FORM 9A. APPENDIX "A" (WITHOUT SEX OFFENDER CONDITIONS)
CONDITIONS FOR SENTENCE TO PROBATION, DEFERRED OR SUSPENDED SENTENCE IN THE CASE OF
State vs. _______
Criminal Case No. ________--_______ County
By Order of the Court:
1. You must not violate any federal, tribal, state, county or municipal criminal law or ordinance during the period of probation.
(___) 2. You must not own, purchase, borrow, possess, use or carry any type of firearm, destructive device or dangerous weapon while on probation.
3. You must not willfully defraud a urine test administered as a condition of probation.
(___) 4. You must continue your present employment or seek and maintain suitable employment; you may pursue a vocational or educational course of study that will lead to future or better employment.
(___) 5. You must not use or possess any alcoholic beverage, or
enter any liquor, beer
or wine establishment during the period of time you are under probation supervision, unless
otherwise authorized by your parole/probation officer.
(___) 6. You must refrain from excessive use of alcohol. Any excessive use of alcohol or controlled substances will give your parole/probation officer the right to require you to undergo an outpatient evaluation and abide by the recommendations of the evaluator. Excessive use of alcohol is presumed if you have an alcohol concentration of ____ percent or higher.
(___) 7. You must not use or possess any non-prescribed controlled substance while on probation supervision. You must not knowingly associate with users or traffickers in narcotics, marijuana, or other controlled substances.
(___) 8. You must not associate with any known felons without prior permission from your parole/probation officer.
(___) 9. You must not possess or use any type of surveillance equipment such as audio, video, and motion detectors, scanners or any type of surveillance or counter surveillance equipment without prior written permission from your parole/probation officer.
(___) 10. You must inform your parole/probation officer in the manner that they direct
any changes in your place of residence and employment, and other pertinent activities. You
must answer truthfully all reasonable inquiries by the parole/probation officer and report to
them as directed. This information must be furnished to the parole/probation officer by
written report, telephone, or a personal visit to their office. Your parole/probation officer
may visit your residence or place of employment at reasonable hours. You
within twenty-four hours to: _____________________________.
(___) 11. You must submit your person, place of residence and vehicle, or any other property to which you may have access, to search and seizure at any time of day or night by a parole/probation officer, with or without a search warrant.
(___) 12. You must waive extradition to the State of North Dakota from any
in or outside the United States where you may be found, and you
also agree not
any effort by any jurisdiction to return you to the State of North Dakota while this probation
is in effect.
(___) 13. You must support your dependents.
(___) 14. You must regularly attend weekly self-help groups such as Alcoholic Anonymous/Narcotics Anonymous, Gamblers Anonymous, Sex Addicts Anonymous, Sexaholics Anonymous or equivalent non-faith-based alternative as approved by the court.
(___) 15. You must submit to a medical examination or other reasonable testing to include breath, blood, saliva or urine samples for the purpose of determining the use of alcohol or controlled substances whenever requested by any parole/probation officer. You must not use any adulterants that may affect the results of a breath, blood, saliva, or urine test.
(___) 16. You must receive a chemical dependency/addiction evaluation and comply with all treatment recommendations, subject to your right to a hearing before the court if you disagree with any treatment recommendation.
(___) 17. You must pay the following monetary obligations in the total amount of $____. The total amount of the obligation must be paid prior to the end of probation:
a. Fines in the amount of $___;
b. Court appointed attorney fees in the amount of $___;
c. Court administration fees and facility improvement fee in the amount of $___;
d. Restitution in the amount of $___;
e. Victim assistance fees in the amount of $___;
f. Community service fees in the amount of $ _____;
g. Other in the amount of $___.
(___) 18. You must pay a supervision fee in the amount of $______each month to the North Dakota Division of Parole and Probation, also known as the Division of Field Services, as required by N.D.C.C. § 12.1-32-07 (2).
(___) 19. You must pay the amount of $______ to the North Dakota Division of Parole and Probation, also known as the Division of Field Services, as required by N.D.C.C. § 12.1-32-02 (10) and (11), for preparation of the presentence investigation report.
(___) 20. You must undergo various agreed-to community constraints as intermediate measures of the Department of Corrections and Rehabilitation to avoid revocation under N.D.C.C. § 12.1-32-07 (3).
(___) 21. You must submit to fingerprinting at the direction of your parole/probation officer.
(___) 22. You must not telephone or write to the victim(s), or contact the victim(s) through third parties or be within ____ yards of the victim(s) without written permission of your parole/probation officer.
(___) 23. You must not enter onto the premises, travel past, or loiter near where the victim(s) resides without written permission of your parole/probation officer.
(___) 24. You must provide a sample of blood or other body fluid for DNA law enforcement identification purposes and inclusion in law enforcement identification databases as required by N.D.C.C. ch. 31-13. You must pay the cost of the collection and processing of the DNA sample.
(___) 25. You must attend, participate in, and successfully complete a cognitive restructuring program.
(___) 26. You must submit to placement on and compliance with an electronic surveillance or monitoring system. You must not tamper with, damage, destroy or remove any of this equipment. You must be within the range of this equipment for monitoring, reporting or surveillance purposes. You must reimburse the North Dakota Department of Corrections and Rehabilitation for the actual cost of replacement for any tampered with, damaged, destroyed, lost, or misplaced equipment.
(___) 27. You must perform _____ hours of community service to be completed as follows: _____________________.
(___) 28. You must not leave the State of North Dakota without permission of your probation officer.
(___) 29. Other: ___________________________________________.
Dated (Month) (Day), (Year).
BY THE COURT,
The above conditions of probation have been read and explained to me and I fully understand each one. I must follow the conditions that the Court has listed or checked; and I understand that failure to follow any one or more of those conditions may result in a revocation of the probation and that the Court may re-sentence me to any sentence that was available to the Court at the time of the initial sentencing. I acknowledge receipt of a copy of the Judgment.
Dated (Month) (Day), (Year).
The probation conditions have been read and explained to my client by the Court. I attest that my client has stated that he/she understands each one of the court ordered probation conditions.
Dated (Month) (Day), (Year).
Original to Court file
___ 1 Certified copy to Warden/Superintendent of NDSP, TRCU, MRCC -- if imprisonment is ordered
___ 1 Certified copy to Sheriff/Jail Administrator -- if county imprisonment is ordered
___ 1 Copy to Defendant
___ 1 Copy to State's Attorney
___ 1 Copy to Local Probation Officer -- if on supervised probation