Free cc243a.pmd - Michigan

Approved, SCAO

Original - Court (Part 1) 1st copy - Probation department (Part 1) 2nd copy - Defendant (Part 1)

3rd copy - Prosecutor (Part 1) 4th copy - Law enforcement agency (Part 2) 5th copy - Court LEIN copy (Part 2)

STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
ORI Court address

CASE NO. ORDER OF PROBATION
Court telephone no.

MI-

Police Report No. The State of Michigan THE PEOPLE OF v
CTN/TCN SID DOB Defendant's name, address, and telephone no.

Probation officer Offense and PACC

Term

Judgment of guilt is deferred under: MCL 333.7411, Controlled Substance Act MCL 750.350a, Parental Kidnapping Act

MCL 762.14, Youthful Trainee Status MCL 600.1070, Drug Treatment Court

Pursuant to 18 USC 922(g)(8), the court found, at a hearing, that the defendant represents a credible threat to the physical safety of one or more persons as defined in 18 USC 922(g)(8) and 18 USC 921(32) and named in item 9. **Needed for NCIC entry. IT IS ORDERED that the defendant be placed on probation under the supervision of the probation officer named above for the term indicated, and the defendant shall: 1. Not violate any criminal law of any unit of government. 2. Not leave the state without the consent of this court. 3. Make a truthful report to the probation officer monthly, or as often as the probation officer may require, either in person or in writing, as required by the probation officer. 4. Notify the probation officer immediately of any change of address or employment status. 5. Not purchase or possess a firearm. (Needed for NCIC entry.) 6. Pay the following to the court: Crime Victim Assessment ... $ Fine ................... $ Restitution ........................... $ Costs ................. $ State minimum costs ........... $ Other .................. $ 0.00 Total ................... $ a. The due date for payment is . b. The total amount due shall be paid in installments of $ per starting on and paid in full by the due date stated in the judgment of sentence or by .Date Fines, costs, and fees not paid within 56 days of the date owed or of any installment payment date are subject to a 20% late penalty on the amount owed. 7. Pay a supervision fee to the Department of Corrections in the amount of $ . The fee is payable immediately. The total amount due may be paid in installments of $ per starting on Date payable to the State of Michigan. 8. Comply with the attached wage assignment order. 9. Other: (Use this space for conditions for the protection of one or more named persons - also complete the LEIN order on Part 2 of this form. See
back of form for required language when conditions are ordered pursuant to 18 USC 922[g][8].)

Failure to comply with this order may result in a revocation of probation and incarceration.
Date Judge Bar no.

I have read or heard the above order of probation and have received a copy. I understand and agree to comply with this order. I also understand that federal and/or state law may prohibit me from possessing or purchasing ammunition or a firearm (including a rifle, pistol, or revolver) if the court found I represent a credible threat to the physical safety of a named person and/or explicity prohibited (in item 9) the use, attempted use, or threatened use of physical force that would reasonably be expected to cause bodily injury to that named person.
Date Defendant signature

If the judgment of guilt is deferred as stated above, the clerk of the court shall advise the Michigan State Police Criminal Justice Information Center of the disposition as required under MCL 769.16a.
CC 243a (1/08)

ORDER OF PROBATION, Part 1

MCL 600.4803, MCL 769.1a, MCL 771.1 et seq., MCL 775.22, MCL 780.826, MCR 6.445, 18 USC 922(g)(8)

Approved, SCAO

Original - Court (Part 1) 1st copy - Probation department (Part 1) 2nd copy - Defendant (Part 1)

3rd copy - Prosecutor (Part 1) 4th copy - Law enforcement agency (Part 2) 5th copy - Court LEIN copy (Part 2)

STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
ORI Court address

CASE NO. ORDER OF PROBATION
Court telephone no.

MI-

Police Report No. The State of Michigan THE PEOPLE OF v
CTN/TCN SID DOB Defendant's name, address, and telephone no.

Probation officer Offense and PACC

Term

Judgment of guilt is deferred under: MCL 333.7411, Controlled Substance Act MCL 750.350a, Parental Kidnapping Act

MCL 762.14, Youthful Trainee Status MCL 600.1070, Drug Treatment Court

Pursuant to 18 USC 922(g)(8), the court found, at a hearing, that the defendant represents a credible threat to the physical safety of one or more persons as defined in 18 USC 922(g)(8) and 18 USC 921(32) and named in item 9. **Needed for NCIC entry. IT IS ORDERED that the defendant be placed on probation under the supervision of the probation officer named above for the term indicated, and the defendant shall: 1. Not violate any criminal law of any unit of government. 2. Not leave the state without the consent of this court. 3. Make a truthful report to the probation officer monthly, or as often as the probation officer may require, either in person or in writing, as required by the probation officer. 4. Notify the probation officer immediately of any change of address or employment status. 5. Not purchase or possess a firearm. (Needed for NCIC entry.) 6. Pay the following to the court: Crime Victim Assessment ... $ Fine ................... $ Restitution ........................... $ Costs ................. $ State minimum costs ........... $ Other .................. $ 0.00 Total ................... $ a. The due date for payment is . b. The total amount due shall be paid in installments of $ per starting on and paid in full by the due date stated in the judgment of sentence or by .Date Fines, costs, and fees not paid within 56 days of the date owed or of any installment payment date are subject to a 20% late penalty on the amount owed. 7. Pay a supervision fee to the Department of Corrections in the amount of $ . The fee is payable immediately. The total amount due may be paid in installments of $ per starting on Date payable to the State of Michigan. 8. Comply with the attached wage assignment order. 9. Other: (Use this space for conditions for the protection of one or more named persons - also complete the LEIN order on Part 2 of this form. See
back of form for required language when conditions are ordered pursuant to 18 USC 922[g][8].)

Failure to comply with this order may result in a revocation of probation and incarceration.
Date Judge Bar no.

TO LOCAL LAW ENFORCEMENT:The protective conditions in item 9 and the following identifying information of the defendant must be entered on the LEIN system. The court will notify local law enforcement of any amendments to or revocation of this order.
Height Weight Race Sex Date of Birth Hair Color Eye Color Other Identifying Information

Effective date of conditions in item 9 Date CC 243a (1/08)

Expiration date of order Judge/Magistrate Bar no.

ORDER OF PROBATION, Part 2

Required Language When Conditions are Issued Pursuant to 18 USC 922(g)(8): Use the following language when the conditions involve an intimate partner of the defendant or child of the intimate partner or defendant as defined in 18 USC 922(g)(8) and 18 USC 921(32). Defendant is restrained from harassing, stalking, or threatening, or engaging in other conduct that would place [insert name(s)] in reasonable fear of bodily injury. For details about these conditions, see SCAO Administrative Memorandum 2008-02.