Defendant DOB Sex Total Number of Counts SID # Race & Ethnicity Supervision Status at Time of Offense A.C.A. # of Offense/ Name of Offense+ Case # A.C.A. # of Original Charged Offense ATN Offense was Appeal from District Court Probation/SIS Revocation+ Offense DateOffense is Offense Classification Number of Counts: Criminal History Score Seriousness LevelDefendant Presumptive Sentence Defendant Sentence 247247. 247 Victim Info Age Sex Race & Ethnicity Defendant voluntarily, intelligently, and knowingly entered a Sentence is a Departure Sentence Departure is Durational or Dispositional Departure Reason Aggravating # or Mitigating # . For Agg. #17 or Mit. #9, or if departing from guidelines, please explain: Sentence will run: Judge Prosecuting Attorney/Deputy Defendant222s Attorney Change of Venue S ENTEN C IN G O RDE R Offense #1 Le g al Statement Court Info Offender American LegalNet, Inc. www.FormsWorkFlow.com NOTE: *Defendant Sentence# Victim Info.+A.C.A. # of Offense/Name of Offense & Probation/SIS Revocation. Reasons for Departure AggravatingMitigating American LegalNet, Inc. www.FormsWorkFlow.com A.C.A. # of Offense/ Name of Offense+ Case # A.C.A. # of OriginalCharged Offense ATN Offense was Appeal from District Court Probation/SIS Revocation+ Offense DateOffense is Offense Classification Number of Counts: Criminal History Score Seriousness LevelDefendant Presumptive Sentence Defendant Sentence 247 Victim Info Age Sex Race & Ethnicity Defendant voluntarily, intelligently, and knowingly entered a Sentence is a Departure Sentence Departure is Durational or Dispositional Departure Reason Aggravating # or Mitigating # . For Agg. #17 or Mit. #9, or if departing from guidelines, please explain: Sentence will run: A.C.A. # of Offense/ Name of Offense+ Case # A.C.A. # of OriginalCharged Offense ATN Offense was Appeal from District Court Probation/SIS Revocation+ Offense DateOffense is Offense Classification Number of Counts: Criminal History Score Seriousness LevelDefendant Presumptive Sentence Defendant Sentence Victim Info Age Sex Race & Ethnicity Defendant voluntarily, intelligently, and knowingly entered a Sentence is a Departure Sentence Departure is Durational or Dispositional Departure Reason Aggravating # or Mitigating # . For Agg. #17 or Mit. #9, or if departing from guidelines, please explain: Sentence will run: Offense #: Offense #: American LegalNet, Inc. www.FormsWorkFlow.com Sex Offenses Domestic Violence Offenses DNA Sample/Qualifying Offense Drug Crime Extended Juvenile Jurisdiction Applied JAIL TIME CREDITTOTAL TIME TO BE SERVED FOR ALL OFFENSES Death Penalty If Yes, State Execution Date: Life LWOP DEFENDANT IS ASSIGNED TO: DEFENDANT WAS INFORMED OF APPELLATE RIGHTS Appeal Bond $ Prosecuting Attorney/Deputy (Print Name): Signature: Date: Circuit Judge (Print Name): Signature: Date: Additional Info: Court CostsRestitution to Terms Fines Booking/Admin Fees ($20) Drug Crime Assessment Fee ($125) DNA Sample Fee ($250) Children's Advocacy Center Fund Fee Public Defender User Fee Public Defender Attorney Fee Other (explain) Signature Sentence Options Fines, Fees, Restitution Special Conditions American LegalNet, Inc. www.FormsWorkFlow.com Additional Victim Information Offense # Victim # Age Sex Race/Ethnicity American LegalNet, Inc. www.FormsWorkFlow.com