AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 1 UNITED STATES DISTRICT COURT __________ District of __________ UNITED STATES OF AMERICA v. Judgment in a Criminal Case (For Revocation of Probation or Supervised Release) Case No. USM No. THE DEFENDANT: G admitted guilt to violation of condition(s) G was found in violation of condition(s) The defendant is adjudicated guilty of these violations: Violation Number Nature of Violation Violation Ended Defendant's Attorney of the term of supervision. after denial of guilt. The defendant is sentenced as provided in pages 2 through the Sentencing Reform Act of 1984. G The defendant has not violated condition(s) of this judgment. The sentence is imposed pursuant to and is discharged as to such violation(s) condition. It is ordered that the defendant must notify the United States attorney for this district within 30 days of any change of name, residence, or mailing address until all fines, restitution, costs, and special assessments imposed by this judgment are fully paid. If ordered to pay restitution, the defendant must notify the court and United States attorney of material changes in economic circumstances. Last Four Digits of Defendant's Soc. Sec. No.: Defendant's Year of Birth: City and State of Defendant's Residence: Signature of Judge Date of Imposition of Judgment Name and Title of Judge Date American LegalNet, Inc. www.FormsWorkFlow.com AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 1A Judgment--Page DEFENDANT: CASE NUMBER: ADDITIONAL VIOLATIONS of Violation Number Nature of Violation Violation Concluded American LegalNet, Inc. www.FormsWorkFlow.com AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 2-- Imprisonment Judgment -- Page of DEFENDANT: CASE NUMBER: IMPRISONMENT The defendant is hereby committed to the custody of the United States Bureau of Prisons to be imprisoned for a total term of : G The court makes the following recommendations to the Bureau of Prisons: G The defendant is remanded to the custody of the United States Marshal. G The defendant shall surrender to the United States Marshal for this district: G G at G a.m. G p.m. on . as notified by the United States Marshal. G The defendant shall surrender for service of sentence at the institution designated by the Bureau of Prisons: G G G before 2 p.m. on as notified by the United States Marshal. as notified by the Probation or Pretrial Services Office. RETURN I have executed this judgment as follows: . Defendant delivered on at to with a certified copy of this judgment. UNITED STATES MARSHAL By DEPUTY UNITED STATES MARSHAL American LegalNet, Inc. www.FormsWorkFlow.com AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 2A -- Imprisonment Judgment--Page of DEFENDANT: CASE NUMBER: ADDITIONAL IMPRISONMENT TERMS American LegalNet, Inc. www.FormsWorkFlow.com AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 3 -- Supervised Release Judgment--Page of DEFENDANT: CASE NUMBER: SUPERVISED RELEASE Upon release from imprisonment, the defendant shall be on supervised release for a term of : The defendant must report to the probation office in the district to which the defendant is released within 72 hours of release from the custody of the Bureau of Prisons. The defendant shall not commit another federal, state or local crime. The defendant shall not unlawfully possess a controlled substance. The defendant shall refrain from any unlawful use of a controlled substance. The defendant shall submit to one drug test within 15 days of release from imprisonment and at least two periodic drug tests thereafter as determined by the court. G G G G G The above drug testing condition is suspended, based on the court's determination that the defendant poses a low risk of future substance abuse. (Check, if applicable.) The defendant shall not possess a firearm, ammunition, destructive device, or any other dangerous weapon. (Check, if The defendant shall cooperate in the collection of DNA as directed by the probation officer. (Check, if applicable.) The defendant shall register with the state sex offender registration agency in the state where the defendant resides, works, or is a student, as directed by the probation officer. (Check, if applicable.) The defendant shall participate in an approved program for domestic violence. (Check, if applicable.) If this judgment imposes a fine or restitution, it is be a condition of supervised release that the defendant pay in accordance with the Schedule of Payments sheet of this judgment. The defendant must comply with the standard conditions that have been adopted by this court as well as with any additional conditions on the attached page. STANDARD CONDITIONS OF SUPERVISION 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) the defendant shall not leave the judicial district without the permission of the court or probation officer; the defendant shall report to the probation officer in a manner and frequency directed by the court or probation officer; the defendant shall answer truthfully all inquiries by the probation officer and follow the instructions of the probation officer; the defendant shall support his or her dependents and meet other family responsibilities; the defendant shall work regularly at a lawful occupation, unless excused by the probation officer for schooling, training, or other acceptable reasons; the defendant shall notify the probation officer at least ten days prior to any change in residence or employment; the defendant shall refrain from excessive use of alcohol and shall not purchase, possess, use, distribute, or administer any controlled substance or any paraphernalia related to any controlled substances, except as prescribed by a physician; the defendant shall not frequent places where controlled substances are illegally sold, used, distributed, or administered; the defendant shall not associate with any persons engaged in criminal activity and shall not associate with any person convicted of a felony, unless granted permission to do so by the probation officer; the defendant shall permit a probation officer to visit him or her at any time at home or elsewhere and shall permit confiscation of any contraband observed in plain view of the probation officer; the defendant shall notify the probation officer within seventy-two hours of being arrested or questioned by a law enforcement officer; the defendant shall not enter into