Defendant’s full name: JUDGMENT AND DISPOSITION ORDER IN THE CIRCUIT COURT OF _______________, ARKANSAS _____DISTRICT _____ DIVISION On _________________________ the Defendant appeared before the Court, was advised of the nature of the charge(s), of constitutional and legal rights, of the effect of a guilty plea upon those rights, and of the right to make a statement before sentencing. The Court made the following findings: DEFENDANT'S FULL NAME: DATE OF BIRTH: RACE: SEX: SID #: DEFENDANT'S ATTORNEY: PROSECUTING ATTORNEY OR DEPUTY: Defendant was represented by ___ private counsel ___ public defender ___ appointed counsel ___ himself/herself Defendant made a voluntary, knowing and intelligent waiver of the right to counsel: ___ Yes ___ No There being no legal cause shown by the Defendant, as requested, why judgment should not be pronounced, a judgment is hereby entered against the Defendant on each charge enumerated, fines levied, and court costs assessed. Defendant was advised of the conditions of the sentence and/or placement on probation and understands the consequences of violating those conditions. The Court retains jurisdiction during the period of probation/suspension and may change or set aside the conditions of probation/suspension for violations or failure to satisfy Department of Community Punishment rules and regulations. -------------------------------------------------------------------------------------------------------------------------------------------------------------TOTAL NUMBER OF COUNTS: -------------------------------------------------------------------------------------------------------------------------------------------------------------Offense # 1 Docket #: Arrest Tracking #: A.C.A. # of Offense: Name of Offense: Seriousness Level of Offense: Criminal History Score: Presumptive Sentence: Sentence is a departure from the sentencing grid. ___ Yes ___ No. Offense is a ___felony ___misdemeanor. Classification of offense: ___A ___B ___C ___D ___U ___Y Period of Confinement: ___ months. Suspended imposition of sentence: ___ months. Period of Probation: ___ months. Defendant is assigned to ___ county jail ___ Department of Community Punishment and/or probation ___ confinement under special conditions. Special conditions of confinement are attached. ___ Yes ___ No. Defendant ___attempted ___solicited ___conspired to commit the offense. Offense date: Number of counts: Commitment on this offense is a result of the revocation of Defendant's probation or suspended imposition of sentence. ___ Yes ___ No. Victim of the offense was ___under ___over the age of 18 years. Defendant voluntarily, intelligently, and knowingly entered a ___ negotiated plea of guilty or nolo contendere. ___ plea directly to the court of guilty or nolo contendere. Defendant ___ entered a plea as shown above and was sentenced by a jury. ___ was found guilty of said charge(s) by the court, and sentenced by ___the court ___a jury. ___ was found guilty at a jury trial, and sentenced by ___the court ___a jury. ___ Defendant committed a target offense and was sentenced under the Community Punishment Act. Upon successful completion of the conditions of probation/S.I.S. Defendant shall be eligible to have his/her records sealed. Page ___ of ___ American LegalNet, Inc. www.FormsWorkflow.com Offense # Defendant’s full name: Docket #: Arrest Tracking #: A.C.A. # of Offense: Name of Offense: Seriousness Level of Offense: Criminal History Score: Presumptive Sentence: Sentence is a departure from the sentencing grid. ___ Yes ___ No. Offense is a ___felony ___misdemeanor. Classification of offense: ___A ___B ___C ___D ___U ___Y Period of Confinement: ___ months. Suspended imposition of sentence: ___ months. Period of Probation: ___ months. Defendant is assigned to ___ county jail ___ Department of Community Punishment and/or probation ___ confinement under special conditions. Special conditions of confinement are attached. ___ Yes ___ No. Defendant ___attempted ___solicited ___conspired to commit the offense. Offense date: Number of counts: Commitment on this offense is a result of the revocation of Defendant's probation or suspended imposition of sentence. ___ Yes ___ No. Victim of the offense was ___under ___over the age of 18 years. Defendant voluntarily, intelligently, and knowingly entered a ___ negotiated plea of guilty or nolo contendere. ___ plea directly to the court of guilty or nolo contendere. Defendant ___ entered a plea as shown above and was sentenced by a jury. ___ was found guilty of said charge(s) by the court, and sentenced by ___the court ___a jury. ___ was found guilty at a jury trial, and sentenced by ___the court ___a jury. ___ Defendant committed a target offense and was sentenced under the Community Punishment Act. Upon successful completion of the conditions of probation/S.I.S. Defendant shall be eligible to have his/her records sealed. -------------------------------------------------------------------------------------------------------------------------------------------------------------------Offense # Docket #: Arrest Tracking #: A.C.A. # of Offense: Name of Offense: Seriousness Level of Offense: Criminal History Score: Presumptive Sentence: Sentence is a departure from the sentencing grid. ___ Yes ___ No. Offense is a ___felony ___misdemeanor. Classification of offense: ___A ___B ___C ___D ___U ___Y Period of Confinement: ___ months. Suspended imposition of sentence: ___ months. Period of Probation: ___ months. Defendant is assigned to ___ county jail ___ Department of Community Punishment and/or probation ___ confinement under special conditions. Special conditions of confinement are attached. ___ Yes ___ No. Defendant ___attempted ___solicited ___conspired to commit the offense. Offense date: Number of counts: Commitment on this offense is a result of the revocation of Defendant's probation or suspended imposition of sentence. ___ Yes ___ No. Victim of the offense was ___under ___over the age of 18 years. Defendant voluntarily, intelligently, and knowingly entered a ___ negotiated plea of guilty or nolo contendere. ___ plea directly to the court of guilty or nolo contendere. Defendant ___ entered a plea as shown above and was sentenced by a jury. ___ was found guilty of said charge(s) by the court, and sentenced by ___the court ___a jury. ___ was found guilty at a jury trial, and sentenced by ___the court ___a jury. ___ Defendant committed a target offense and was sentenced under the Community Punishment Act. Upon successful completion of the conditions of probation/S.I.S. Defendant shall be eligible to have his/her records sealed. Page ___ of ___ American LegalNet, Inc. www.FormsWorkflow.com Defendant’s full name: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------Jail Time Credit: ______ days Conditions of disposition or probation are attached. ___ Yes ___ No. A copy of the presentence investigation on sentencing information, including but not limited to criminal history elements is attached. ___ Yes ___ No. Fines $ Court Costs $ A judgment of restitution is hereby entered against the Defendant in the amount and terms as shown below: Amount $ ___ Due immediately ___ Installments of: Payment to be made to: If multiple beneficiaries, give names and show payment priority: Defendant has been adjudicated guilty of an offense requiring registration as a sex offender, and is ordered to complete the Sex Offender Registration Form: ___ Yes ___ No. Defendant adjudicated guilty of an offense requiring registration as a sex offender has been adjudicated guilty of a prior sex offense under a separate case number: Yes ____ No. If yes, list prior case number(s): _________________________ Defendant is alleged to be a Sexually Violent Predator, and is ordered to undergo an evaluation at a facility designated by the Department of Correction pursuant to A.C.A. 12-12-918: ___ Yes ___ No. Defendant has committed an aggravated sex offense, as defined in A.C.A. 12-12-903. ___ Yes ___ No. Defendant was adjudicated guilty of a felony offense, a misdemeanor sexual offense or a repeat offense (as defined in A.C.A. 12-12-1103), and is ordered to have a DNA sample drawn at: ___ a D.C.P. facility ___ the A.D.O.C. or _____________ (other): ___ Yes ___ No. Defendant was informed of the right to appeal: ___ Yes ___ No. Appeal Bond: $ The County Sheriff is hereby ordered to ___ transport the Defendant to the County Jail or ___ take custody of the Defendant for referral to a Regional Punishment Facility. Defendant shall report to the probation officer for assignment of a reporting date to a Regional Punishment Facility. ---------------------------------------------------------------------------------------------- Date: Circuit Judge: Signature:_____________________ I certify this is a true and correct record of this Court. Date: Circuit Clerk/Deputy:____________________________________ (Seal) Form Revised 08/2006 Page ___ of ___ American LegalNet, Inc. www.FormsWorkflow.com