pg. 1 In the Circuit Court of County, Arkansas STATE PLA I NTIFF vs CR# DEFENDANT CONDITIONS OF PROBATION Now on this day of , 201, the defendant having entered a plea of guilty or having been found guilty in the above - styled action and having been plac ed on pr obation for a period of years for the offense(s) of will be subject to the following Conditions: IT IS HEREBY ORDERED that t he following conditions of probation are imposed upon the Defendant: 1 . REPORTING. You must report as directed to a supervising officer . You must report any contact with law enforcement to your supervising offi cer on the next regular week day . If you are transferring to another state, you should follow Interstate Compact reporting instructions. 2. EMPLOYMENT /EDUCATION. You must maintain employment that is approved by this Court and/or your supervising officer or be enrolled in an approved educational program unless otherwise directed. You must obtain permission from this Court and/or your supervising officer before quitting your employme nt or education al pro gram. If you lose your job or are dismissed from your educatio n al program, you must notify your supervising officer wi thin 48 hours. 3. RESIDENCE AND TRAVEL. You must obtain prior approval from you supervising officer to change your place of residence, stay away from your approved residence overnight, or leave Arkansas or a nother area established by the C ourt or your supervising officer. 4 . LAWS. You must obey all federal a nd state laws, local ordinances, and court orders. American LegalNet, Inc. www.FormsWorkFlow.com pg. 2 5. FIREARMS. You must not own, possess, use, pawn, sell, or have under you control any firearm (or imitation firearm) or be in the company of any person possessing such weapons. You must not posses s any ammunition. 6 . CONTROLLED SUBSTANCES. Y ou must not use, sell, distribute, or possess any controlled substance, or associate with any person who is participating in or is known to participate in the illegal use, sale, distribution, or possession of controlled substances, or be in places where such p ersons congregate. You may use or possess controlled substances pursuant to a legitimate prescription from a physician. You must be able to present pr oof of your prescription and provide the physician's name when requested. You must submit to random testing fo r the use of controlled substances . Testing may be of your breath, blood, o r urine at the direction of any supervising officer. 7. ALCOHOL . You must avoi d the excessive use of alcohol or abstain completely if directed. 8 . ASSOCIATION . You must not associate with convicted felons, persons who are engaged in criminal activity, or other persons specified by the C ourt or your supervising officer. However, contact with convicted felons at w ork, in counseling programs, in church, or in other locations and circumstances specifically approved by the Court or your superv ising officer is not prohibited. If you are unsure about whether you r contact with an individual is prohibited, you should s eek clarificati on from your supervising officer or this Court. 9 . FINANCIAL OBLIGATIONS. You are required to pay all court - ordered fines, fees, and/or rest itution. You must pay a monthly supervision fee and applicable program fees unless granted an exemption. You may be required to do community service work in place of paying certain fees. You must meet your personal financial responsibilities including paying your share of household expe nses and supporting your leg al dependents. 10 . TREATMENT AND COUNSELING . You must submit yourself to any rehabilitative, medical , or counseling program tha t the C ourt or your supervising officer deems appropriate and you are obligated to pay for these services. As evidence of your compliance, you must cause periodic reports to be submitted to your supervisin g officer by the treating or counseling progr am. American LegalNet, Inc. www.FormsWorkFlow.com pg. 3 11 . SEARCH AND SEIZURE. You must submit yo ur person, place of residence, motor v ehicles, and/or any other area or property under your control to search and seizure at any time, day or night, with or without a search warrant by any Arkansas Community C orrection officer or any other certified law enforcement officer. 12 . WAIVER OF EXTRADITION. You must remain within Arkansas unless granted permission to leave by a supervising officer. You agree to waive extradition from any jurisdiction in or outside of the United States and you must not contest any effort to return you to Arkansas to answer a charge of violation of any of the conditions of your probation . 13. COOPERATION AND HONESTY. You must always cooperate with your sup ervising officer and the C ourt. All written and oral statements made by you to y our supervising officer must be trut hful. Special Conditions: Anger Management Domestic Violence Classes Pay Fines and Court Costs Pay Restitution Dated: Circuit Judge (signature) American LegalNet, Inc. www.FormsWorkFlow.com pg. 4 I HAVE RECEIVED, READ, AND UNDERSTAND THE ABOVE CONDITIONS. I further understand that if I am found to have violated any of the above conditions during this period of probation that this Court could impose a sentence of up to years in the Arkansas Department of Correction and/or a fine of up to $. Additionally, my supervising officer has explained to me that if I am found to have violated any of the above conditions I could be subjected to the imposition of an administrative sanction, which could include a period of incarceration, imposed by the Arkansas Department of Community Correction. I hereby waive extradition to the State of Arkansas from any jurisdiction in or outside the United States where I may be found and agree that I will not contest any effort by any jurisdiction to return me to the State of Arkansas. Supervision Officer (print) /Date Supervision Officer (signature) Defendant (print)/Date Defendant (signature) My signature indicates that this Order was reviewedby me and a copy of the Order was provided to me. American LegalNet, Inc. www.FormsWorkFlow.com