IN THE SUPERIOR COURT OF GWINNETT COUNTY STATE OF GEORGIA STATE OF GEORGIA vs. _______________________________________________ Defendant Warrant Nos: _______________________________ Inmate No: _______________________________ CONSENT TO SEARCH & ACKNOWLEDGEMENT OF CONDITIONS OF PRETRIAL RELEASE REGARDING RESIDENTIAL OWNER/LESSOR OF PREMISES PROVIDING HOUSING TO DEFENDANT ON ELECTRONIC PRETRIAL RELEASE I am the residential owner/lessor of certain residential premises that will be the location of housing to be provided to the above-listed defendant. The Defendant is presently incarcerated in the Gwinnett County Detention Center awaiting trial. The Defendant has been unable to post bond and has made a request to be placed in the Pretrial House Arrest Program. 1. I have been given a copy of the [ ] proposed; [ ] actual; Consent Order House Arrest which sets forth all the terms and conditions of the Defendant’s Pretrial Electronic House Arrest. 2. The terms and provisions of this document regarding the defendant’s electronic pretrial release shall remain in effect until whichever event shall first occur: A. B. 3. The above-listed cases are terminated by adjudication or written dismissal; The defendant posts bond on these offenses which is approved by the sheriff as an alternative to this Pretrial House Arrest order. Defendant shall reside at my residence, until further order of this court, which is: ____________________________________________________________________________ This address is a private residence and is not a hotel, motel, boarding house or extended stay facility. This residence is owned/rented by me. 4. I have been advised, and I hereby agree to the following terms and conditions: A. I hereby consent and agree that my residence, and curtilage thereof, may be searched by any member of the Gwinnett Sheriff’s Department or any employee of the House Arrest Provider, at any time of the day or night, with or without a search warrant, during the term of defendant’s participation in the pretrial house arrest program. B. My residence MUST HAVE A BASIC TELEPHONE LINE in order for the house arrest equipment to properly operate. This basic telephone line cannot have any call waiting, call forwarding, answering service capabilities or such other features as restricted by the House Arrest Provider. It must immediately be available for access twenty four hours per day, seven day per week. The telephone line must be kept in good working condition and shall not emit a “busy” signal to monitoring equipment. I should consider adding such extra phone lines as I considers necessary to fulfill this requirement. -1- Q:\Magforms\MAG 95-09 Consent To Search & Conditions American LegalNet, Inc. www.FormsWorkflow.com C. During the term of this order, the Defendant shall not drink alcohol. The residence in which the defendant resides shall not have any alcoholic beverages within this residence during the term of this order. D. Defendant shall not take or possess any drugs unless prescribed lawfully. E. The Defendant shall immediately submit to all requests for breath, urine or blood specimen(s) which shall be tested for alcohol or drug content made by any member of the Gwinnett County Sheriff’s Department or any employee of the House Arrest Provider. The Defendant shall keep on his/her person the sum of $15.00 in cash to immediately pay for the cost of such drug test. Such tests may be requested daily, or at such interval as the House Arrest Provider determines, but no less than once per month unless specifically exempted. The Defendant acknowledges that the results of any incriminating results may be used against the Defendant in all subsequent criminal justice proceedings. F. While on this program, the Defendant shall immediately submit to all requests from any member of the Gwinnett County Sheriff’s Department, any duly sworn law enforcement officer or by any employee of the House Arrest Provider, to search defendant’s person, vehicle(s), and residence, at any time of the day or night, without a search warrant or further order of this court. This search shall include ALL areas of any residence occupied by the defendant. I have read the above listed terms and provisions and I have had each of the these terms and provisions explained to me. I do not require any further explanations. I freely and voluntarily accept and agree to abide by all the terms and provisions set forth herein and all the terms and provisions set forth regarding the Defendant’s Consent Order House Arrest, Pretrial Electronic Release Program, referred to and incorporated by reference herein. I agree to abide by all the directives, rules and regulations of the Sheriff’s Department and the House Arrest Provider regarding my providing residential premises to the defendant while on this program. This ____ day of _______________, 20____. ____________________________________ Witness _______________________________________ Residential Owner/Lessor _______________________________________ Print Name Address: _______________________________________________________________ City, State, Zip: _______________________________________________________________ Office Phone: ___________________________ Home Phone ________________________ -2- Q:\Magforms\MAG 95-09 Consent To Search & Conditions American LegalNet, Inc. www.FormsWorkflow.com