Municipal Court Order County of ________________________________ Municipal Court of _______________________________ State of New Jersey Summons/Complaint No. __________________ vs. ___ ___ ___ ___ Court Code _____________________ Docket Number ________________________________________________ Defendant Judgment of Conviction ________________________________________________ Change of Judgment ________________________________________________ Address Suspension of Proceedings Whereas, on _____ / _____ / _____ the above named pled guilty to; was convicted of; was granted suspended proceedings for; violating the provisions of __________________, __________________, __________________, __________________, it is Ordered that, commencing on _____ / _____ / _____, the defendant: Be placed/continued on PROBATION for _____ (months) _____ (years) and comply with the standard conditions of probation pursuant to R. 3:21-7 of the Court Rules Governing Criminal Practice. If the offense occurred on or after February 1, 1993 and the sentence is to probation or to a State Correctional facility, a transaction fee of up to $1.00 is to be paid on each occasion when a payment or installment payment is made. (N.J.S.A. 2C:46-1d.); Be placed/continued on SUPERVISORY TREATMENT (N.J.S.A. 2C:36A-1) for _____ (months) _____ (years); Perform COMMUNITY SERVICE for a period of _____ (days) _____ (hours) to be performed under the direction and supervision of the __________________________________ County Probation Services; Serve a JAIL sentence of _______________. Jail Time Credit: _______________' Work Release recommended SLAP recommended Complete an out-patient/residential TREATMENT program at ___________________________________________________________, to be arranged by Probation by defendant; Pay the following: PAY TO ( AMOUNT VCCB PROB CRT ü Other: Please specify ) *OTHER PAY TO ( PAID AT SENTENCING AMOUNT PROB ü ) *OTHER CRT PAID AT SENTENCING $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL The total remaining financial obligation of $ ___________ is to be paid in installments of $ ___________ per ___________________; 1. Restitution Beneficiary: _____________________________________________________________________________ $ ___________ (Name) (Address) (Amount) 2. Restitution Beneficiary: _____________________________________________________________________________ $ ___________ (Name) (Amount) (Address) *OTHER (Please identify creditor) The defendant's driving privileges are revoked for _________________ (months) _________________ (years); Comply with the following ADDITIONAL conditions of Probation/Supervisory Treatment: ________________________________ ___________________________________________________________________________________________________________________; Judge (name): _________________________ Judge (signature): ____________________________ Date: ____ / ____ / ____ Failure to comply with this Order may be cause for returning this case to court for another disposition that may include sentence to a period of incarceration. Receipt of this Order is acknowledged: Name: ____________________________________ Signature: _______________________________ Date: ____ / ____ / ____ Note: There is a related active Domestic Violence TRO Attachments: TRO/PRO Complaint PSR PRO (attach copy). DEFENDANT INFORMATION: Defendant's Name: ______________________________________ Date of Birth: ________________________________________ Social Security Number: _________________________________ Telephone Number: ( Driver's License Number: ________________________________ Eye Color: __________________________________________ Employer: ______________________________________________ Address: ___________________________________________ Other Contact Person: ___________________________________ Telephone Number: ( ) _________________________ ) _________________________ American LegalNet, Inc. www.USCourtForms.com Municipal Court Order Municipal Court of _______________________________ County of ________________________________ State of New Jersey Summons/Complaint No. __________________ vs. ___ ___ ___ ___ Court Code _____________________ Docket Number ________________________________________________ Defendant JUDGMENT OF CONVICTION ________________________________________________ CHANGE OF JUDGMENT ________________________________________________ Address SUSPENSION OF PROCEEDINGS Whereas, on _____ / _____ / _____ the above named defendant pled guilty to; was convicted of; or was granted suspended proceedings for: violating the provisions of __________________, __________________, __________________, __________________. It is Ordered that, commencing on _____ / _____ / _____, the defendant: Be placed/continued on PROBATION for _____ (months) _____ (years) and comply with the standard conditions of probation pursuant to R. 3:21-7 of the Court Rules Governing Criminal Practice. If the offense occurred on or after February 1, 1993 and the sentence is to probation or to a State Correctional facility, a transaction fee of up to $1.00 is to be paid on each occasion when a payment or installment payment is made. (N.J.S.A. 2C:46-1d.); Be placed/continued on SUPERVISORY TREATMENT (N.J.S.A. 2C:36A-1) for _____ (months) _____ (years); Perform COMMUNITY SERVICE for a period of _____ (days) _____ (hours) to be performed under the direction and supervision of the __________________________________ County Probation Services; Work Release recommended SLAP recommended Serve a JAIL sentence of _______________. Jail Time Credit: _______________ Complete an out-patient/residential TREATMENT program at __________________________________________________, to be arranged by Probation by defendant; Pay the following: PROB AMOUNT VCCB Other: Please specify PAY TO ( ü ) CRT PAY TO ( ü ) PROB AMOUNT PAID AT SENTENCING CRT PAID AT SENTENCING $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL The total remaining financial obligation of $ ___________ is to be paid in installments of $ ___________ per ___________________; 1. Restitution Beneficiary: _____________________________________________________________________________ $ ___________ (Name) (Address) (Amount) 2. Restitution Beneficiary: _____________________________________________________________________________ $ ___________ (Name) (Amount) (Address) The defendant's driving privileges are revoked for _________________ (months) _________________ (years); Comply with the following ADDITIONAL conditions of Probation/Supervisory Treatment: (see attached) THE FOLLOWING MUST BE COMPLETED PRIOR TO FILING WITH THE SUPERIOR COURT CLERK: CREDITOR AMOUNT CREDITOR AMOUNT CREDITOR AMOUNT 1. $ 4. $ 5. $ 2. $ 3. $ 6. $ Judge's name: _________________________ Judge's signature: ____________________________ Date: ____ / ____ / ____ Failure to comply with this Order may be cause for returning this case to court where you may be resentenced which may include a period of incarceration. Receipt of this Order is acknowledged: Name: ____________________________________ Signature: _______________________________ Date: ____ / ____ / ____ Note: There is a related active Domestic Violence Attachments: Complaint PSR TRO PRO (attach copy). TRO/PRO DEFENDANT INFORMATION: Defendant's Name: ______________________________________ Date of Birth: ________________________________________ Social Security Number: _________________________________ Telephone Number: ( Driver's License Number: ________________________________ Eye Color: __________________________________________ Employer: ______________________________________________ Address: ___________________________________________ Other Contact Person: ___________________________________ Telephone Number: ( Gold: FILE ) _________________________ ) _________________________ American LegalNet, Inc. www.USCourtForms.com Municipal Court Order Municipal Court of _______________________________ County of ________________________________ State of New Jersey Summons/Complaint No. __________________ vs. ___ ___ ___ ___ Court Code ________________________________________________ Defendant _____________________ Docket Number JUDGMENT OF CONVICTION ________________________________________________ ________________________________________________ Address CHANGE OF JUDGMENT SUSPENSION OF PROCEEDINGS Whereas, on _____ / _____ / _____ the above named defendant pled guilty to; was convicted of; or was granted suspended proceedings for: violating the provisions of __________________, __________________, __________________, __________________. It is Ordered that, commencing on _____ / _____ / _____, the defendant: Be placed/continued on PROBATION for _____ (months) _____ (years) and comply with the standard conditions of probation pursuant to R. 3:21-7 of the Court Rules Governing Criminal Practice. If the offense occurred on or after February 1, 1993 and the sentence is to probation or to a State Correctional facility, a transaction fee of up to $1.00 is to be paid on each occasion when a payment or installment payment is made. (N.J.S.A. 2C:46-1d.); Be placed/continued on SUPERVISORY TREATMENT (N.J.S.A. 2C:36A-1) for _____ (months) _____ (years); Perform COMMUNITY SERVICE for a period of _____ (days) _____ (hours) to be performed under the direction and supervision of the __________________________________ County Probation Services; Work Release recommended SLAP recommended Serve a JAIL sentence of _______________. Jail Time Credit: _______________ Complete an out-patient/residential TREATMENT program at __________________________________________________, to be arranged by Probation by defendant; Pay the following: PAY TO ( ü ) PROB AMOUNT VCCB Other: Please specify CRT PAY TO ( ü ) PROB AMOUNT PAID AT SENTENCING CRT PAID AT SENTENCING $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL The total remaining financial obligation of $ ___________ is to be paid in installments of $ ___________ per ___________________; 1. Restitution Beneficiary: _____________________________________________________________________________ $ ___________ (Name) (Address) (Amount) 2. Restitution Beneficiary: _____________________________________________________________________________ $ ___________ (Name) (Amount) (Address) The defendant's driving privileges are revoked for _________________ (months) _________________ (years); Comply with the following ADDITIONAL conditions of Probation/Supervisory Treatment: (see attached) THE FOLLOWING MUST BE COMPLETED PRIOR TO FILING WITH THE SUPERIOR COURT CLERK: CREDITOR AMOUNT CREDITOR AMOUNT CREDITOR AMOUNT 1. $ 4. $ 5. $ 2. $ 3. $ 6. $ Judge's name: _________________________ Judge's signature: ____________________________ Yellow: SUPERIOR COURT Date: ____ / ____ / ____ American LegalNet, Inc. www.USCourtForms.com