SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE BANNING 311 E. Ramsey St., Banning, CA 92220 BLYTHE 265 N. Broadway, Blythe, CA 92225 INDIO 46-200 Oasis St., Indio, CA 92201 RIVERSIDE 4100 Main St., Riverside, CA 92501 MURRIETA 30755-D Auld Rd., Ste. 1226, Murrieta, CA 92563 RI-CR027 PEOPLE OF THE STATE OF CALIFORNIA FOR COURT USE ONLY vs. DEFENDANT: CASE NUMBER: AGREEMENT FOR SUPERVISED OWN RECOGNIZANCE RELEASE I agree to all of the following conditions of a supervised release on my own recognizance as ordered by the court: 1. I will appear in person at all times and places as ordered by this court and as ordered by any court in which the charge is subsequently pending; 2. I will obey all conditions imposed by the court; 3. I promise not to depart this state without permission of the court; 4. I WAIVE EXTRADITION if I fail to appear as ordered by the court and am apprehended outside of State of California; 5. The court may revoke the order for my release on my own recognizance, at its discretion, and either return me to custody or require that I give bail or other assurance for my appearance; and 6. I promise to obey the following additional conditions of my release: Inform the Probation Department's Pretrial Services Unit of your place of residence and reside at a residence approved by the probation officer. Give written notice to the probation officer 24 hours before changing your residence and not move without approval of the probation officer (P.O.). Report any law enforcement contacts to the Probation Department's Pretrial Services Unit within 48 hours. Report to the Probation Department's Pretrial Services Unit as directed & follow all reasonable directives of the P.O. Call the Probation Department's Pretrial Services Unit by telephone every Monday, or as directed by the probation officer, and call in after every court appearance at (951) 955-2885 for Banning, Riverside, and Southwest or (760) 863-8239 for Indio. Submit to chemical test for blood, saliva, breath or urine, or combination and reasonable physical tests requested by probation officer or law enforcement officer for detection of controlled substances or alcohol. Do not consume alcoholic beverages; do not frequent places where it is the main item of sale. Do not knowingly possess, use or have in your control, any controlled substances/drug related paraphernalia unless medically prescribed; report any prescribed usage to the probation officer. Attend ____________ rehabilitation/treatment program deemed appropriate by probation officer and authorize the release of information relative to the progress. Enroll in SCRAM within 1 business day. Pay the installation and monitoring fees in an amount/manner determined by LCA Client Services, and as directed by probation officer. Have no direct or indirect contact with . Do not annoy, harass, threaten or disturb the peace of . Reside at . Do not leave your place of residence between the hours of 9:00 p.m. and 5:00 a.m. without permission of the P.O. Submit to immediate search and seizure of your person and property, including any and all residences, premises, storage unit, containers or vehicles accessible to or under your control at any time, by any probation officer or law enforcement officer, with or without reasonable cause. I acknowledge that I have been informed and understand that: (1) Noncompliance with any of the above-stated conditions will result in a report of the violation to the court and the issuance of a bench warrant for my arrest (PC §§ 978.5, 1043, 1038); (2) Any person who is charged with the commission of a misdemeanor who is released on his/her own recognizance and who willfully fails to appear as agreed is guilty of a separate misdemeanor punishable by imprisonment in the County Jail not exceeding 6 months, or by fine up to $1,000.00 or both; (3) Any person who is charged with the commission of a felony who is released on his/her own recognizance and who willfully fails to appear as agreed is guilty of a separate felony punishable by imprisonment in the state prison not more than 3 years, or by fine up to $10,000.00, or by both. Defendant's Signature: Street Address: City, State, Zip: Witness to Signature: Approved for Optional Use Riverside Superior Court RI-CR027 [Rev. 12/01/15] Telephone Number: Page 1 of 1 AGREEMENT FOR SUPERVISED OWN RECOGNIZANCE RELEASE California Penal Code §1318-1320 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com