Approved, SCAO Original - Court 1st copy - Corrections 2nd copy - Corrections (for return) 3rd copy - Michigan State Police CJIC 4th copy - Defendant 5th copy - Prosecutor STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY ORI JUDGMENT OF SENTENCE COMMITMENT TO DEPARTMENT OF CORRECTIONS CASE NO. Court address Court telephone no. MIPolice Report No. Defendant name, address, and telephone no. THE PEOPLE OF THE STATE OF MICHIGAN v CTN/TCN SID DOB Bar no. Prosecuting attorney's name Bar no. Defendant attorney's name THE COURT FINDS: 1. The defendant was found guilty on CONVICTED BY DISMISSED BY* Count Plea* Court Jury Date of the crime(s) stated below. CRIME CHARGE CODE(S) MCL citation/PACC Code *Insert "G" for guilty plea, "NC" for nolo contendere, or "MI" for guilty but mentally ill, "D" for dismissed by court, or "NP" for dismissed by prosecutor/plaintiff. 2. The conviction is reportable to the Secretary of State under MCL 257.625(21)(b). Defendant's driver's license number 3. HIV testing and sex offender registration are completed. 4. The defendant has been fingerprinted according to MCL 28.243. 5. A DNA sample is already on file with the Michigan State Police from a previous case. No assessment is required. IT IS ORDERED: 6. Probation is revoked. 7. Participating in a special alternative incarceration unit is prohibited. permitted. 8. The defendant is sentenced to custody of the Michigan Department of Corrections. This sentence shall be executed immediately. Count MINIMUM SENTENCE MAXIMUM Years Mos. Days Years Mos. Days DATE DATE SENTENCE BEGINS JAIL CREDIT Mos. Days OTHER INFORMATION 9. Sentence(s) to be served consecutively to each other. case numbers 10. The defendant shall pay: State Minimum Crime Victim Restitution (If this item is not checked, the sentence is concurrent.) . Court Costs Attorney Fees Fine Other Costs Total DNA Assess. $ $ $ $ $ $ $ $ The due date for payment is . Fine, costs, and fees not paid within 56 days of the due date are subject to a 20% late penalty on the amount owed. 11. The concealed weapon board shall suspend for days permanently revoke the concealed weapon license, permit number , issued by County. 12. The defendant is subject to lifetime monitoring under MCL 750.520n. 13. Court recommendation: Date Judge Bar no. $ I certify that this is a correct and complete abstract from the original court records. The sheriff shall, without needless delay, deliver the defendant to the Michigan Department of Corrections at a place designated by the department. (SEAL) Deputy court clerk CC 219b (6/15) MCL 765.15(2), MCL 769.1k, MCL 769.16a, MCL 775.22, MCL 780.766, MCR 6.427 American LegalNet, Inc. www.FormsWorkFlow.com JUDGMENT OF SENTENCE, COMMITMENT TO DEPARTMENT OF CORRECTIONS