Original - Court 1st copy - Jail 2nd copy - Michigan State Police CJIC
3rd copy - Defendant 4th copy - Prosecutor 5th copy - Gun board (if needed)
STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT
ORI Court address
CASE NO. JUDGMENT OF SENTENCE COMMITMENT TO JAIL
Court telephone no.
Police Report No. The State of Michigan THE PEOPLE OF v
CTN/TCN SID DOB Defendant name, address, and telephone no.
THE COURT FINDS: 1. Defendant was found guilty on
Date CONVICTED BY Count Plea* Court Jury DISMISSED BY*
of the crime(s) as stated below:
CRIME CHARGE CODE(S) MCL citation/PACC Code
*For plea: insert "G" for guilty plea, "NC" for nolo contendere, or "MI" for guilty but mentally ill. For dismissal: insert "D" for dismissed by court or "NP" for dismissed by prosecutor/plaintiff.
represented by an attorney: advised of right to counsel and appointed counsel and knowingly, intelligently, and voluntarily waived that right. 3. Conviction reportable to Secretary of State**. Defendant's driver's license number is . 4. Sanctions reportable to State Police**. Revoked. Suspended days. Restricted days. ** (see back) 5. HIV testing and sex offender registration is completed. 6. Defendant has been fingerprinted according to MCL 28.243. IT IS ORDERED: 7. Probation is revoked. 8. Defendant is sentenced to jail as follows: Report at m. 2. Defendant
Date Sentence Begins
To Be Served
Release Authorized for the Following Purpose
Release Period From To
Upon payment of fine and costs .... To work or seek work ..................... For attendance at school ............... For medical treatment.................... Other: 9. Defendant shall pay:
State Minimum Crime Victim Restitution Court Costs Attorney Fees Fine Other Costs Total
$ $ $ $ $ $ $ $ The due date for payment is . Fine, costs, and fees not paid within 56 days of the due date are subject to a 20% late penalty on the amount owed. Only the fine and some costs may be satisfied by serving time in jail. Defendant shall serve days in jail beginning for failure to pay on time. 10. Defendant shall be placed on probation for months and abide by the terms of probation. (See separate order.) 11. Defendant shall complete the following rehabilitative services. Alcohol Highway Safety Education Treatment ( outpatient, inpatient, residential, mental health). Specify: 12. The vehicle used in the offense shall be immobilized or forfeited. (See separate order.) 13. The concealed weapon board shall suspend for days permanently revoke the concealed weapon license, permit number , issued by County. 14. Other:
Date MC 219 (3/09) Judge/Magistrate Bar no. MCL 765.15(2), MCL 769.1k, MCL 769.16a, MCL 775.22, MCL 780.766, MCL 780.826, MCR 6.427
JUDGMENT OF SENTENCE/COMMITMENT TO JAIL
Currently convictions are reportable to the Secretary of State pursuant to: · MCL 257.625(21)(a) · MCL 257.732 · MCL 324.80131 · MCL 324.81134(12) · MCL 324.81135(7) · MCL 324.82157 · MCL 333.7408a(11) Sanctions are reportable to the State Police pursuant to: · MCL 333.7408a(11) and MCL 333.7408a(12)(b), including sentences for imprisonment under 90 days · MCL 257.625(21)(b)