Approved, SCAOOriginal - Court1st copy - Defendant2nd copy - Prosecutor3rd copy - Sheriff/Facility 4th copy - � Originating law enforcement � agency (when applicable) 5th copy - LEIN (when applicable)STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUIT PRETRIAL RELEASE ORDER � AMENDED CONDITIONS � AMENDED LEIN EXPIRATION DATECASE NO. Bound Over from District CourtDistrict Case No:ORICourt addressCourt telephone no.MI- Date of arrestType of offense Misdemeanor � FelonyArresting agencyAgency file no. Offense(s) � Statute/ordinance citation(s) Purpose of next appearanceTime of appearanceDate of appearance Place of appearance At the court address above � Other: TYPE OF BOND: � � � Personal recognizance � Cash/Surety � � � Cash/Surety/10% Cash � � Real property* � *Proof of value and interest in real property is required.Full bail amount$Bond set by Judge/Magistrate � The State of MichiganTHE PEOPLE OF en-US Juvenile � In the matter of en-US en-USven-USDefendant222s name, address, and telephone no.en-USDate of birthen-USCTN/TCN 1. � � a. � Release on personal recognizance shall be ordered as required by MCR 6.106(C). � � � b. � Release on personal recognizance will not reasonably ensure � appearance. � en-US public safety. � 2. � Under 18 USC 922(g)(8), the court found, at a hearing, that the defendant/juvenile represents a credible threat to the � physical safety of one or more persons as defined in 18 USC 922(g)(8) and 18 USC 921(a)(32) and named in item 4q. � � en-US**Needed for NCIC.en-USIT IS ORDERED: 3. � � a. � The defendant/juvenile shall post a new bond and comply with the terms and conditions in item 4. � � b. � The bond previously ordered is continued, and the defendant/juvenile shall comply with the terms and conditions in item 4. 4. � The defendant/juvenile shall comply with the following terms and conditions that are checked: � � a. � Personally appear for any examination, arraignment, trial, sentencing, or at any time and place as directed by this court. � If represented by an attorney in this case, any notice to appear may be given to the defendant222s attorney instead of the � defendant. � � � b. � Abide by any judgment entered in this case and surrender to serve any sentence imposed. � � � c. � Do not leave the State of Michigan without the permission of this court. � � � d. � Do not commit any crime while released. � � e. � Immediately notify this court, in writing, of any change of address or telephone number. � � f. � Make reports to a court agency as specified by this court or the agency. � � g. � Do not use alcohol or any other illegal controlled substance. � � h. � Participate in a substance abuse testing or monitoring program. en-US(See additional page for more conditions) American LegalNet, Inc. www.FormsWorkFlow.com Case No. en-USIT IS ORDEREDen-US (continued): � � i. � Participate in a specified treatment program for any physical or mental condition, including substance abuse. � � j. � Comply with restrictions on personal association, place of residence, place of employment, or travel. � � k. � Surrender driver222s license or passport. � � � l. � Continue to seek employment. � � � m. � Comply with the following curfew: en-US � � n. � Continue or begin an educational program. � � � o. � Remain in the custody of a responsible member of the community. The community member agrees to monitor the � � defendant/juvenile and report any violation of these release conditions to the court. � � p. � Do not possess or purchase a firearm or other dangerous weapon. � � q. � Do not harass, intimidate, beat, molest, wound, stalk, threaten, or engage in other conduct that would place any of the � following persons or a child of any of the following persons in reasonable fear of bodily injury: spouse, former spouse, � individual with whom the defendant has a child in common, resident or former resident of the defendant222s household. en-US � � r. � Do not assault, harass, intimidate, beat, molest, wound, or threaten the following person(s): � � en-USName(s) � � s. � Do not have (or cause any third party to have) any direct or indirect contact with the following person(s): � ( en-USNote:en-US This condition also applies while the defendant/juvenile is in custody.) � en-USName(s) � � t. � Do not enter the following specified premises or areas: � en-USAddress or other location � � May go to the address once, accompanied by a peace officer, to remove personal belongings. � � u. � Other: � 5. � The � sheriff � en-US en-USCustodial agency/Facilityen-US � shall hold the defendant/juvenile named above in its care and custody until bond is posted and the terms and conditions � � specified in item 4 are acknowledged. The defendant/juvenile shall be brought to all court appearances while in custody � or as otherwise ordered. The sheriff or director or designee of the custodial facility is authorized to obtain and consent to � routine, nonsurgical medical and dental care for the juvenile and emergency medical, dental, and surgical treatment of the � juvenile. � 6. � This order shall be entered into LEIN, is effective when signed, and expires on en-US en-US . � en-US(en-USNote:en-US Check when release is subject to conditions necessary to protect 1 or more named persons under MCL 765.6b or for NCIC.) en-USHeighten-USWeighten-USRaceen-USSexen-USDate of birthen-USHair coloren-USEye coloren-USOther identifying information en-USDate � Judge/Magistrate � Bar no. American LegalNet, Inc. www.FormsWorkFlow.com Case No. en-USI acknowledge and understand the terms and conditions of my release from jail. If I fail to perform all the terms and conditions, en-USI may be subject to arrest without a warrant, jail, contempt of court, and new conditions of release. If my release is revoked and en-USa bond was posted, the full amount of my bond, regardless of who posted it, may be forfeited. If I am arrested for a violation of en-USthese terms and conditions in another state, I waive all extradition proceedings and will be immediately returned to this state.en-USNOTICE OF FIREARMS RESTRICTIONen-US: If item 4q is a condition of my release, federal and/or state law may prohibit me from en-USpossessing or purchasing ammunition or a firearm (including a rifle, pistol, or revolver). en-USDate � en-USDefendant/Juvenile222s signatureen-USBond deposited by Defendant: en-USIf all the terms and conditions of pretrial release are met, the money deposited (bond) will be en-USused to pay any fine, state minimum costs, restitution, statutory assessments, and other costs imposed. Any balance will be en-USreturned to me as authorized by statute and court rule. en-USDate � en-USDefendant222s signature Bond deposited by � Third Party: � Surety/Agent: � en-USI understand and agree that if the defendant fails to appear,en-USthe money deposited (bond) may be forfeited and a judgment entered for the entire amount of the bond. If the defendant en-USappears as directed, the full amount of the bond will be returned to me unless I deposited a 10% cash bond. In that instance,en-USthe court will return only 90% of the bond to me. en-USDate � en-USSignature of depositor/surety/agent and identification (i.e. DLN) � � en-USName of depositor/surety/agent (type or print) � en-USAddress � en-USCity, state, zip Telephone no.en-USNote: � If a third party or surety posted bond for the defendant, the court clerk may provide the third party or surety with a copy en-USof the terms and conditions of release.en-USACKNOWLEDGMENT OF PRETRIAL RELEASE CONDITIONS en-USAcknowledgment of Pretrial Release Conditions American LegalNet, Inc. www.FormsWorkFlow.com