs of incarceration. RCW 9.94A.760. 2.6 [ ] Felony Firearm Offender Registration . The defendant committed a felony firearm offense as defined in RCW 9.41.0 10, and: [ ] The defendant should register as a felony firearm offender. The court considered the following factors in making this determination: [ ] the defendant’s criminal history. [ ] whether the defendant has previously been found not guilty by r eason of insanity of any offense in this state or elsewhere. [ ] evidence of the defendant’s propensity for violence that would likely endanger persons. [ ] other:_______________________________________________________________________. [ ] The defendant must register as a felony firearm offender because the offense was committed in conjunction with an offense committed against a person under the age of 18, or a serious violent offense or offense involving sexual motivation as defined in RCW 9.94A.030. III. Judgment 3.1 The defendant is guilty of the Counts and Charges listed in Paragraph 2.1 and Appendix 2.1. 3.2 [ ] The court dismisses Counts in the charging document. IV. Sentence and Order It is ordered : 4.1 Theft or Taking of a Motor Vehicle . Laws of 2019, ch. 191, §1 . The defendant is eligible for the theft or taking of a motor vehicle sentence . The court waives imposition of a sentence within the standard sentence range and imposes the following sentence: (1) Confinement . A term of confin ement in the custody of : [ ] the__________________________________ jail. [ ] the Department of Corrections (DOC) . [ ] The defendant was under 18 at the time of the offense and shall be initially placed in the custody of the Department of Children, You th, and Families (DCYF) : (Cannot be more than t he midpoint of the standard range, reduced by one -third of the ordered community custody term): _____________________ months of total confinement on Count ____________. _____________________ months of total co nfinement on Count ____________. _____________________ months of total confinement on Count ____________. Actual number of months of total confinement ordered is: ___________________________________. All counts shall be served concurrently, except fo r the following which shall be served consecutively: ________________________________________________________________________________. Felony Judgment and Sentence (FJS) Page 4 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/2019 )) This sentence shall run consecutively with the sentence in the following cause number(s) (see RCW 9.94A.589(3)): _____ ____________________________________________________________. Confinement shall commence immediately unless otherwise set forth here: ________________________ ____________________________________________________________________________________. Sentencin g alternatives for sentences under one year: [ ] Partial Confinement . The defendant may serve the sentence, if eligible and approved, in partial confinement in the following programs, subject to the following conditions:________________________ _____ _______________________________________________________________________________. [ ] work crew RCW 9.94A.725 [ ] home detention RCW 9.94A.731, .190 [ ] work release RCW 9.94A.731 [ ] electronic monitoring RCW 9.94A.030 [ ] Conversion of Jail Confinement (Nonviolent and Nonsex Offenses) . RCW 9.94A.680(3). The county jail is authorized to convert jail confinement to an available county supervised community option, to reduce the time spent in the community option by earned release credit consistent with local correctional facility standards, and may require the offender to perform affirmative conduct pursuant to RCW 9.94A. [ ] The defendant shall receive credit for time served in an available county supervised community option prior to sentencing. The jail shall compute time served. [ ] Alternative Conversion . RCW 9.94A.680. _______________ days of total confinement ordered above are hereby converted to ________________ hours of community restitution (service) (8 hours = 1 day, no nviolent offenders only, 30 days maximum) under the supervision of the Department of Corrections (DOC) to be completed on a schedule established by the defendant's community corrections officer but not less than ______________ hours per month. [ ] Alt ernatives to total confinement were not used because of: ______________________________ [ ] criminal history [ ] failure to appear (finding required for nonviolent offenders only RCW 9.94A.680). Confinement begins : Confinement shall commence immedia tely unless otherwise set for th here: _________________________________________________________________________________ _______ . Credit for Time Served . The defendant shall receive credit for eligible time served prior to sentencing if that confinement w as solely under this cause number. RCW 9.94A.505. The jail shall compute time served. (2) Community Custody . The defendant shall serve (6 to 12 months on community custody ): _____________________ months in community custody on Count ________________. _____________________ months in community custody on Count ________________. _____________________ months in community custody on Count ________________. The defendant shall comply with the community custody conditions in paragraph 4.2. 4.2 Community Cust ody Conditions . The defendant shall report to the Department of Corrections ( DOC ) not later than 72 hours after sentencing or release from custody at the address provided in open court or by separate document. The defendant shall cooperate with the DOC as sessment and comp ly with any programs that result from the assessment that DOC makes available during community custody. The defendant shall :  comply with the instructions, rules and regulations of DOC for the conduct of the defendant during the period of community custody.  obey all laws, perform affirmative acts as required by DOC to confirm compliance with the court orders .  inform DOC of court -ordered treatment upon the request of DOC.  comply with any other conditions of community custody stated in t his Judgment and Sentence or imposed by DOC under RCW 9.94A.704 during community custody. Felony Judgment and Sentence (FJS) Page 5 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/2019 )) While under supervision, the defendant shall not own, use, or possess firearms or ammunition. The court orders that during the period of supervision the defendant shall: [ ] pay all court -ordered legal financial obligations. [ ] notify the community corrections officer in advance of any change in defendant’s address or employment. [ ] not possess or consume controlled substances, including marijuana, without vali d prescription. [ ] not possess or consume alcohol. [ ] report as directed to a community corrections officer. [ ] remain within prescribed geographical boundaries. [ ] devote time to specific employment or occupation. [ ] obtain prior approval from DOC of residence location and living arrangements. [ ] obtain a mental health evaluation and comply with recommended treatment. [ ] obtain a substance use disorder evaluation and comply with recommended treatment. Other conditions: ______________ ___________________________________________________________ ________________________________________________________________________________________ . The conditions of community custody shall begin immediately unless otherwise set forth here:__________ _________________________________________________________________________. Court -Ordered Treatment: If any court orders mental health or substance use disorder treatment, the defendant must notify DOC and the defendant must release treatment information to DOC for the duration of incarceration and supervision. RCW 9.94A.562. 4.3 Legal Financial Obligations : The defendant shall pay to the clerk of this court: JASS/Odyssey CODE PCV 310 5 $ 500 Victim assessment RCW 7.68.035 PDV 3102 $_____________Dom estic Violence (DV) assessment RCW 10.99.080 $ Violation of a DV protection order ($15 mandatory fine) RCW 26.50.110 CRC 3403 $ Court costs, including RCW 9.94A.760, 9.94A.505, 10.01.160, 10.46.190 Criminal filing fee $200.00 FRC Witness costs $ WFR Sheriff service fees $ SFR/SFS/SFW/WRF Jury demand fee $ JFR Extradition costs $ EXT Other $ PUB 3225 $ Fees for court appointed attorney RCW 9.94A.760 WFR 3231 $ Court appointed defense expert and other defense costs RCW 9.94A.760 CLF 3212 $ Crime lab fee [ ] suspended due to indigency RCW 43.43.690 $ 100 DNA collection fee [ ] suspended . DNA previously collected RCW 43.43.75 41 $ Other fines or costs for: Felony Judgment and Sentence (FJS) Page 6 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/2019 )) $ Restitution to: RTN/RJN 3801 $ Restitution to: $ Restitution to: (Name and Address --address may be withheld and provided confidentially to Clerk of the Court’s office.) $ Total RCW 9.94A.760 [ ] The above total does not include all restitution or other legal financial obligations, which may be set by later order of the court. An agr eed restitution order may be entered. RCW 9.94A.753. A restitution hearing: [ ] shall be set by the prosecutor. [ ] is scheduled for (date). [ ] The defendant waives any right to be present at any restitution hearing (sign initials):_____________. [ ] Restitution Schedule attached. [ ] Restitution ordered above shall be paid jointly and severally with: Name of other defendant Cause Number (Victim’s name) (Amount -$) RJN ________________________________ ________________________________ ____________________ ________________________________ ________________________________ ___________________ [ ] The Department of Corrections (DOC) or clerk of t he court shall immediately issue a Notice of Payroll Deduction. RCW 9.94A.7602, RCW 9.94A.760(8). [ ] All payments shall be made in accordance with the policies of the clerk of the court and on a schedule established by DOC or the clerk of the court, c ommencing immediately, unless the court specifically sets forth the rate here: Not less than $_____ per month commencing _______________________________. RCW 9.94A.760. (Restitution payments must begin immediately. RCW 9.4A.750(1).) The defendant shall report to the clerk of the court or as directed by the clerk of the court to provide financial and other information as requested. RCW 9.94A.760(7)(b). [ ] The court orders the defendant to pay costs of incarceration at the rate of $______________ per day (actual costs not to exceed $100 per day). ( JLR ) RCW 9.94A.760. (This provision does not apply to costs of incarceration collected by DOC under RCW 72.09.111 and 72.09.480.) The restitution obligations imposed in this judgment shall bear interest from the date of the judgment until payment in full, at the rate applicable to civil judgments. No interest shall accrue on non -restitution obligations imposed in this judgment. RCW 10.82.090. An award of costs on appeal against the defendant may be ad ded to the total legal financial obligations. RCW 10.73.160. 4.4 DNA Testing . The defendant shall have a biological sample collected for purposes of DNA identification analysis and the defendant shall fully cooperate in the testing. The appropriate age ncy shall be responsible for obtaining the sample prior to the defendant's release from confinement. This paragraph does not apply if it is established that the Washington State Patrol crime laboratory already has a sample from the defendant for a qualify ing offense. RCW 43.43.754. The facility where the defendant serves the term of confinement shall be responsible for obtaining the sample as part of the defendant ’s intake process or as soon as practicable . If further c onfinement is not ordered, t he defen dant shall report to ____________________________________ (law enforcement agency) by _____________________________ (date/time) to provide a biological sample. Failure to provide a biological sample is a gross misdemeanor. Felony Judgment and Sentence (FJS) Page 7 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/2019 )) 4.5 No Contact : [ ] The defe ndant shall not have contact with _________________________________________________ __________________________________________________________ (name) including, but not limited to, personal, verbal, telephonic, written , or contact through a third party unt il ___________________ (which does not exceed the maximum statutory sentence). [ ] The defendant is excluded or prohibited from coming within ______________________ (distance) of: [ ] _______________________________________________ (name of protected pe rson(s)’s [ ] home/ residence [ ] work place [ ] school [ ] (other location(s)) ______________________________________ _________________________________________________________________________________, or [ ] other location __________________________ __________________________________________, until _______________________ (which does not exceed the maximum statutory sentence). [ ] A separate Domestic Violence No -Contact Order, Antiharassment No -Contact Order, Stalking No -Contact Order, or Sexual As sault Protection Order is filed concurrent with this Judgment and Sentence. 4.6 Other : . 4.7 Exoneration : The Court hereby exonerates any bail, bond , and/or personal recognizance conditions. V. Notices and Signatures 5.1 Collateral Attack on Judgment . If you wish to petition or move for collateral attack on this Judgment and Sentence, including but not limited to any personal restraint petition, state habeas corpus petition, motion to vacate judgment, motion to withdraw guilty plea, motion f or new trial or motion to arrest judgment, you must do so within one year of the final judgment in this matter, except as provided for in RCW 10.73.100. RCW 10.73.090. 5.2 Length of Supervision . The court shall retain jurisdiction over you, for the purp ose of your compliance with payment of the legal financial obligations, until you have completely satisfied your obligation, regardless of the statutory maximum for the crime. RCW 9.94A.760 and RCW 9.94A.505(5). The clerk of the court has authority to c ollect unpaid legal financial obligations at any time while you remain under the jurisdiction of the court for purposes of your legal financial obligations. RCW 9.94A.760(4) and RCW 9.94A.753(4). 5.3 Notice of Income -Withholding Action . If the court has not ordered an immediate notice of payroll deduction in Section 4.1, you are notified that the Department of Corrections (DOC) or the clerk of the court may issue a notice of payroll deduction without notice to you if you are more than 30 days past due in monthly payments in an amount equal to or greater than the amount payable for one month. RCW 9.94A.7602. Other income -withholding action under RCW 9.94A.760 may be taken without further notice. RCW 9.94A.7606. 5.4 Reserved 5.5a Firearms . You may not own, use or possess any firearm, and under federal law any firearm or ammunition, unless your right to do so is restored by the court in which you are convicted or the superior court in Washington State where you live, and by a federal court if required. You must immediately surrender any concealed pistol license. (The clerk of the court shall forward a copy of the defendant's driver's license, Felony Judgment and Sentence (FJS) Page 8 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/2019 )) identicard, or comparable identification to the Department of Licensing along with the date of conviction or com mitment.) RCW 9.41.040, 9.41.047. 5.5b [ ] Felony Firearm Offender Registration . The defendant is required to register as a felony firearm offender. The specific registration requirements are located in the “Felony Firearm Offender Registration” attach ment. 5.6 Reserved. 5.7 [ ] Department of Licensing Notice : The court finds that Count ________ is a felony in the commission of which a motor vehicle was used. 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 46.20.285. 5.8 [ ] Department of Licensing Notice – Defendant under age 21 only. Count ________ is 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 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 revoke the Defendant’s driver’s license. RCW 46.20.265 5.9 Other : ________________________________ ________________________________ _______________ . Done in Open Court and in the presence of the defendant this date:_________________________ _____ ____ . _____ _______________________________________________ Judge /Print Name: _____________________________ ____________________________ _____________________________ Deputy Prosecuting Attorney Attorney for Defendant Defendant WSBA No. WSBA No. Print Name: Print Name: Print Name: Voting Rights Statement : I acknowledge that I have lost my right to vote because of this felony conviction. If I am registered to vote, my voter registration will be cancelled. My right to vote is provision ally restored as long as I am not under the authority of DOC (not serving a sentence of confinement in the custody of DOC and not subject to community custody as defined in RCW 9.94A.030). I must re - register before voting. The provisional right to vote m ay be revoked if I fail to comply with all the terms of my legal financial obligations or an agreement for the payment of legal financial obligations. My right to vote may be permanently restored by one of the following for each felony conviction: a) a ce rtificate of discharge issued by the sentencing court, RCW 9.94A.637; b) a court order issued by the sentencing court restoring the right, RCW 9.92.066; c) a final order of discharge issued by the indeterminate sentence review board, RCW 9.96.050; or d) a certificate of restoration issued by the governor, RCW 9.96.020. Voting before the right is restored is a class C felony, RCW 29A.84.660. Registering to vote before the right is restored is a class C felony, RCW 29A.84.140. Defendant’s signature: _____ _________________________________________ Felony Judgment and Sentence (FJS) Page 9 of 9 (Parenting Sentencing Alternative) (RCW 9.94A.500, .505)(WPF CR 84.0400 ( 07/2019 )) I am a certified or registered interpreter , or the court has found me otherwise qualified to interpret, in the _________________________________ language, which the defendant understands. I interpreted this Ju dgment and Sentence for the defendant into that language. I certify 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) ______ ________________. _______________________________________ ____________________________________________ Interpreter Print Name VI. Identification of the Defendant SID No. ______________________________________ (If no SID complete a separate Applica nt card (Form FD -258) for State Patrol) Date of Birth __________________________ FBI No. __________________________________ Local ID No. __________________________ PCN No. __________________________________ Other ________________________________ Alias n ame, DOB: ___________________________________________________________________ Race : Ethnicity : Sex : [ ] Asian [ ] Black [ ] Indian -American Indian or Alaska Native [ ] Hispanic [ ] Male [ ] Multiracial [ ] Native Hawaiian or Other Pacific Isla nder [ ] Non -Hispanic [ ] Female [ ] Refused [ ] White [ ] Unavailable [ ] Refused [ ] Unknown [ ] Other: [ ] Unknown Fingerprints : I attest that I saw the defendant who appeared in court affix his or her fingerprints and signature on this document. Clerk of the Court, Deputy Clerk, _______________________________ Dated:_________________ The defendant’s signature : Left four fingers taken simultaneously Left Thumb Right Thumb Right four fingers taken simultaneously