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

JUDGMENT AND COMMITMENT CONDITIONS
NORTH DAKOTA DEPARTMENT OF CORRECTIONS AND REHABILITATION
FIELD SERVICES DIVISION

APPENDIX (A)
CONDITIONS FOR SENTENCE TO PROBATION,
DEFERRED, OR SUSPENDED SENTENCE IN THE CASE OF
State vs. __________________________________
Criminal Case No. ____- 20____ - CR - __________
Term of Probation _________years / months

BY ORDER OF THE COURT:
While you are on probation, you must not:
(__) 1. Violate any criminal law or ordinance. This includes any violation of a federal,
tribal, state, county or municipal criminal law or ordinance.
(__) 2. Use or possess any type of firearm, destructive device, or dangerous weapon.
(__) 3a. Use or possess any alcoholic beverage or enter any place licensed to sell or serve
alcoholic beverages.
(__)3b. Use alcohol to excess. Excessive use of alcohol is presumed if you have an
alcohol concentration of ____% or greater.
(__) 4. Use or possess a controlled substance which has not been prescribed for you or
mis-use any controlled substance which has been prescribed for you.
(__) 5. Use or possess surveillance equipment or counter-surveillance equipment.
(__) 6. Have any contact with ____________________. This includes telephone, written,
and electronic communication and contact through other people.
(__) 7. Come within ____ yards of ________________________ or (his) (her) residence.
(__) 8. Willfully defraud a urine test administered as a condition of probation.
While you are on probation, you must:
(__) 9. Report to the probation office within 24 hours of sentencing or release from
custody.
(__) 10. Stay in regular contact with your probation officer as you are instructed by the
probation officer. You must have the approval of your probation officer before
you change your address. You must inform your probation officer of any
change of employment, or telephone number. You must be truthful with your
probation officer.
(__) 11. Allow your probation officer to visit your residence or place of employment.
(__) 12. Allow your probation officer or other probation officers to search your person,
place of residence, vehicle, or other property you have control over at any time
of the day or night even if the probation officer doesn’t have a search warrant.
Your probation officer may request assistance of law enforcement officers to
conduct a search.
(__) 13. Continue with your present employment or seek and maintain suitable
employment. You may attend school or training that will help you find better
employment.
(__)14. Allow medical examination or other testing for the purpose of determining if you
have used alcohol or controlled substances. This includes testing of breath,
blood, saliva, urine or sweat.
(__)15. Have a chemical addiction evaluation or other diagnostic evaluation and follow
any treatment recommendations. You may ask for a hearing if you disagree
with treatment recommendations.
(__)16. Waive extradition to North Dakota if you are arrested outside of North Dakota.
(__)17. Provide support for your dependents.
(__)18. Pay the following:
a. Fine:
b. Court-appointed attorney fees:
c. Court fees:
d. Restitution:
e. Victim assistance fees:
f. Other:
Total
__________
__________
__________
__________
__________
__________
__________
(__) 19. Pay a monthly supervision fee in the amount of $55 for probation supervision.
(__) 20. Pay $50 for preparation of the pre-sentence investigative report.
(__) 21. Be fingerprinted.
(__) 22. Provide a sample of blood or other body fluid for DNA law enforcement
purposes and pay the cost of collecting and processing the DNA sample.
(__) 23 Successfully complete:
___a. A cognitive restructuring program if your probation officer asks you to
do so.
___b. Domestic violence offender treatment.
___c. An anger management program.
___d. _____ hours of community service.
(__) 24. Participate in electronic monitoring and follow all of the rules of the electronic
monitoring system as required by your probation officer.
(__) 25. Complete any intermediate condition which you agree to complete to avoid
revocation or probation.
While on probation you must have the written approval from your probation
officer before you:
(__) 26. ___a. Associate with anyone you know to be a felon.
___b. Associate with known drug users or traffickers
___c. Leave North Dakota.
(__) 27. Other conditions of probation:
By the Court:
Date: ______________ ______________________________________
Judge
The conditions of probation have been explained to me. I agree to follow the conditions which
are listed and checked. I know that if I don’t follow the conditions of probation, my probation
may be revoked and I could be re-sentenced to any sentence which could have been imposed
at the time I was sentenced.
Date: ______________ ______________________________________
Probationer
The conditions of probation have been explained to my client by the Judge. My client has
indicated (he)(she) understands the conditions of probation.
Date: ______________ ________________________________________
Defense Attorney