FORM 9. (N.D.R.Crim.P.)

Obsolete Date: 3/1/2009

APPENDIX "A"

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. It is a violation of probation for you to violate any federal, tribal, state, county or municipal criminal law or ordinance during the period of probation.

2. It is a violation of probation for you to own, purchase, borrow, possess, use or carry any type of firearm, destructive device or dangerous weapon while on probation.

3. It is a violation of probation for you to willfully defraud a urine test administered as a condition of probation.

(___) 4. You shall 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. It is a violation of probation for you to use or possess any alcoholic beverage, or to 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 shall refrain from excessive use of alcohol. You understand that 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. It is a violation of probation for you to use or possess any non-prescribed controlled substance while on probation supervision. It is a violation of probation to knowingly associate with users or traffickers in narcotics, marijuana, or other controlled substances.

(___) 8. You are not to associate with any known felons without prior permission from your parole/probation officer.

(___) 9. It is a violation of your probation for you to 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 shall inform your parole/probation officer in the manner that they direct of any changes in your place of residence and employment, and other pertinent activities. You shall 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 shall report within twenty-four hours to: ____________________________________________.

(___) 11. You shall 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 shall waive extradition to the State of North Dakota from any jurisdiction in or outside the United States where you may be found, and you also agree not to contest any effort by any jurisdiction to return you to the State of North Dakota while this probation is in effect.

(___) 13. You shall support your dependents.

(___) 14. You shall regularly attend weekly self-help groups such as Alcoholic Anonymous/Narcotics Anonymous, Gamblers Anonymous, Sex Addicts Anonymous, Sexaholics Anonymous.

(___) 15. You shall 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. It is a violation of probation for you to use any adulterants that may affect the results of a breath, blood, saliva, or urine test.

(___) 16. You shall 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 shall pay the following monetary obligations to the clerk of court in the total amount of $____. The total amount of the obligation shall 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. Other in the amount of $___.

(___) 18. You shall pay a supervision fee in the amount of $36.00 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 shall pay the amount of $50.00 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 shall 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 shall submit to fingerprinting at the direction of your parole/probation officer.

(___) 22. It is a violation of your probation for you to 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. It is a violation of your probation for you to enter onto the premises, travel past, or loiter near where the victim(s) resides without written permission of your parole/probation officer.

(___) 24. You shall 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 shall pay the cost of the collection and processing of the DNA sample.

(___) 25. You shall attend, participate in, and successfully complete a cognitive restructuring program.

(___) 26. You shall submit to placement on an electronic surveillance system (GPS/EMS).

(___) 27. Other: ______________________________________________________.

The following are sex offender conditions:

(___) 28. You shall attend, participate in, cooperate with and successfully follow and complete all sex offender treatment program rules and requirements and admit responsibility for your offense(s) as part of the treatment requirements. You shall attend aftercare if recommended by the parole/probation officer or treatment staff.

(___) 29. You shall register your residential address, employment or school as required by N.D.C.C. § 12.1-32-15 with law enforcement in the county or city of your intended residence as a sex offender or a felony offender against children within 10 days of the date of your criminal judgment or your release from physical custody. You shall also notify law enforcement of any change of address, employment or school within 10 days of the change.

(___) 30. You shall not initiate, establish or maintain contact, directly or indirectly, with any child under the age of 18, or attempt to do so, except under circumstances approved in advance and in writing by your parole/probation officer.

(___) 31. You may only reside at a place of residence approved by your parole/probation officer. You may not move from your place of residence or sleep elsewhere overnight without your parole/probation officer's knowledge and permission and those with whom you reside must know that you are a sex offender.

(___) 32. You shall maintain employment at only such places as are approved by your parole/probation officer. It is a violation of probation for you to work outside the State of North Dakota or leave the State of North Dakota without permission under the Interstate Compact for the Supervision of Adult Offenders.

(___) 33. It is a violation of your probation for you to go to or loiter near schoolyards, parks, playgrounds, arcades, or other places primarily used or visited by minors.

(___) 34. It is a violation of your probation for you to obtain employment with any agency or place of business that provides services for the care or custody of minors and you may not operate a business that provides such services without written permission of your parole/probation officer.

(___) 35. It is a violation of your probation for you to purchase, possess, or use sexually stimulating materials of any kind or to use 900 telephone numbers.

(___) 36. It is a violation of your probation for you to subscribe to any Internet service provider, by modem, LAN, DSL or any other manner. You may not use another person's Internet or use Internet through any commercial venue until and unless approved in writing by your parole/probation officer.

(___) 37. It is a violation of your probation for you to possess children's items, including, but not limited to, children's clothing, toys, games, pictures and books, without written permission from your parole/probation officer.

(___) 38. It is a violation of your probation for you to date or socialize with anybody who has children under the age of 18 without written permission of your parole/probation officer.

(___) 39. You shall notify your parole/probation officer of any new and existing romantic or sexual relationships in which you may be involved.

(___) 40. You shall submit to any program of psychiatric, psychological or physiological assessment approved by the court.

(___) 41. You shall be financially responsible for all costs related to assessments, polygraphs and any treatment programming ordered by the court.

(___) 42. Employment: You may travel to _____________each day for employment, provided the employment is regular and the employer requires you to work in ____________. You may only be in_______________ for employment purposes during scheduled working hours and you shall return to ___________________immediately after the completion of work each day. It is a violation of probation for you to be in or remain in ________________ for any purpose except for employment and to travel to and from employment. You shall register as a sex offender in _____________________.

(___) 43. Visitation. You may travel to ____________________for visitation with________________, provided that there are no minor children in the _____________________ household at the time of visitation. You may only be in _____________________ for visitation purposes and may on be at _________________ residence and you shall return to ___________________ immediately after completion of visitation. It is a violation of probation for you to be in or remain in ________________ for any purpose except for visitation. You shall register as a sex offender in ______________.

(___) 44. Other: ______________________________________________________.

Dated (Month) (Day), (Year).

BY THE COURT,

_________________________________________________________.

JUDGE

The above conditions of probation have been read and explained to me and I fully understand each one. I shall 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).

_________________________________________________________.

Probationer

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).

_________________________________________________________.

Defense Attorney

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