Page 1 of 5 DUII Diversion Form 1 Revised 2/2019 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR WASHINGTON COUNTY State of Oregon Case Number : Tracking Violation : v. PETITION AND AGREEMENT DUII Diversion Defendant Date of DUII Offense: Defendant222s Residence: Street City State ZIP Mailing Address (if different) Date of Birth: / / Month Day Year Phone N umber : Driver License N umber : State : S ID number from incarceration if known or applicable (This is not your Social Security number): DEFENDANT222S AGREEMENT AND WAIVER I am the Defendant. I ask the court to grant a diversion under ORS 813.200 to 813.270 for the charge of driving under the influence of intoxicants (DUII). If the court allows this petition: 1) I have been provided with the Explanation of Rights and DUII Diversion Agreement, I have read and understand all of the information contained therein and I agree to: a) Pay the required diversion fees and any restitution ordered b) Complete an alcohol and drug abuse assessment and any recommended treatment c) Attend a victim impact panel as ordered by the court and pay a one-time (cash only) participation fee at the program entrance d) Not use alcohol or other intoxicants except as allowed in the provided Explanation of Rights and DUII Diversion Agreement e) Install and use an approved Ignition Interlock Device (IID) if ordered by the court and pay the additional one time IID monitor fee directly to Evaluation Services. Please note this fee is separate from all other IID fees you will be making directly to the IID service provider f) Keep the court advised of my current mailing address g) I understand that if two or more negative reports are received from my IID provider the court has the ability to order additional treatment. I further understand I will be responsible for all additional fees if this occurs. 2) I have read, understand and signed the Declaration of Eligibility. I will file this document along with my Petition and Agreement. 3) I agree to submit a plea petition with a guilty or no contest plea to the charge of DUII. I will submit my plea petition at my DUII diversion entry hearing; 4) I waive (give up) the rights listed in the Petition to Plead Guilty or No Contest; and 5) I waive my former jeopardy rights under the federal or state constitutions and ORS 131.505 to 131.525 in any future action on the charge or any other offenses based on the same criminal incident. Certificate of Document Preparation. Check all that apply: I chose this form for myself and completed it without paid help A legal help organization helped me choose or complete this form, but I did not pay money to anyone I was assisted by a court appointed attorney I paid (or will pay)for help choosing, completing, or reviewing this form Defendant222s Signature Defendant222s Name (printed) Date American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 5 DUII Diversion Form 1 Revised 2/2019 EXPLANATION OF RIGHTS AND DUII DIVERSION AGREEMENT Read this entire form carefully. You are charged with driving under the influence of intoxicants (DUII). You can apply for the DUII Diversion Program, but you can enter the program only if you meet all eligibility requirements. The court will appoint a lawyer to help you if you ask for one and you are financially eligible. ELIGIBILITY FOR DIVERSION PROGRAM You are eligible to participate in the diversion program only if: you meet all requirements described in the attached Defendant222s Declaration of Eligibility and you appeared in court on the date scheduled for your first appearance on the charge (unless the court finds good reason to excuse your failure to appear) and you file the Petition and Agreement with the court within thirty (30) days of your first appearance in court (unless the court finds there is good cause to allow a later date) AGREEMENT WITH THE COURT The DUII Diversion Petition and Agreement is your agreement with the court. To have the DUII charge dismissed, you must do all the following (unless otherwise ordered by the court): a. Pay the required diversion fees. You are responsible for paying the $490.00, (plus attorney fees) for DUII Diversion; and $400.00 for Reckless Driving Diversion if applicable. All Diversion participants are given a standard payment schedule to pay the filing fees. A breakdown of your fees and a monthly payment schedule will be located on the front of your order for DUII Diversion Entry. The entire amount is to be paid before your diversion termination date or it may adversely affect your case being dismissed. You may make a phone payment by calling 1-888-564-2828 or online at: courts.oregon.gov/OJD/OnlineServices/ePay/index.page b. Pay restitution. Restitution may be ordered in cases where a victim suffered economic damages. You will be informed by the DA222s office if you owe restitution and will be given a summary (explanation) of fees at your DUII entry hearing. c. Complete an alcohol and drug abuse assessment with Evaluation Services and pay the $150.00 evaluation fee. They will NOT perform an evaluation until that fee has been paid. Do not contact them until you have been accepted into the Diversion program. You must give the agency accurate and truthful information about your use of drugs and alcohol. After you are evaluated, they will determine what treatment is necessary, where the location for the classes will be and how long those classes will last. d. Complete the recommended treatment program. You must pay the treatment provider directly. If you cannot pay the cost of treatment, tell the treatment provider. They may be able to waive certain costs or let you make payments over time. e. You will be required to attend a one-time only Victim Impact Panel. The date will be provided for you at your next court appearance and will be indicated on your copy of the Diversion order. You will be required to pay a one-time (cash only) fee at the entrance. You must appear from 7:00 P.M. - 9:00 P.M. at the Washington County Public Services Bldg., 155 N 1st Ave, , Hillsboro OR, 97124. If you live outside the Washington County area, you may attend another county222s Victim Impact Panel. You will need preapproval from Evaluation Services and you will be required to make all the arrangements for the sign-up and provide proof of attendance to Evaluation Services. If you are late you WILL NOT be allowed in. Do not bring children with you. Drinking or illicit drug use prior to attendance is PROHIBITED. Rescheduling will be discouraged. Failure to attend is a violation. f. Do not use any alcohol or other intoxicant (includes marijuana) during the term of the diversion agreement. Comply with state laws that prohibit the use of intoxicants. You can use: American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 5 DUII Diversion Form 1 Revised 2/2019 sacramental wine given or provided as part of a religious rite or service; alcohol or a controlled substance taken as directed with a valid prescription; or a non-prescription drug that contains alcohol if you follow the directions for use that are printed on the label. g. Keep the court advised of your current mailing address h. Install and use an approved ignition interlock device (IID) in all the vehicles you operate during the term of the diversion agreement when you have driving privileges, if ordered by the court and pay the additional one time IID monitor fee directly to Evaluation Services. Please note this fee is separate from all other IID fees you will be making directly to the IID service provider. INFORMATION ON IGNITION INTERLOCK DEVICES (IIDs) i. You must install and use an approved ignition interlock device (IID) in all vehicles you operate during the term of the diversion period when you have driving privileges if: Your Blood Alcohol Content (BAC) was 0.08 or above You refused a breath/blood test when requested by the arresting officer Your BAC was greater than 0.00 and less than 0.08 and your blood test showed the presence of a controlled substance or an inhalant, or The court orders you to do so, if your BAC was less than 0.08 j. The IID requirement applies in all cases and to all vehicles you operate during the term of t