Nevada County Mental Health Treatment Court Referral Defense Atty : Date: DA: Probation Officer (if applicable): Client: Alias: Address: Telephone: D.O.B.: Next Court Date: Case No. Underlying Charges ( note if VOP/1203.2 ) Maximum exposure DA does / does not object to referral (no agreement as to appropriateness). Special conditions of probation, if accepted into M HC (i.e. drug terms, search terms, Disposition upon graduation of MHC ( check all that apply; if not checked, indicates no agreement ): R see above) ; Reduction to misdemeanor per Penal Code 24717 ; Dismissal per Penal Code 2471203.4 Disposition i f terminated from MHC (if there is no new case): Term /type of probation / Custody time / A ny other special conditions ( i.e. drug terms, ): Signature of defense counsel : Signature of DA : 9/12/14, JO/JS American LegalNet, Inc. www.FormsWorkFlow.com