SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO Ukiah Courthouse 100 North State Street Ukiah, CA 95482-0337 Ten Mile Branch 700 South Franklin Street Fort Bragg, CA 95437 For Court Use Only: In the matter of: a minor STIPULATION AND ORDER re: Victim Restitution W&I 654.2 CASE NUMBER: W&I 790 STIPULATION 1) (Minor) is the subject of a delinquency petition filed on (date) . with the following offenses: charging him/her 2) The minor's parent(s)/legal guardian(s) is/are: a. Name of Mother: b. Name of Father: c. Name of Legal Guardian(s): 3) We ask the court to continue the hearing on the petition in order to afford the minor an opportunity to complete: a minimum of six (6) months of informal supervision pursuant to Welfare & Institutions Code � 654.2; or a minimum of twelve (12) months on deferred entry of judgment pursuant to Welfare & Institutions Code � 790. We understand that the minor would benefit from informal supervision or deferred entry of judgment because s/he would not be adjudicated a ward of the court and would not be subject to detention in the Juvenile Hall 4) In addition, we agree to (check one): Pay victim restitution pursuant to the terms of Welfare & Institutions Code � 730.6 and 730.7 in an amount to be determined by the court as a condition of informal supervision. Be jointly and severally responsible for the payment of victim restitution pursuant to the terms of Welfare & Institutions Code � 730.6 and 730.7 as follows: $ $ to victim #1 to victim #2 MJV-200 (new 070714) American LegalNet, Inc. www.FormsWorkFlow.com guardian) for (co-minors' parent/legal (co-minor(s)) and Be jointly and severally liable with the payment of victim restitution pursuant to the terms of Welfare & Institutions Code � 730.6 and 730.7 as follows: $ $ to victim #1 to victim #2 5) We agree that this Stipulation and Order to pay victim restitution shall remain in effect until victim restitution is paid in full and that any unpaid balance shall not be discharged upon termination of informal supervision. We agree that if victim restitution has not been paid in full at the time that informal supervision terminates, the court may issue a civil judgment in favor of the victim pursuant to Welfare & Institutions Code � 730.6(r) and 730.7(c) and Penal Code � 1214, and that the victim shall thereafter have the right to collect the unpaid balance using any method authorized by law. _____________________________ Minor ________________________________ Minor's Attorney 6) ______________________________ Minor's Parent/Legal Guardian ______________________________ Minor's Parent/Legal Guardian ORDER The terms of the foregoing Stipulation are hereby adopted as the order of the court. Dated: _____________________ Judge of the Superior Court MJV-200 (new 070714) American LegalNet, Inc. www.FormsWorkFlow.com