COURT OF COMMON PLEAS, FRANKLIN COUNTY, OHIO STATE OF OHIO, vs. _________________________________________ ____________ , 20___ CASE NO. ___________________ Recog: $_____________________ Reporting: ______________________ Rept. W/: ___: Drug Screens ___: Alcohol Screens ___: Drug and Alcohol Screens ____: by Phone Surety: $____________________ Surety OR Appearance: $_________________________________________ AS A FURTHER CONDITION OF BOND: ___: As a condition of the Defendant's Bond, the Defendant SHALL have no contact, either direct or indirect, with any of the alleged victim(s) identified in the indictment, or with any of the witnesses. Furthermore the Defendant SHALL stay 500 feet away from any address(es) listed in the indictment. Verify employment and maintain employment. Verify and maintain school attendance. The Defendant is not to Possess or Use a Firearm of any kind. Make child support payments. No unsupervised contact with minors. No internet access except as required for employment. Undergo Mental Health assessment. ___: Undergo Drug assessment. House arrest ___: with school privileges. ___: with work privileges. ___: ___: ___: ___: ___: ___: ___: ___: ___: The defendant SHALL have his/her photo identification and fingerprints taken by the Franklin County Sheriff's Office. By:___________________ Surrender Passport, Green card or other government issued travel documents. ___: ___: Other: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________ JUDGE/MAGISTRATE _____________________________________ PROSECUTING ATTORNEY American LegalNet, Inc. www.FormsWorkFlow.com