COURT WASHINGTON COUNTY ADULT PROBATION AND PAROLE OFFICE COUNTY .OF. . . . . . . . . . . . . . . . . . .90. West.Chestnut .Street. . . . ......... .. . .... ....... .... PA 15301 Millcraft Center, Room 220 E.W., 2nd Floor, Washington,Index No. : Phone: 724/228-5886 Fax: 724/228-9306 Toll Free: 1-888-619-9904 : Calendar No. : JUDICIAL house arrest with Plaintiff(s) I have read, or had read to me, these conditions, and I will comply with any/all conditions governing the SUBPOENA electronic monitoring program. I am knowingly, willingly, and voluntarily accepting and/all terms and conditions of the house arrest -against: with electronic monitoring program. I further understand that electronic monitoring is a sentencing alternative to incarceration, and any failure to comply with any/all terms and conditions stated herein can/will result in incarceration. : : Defendant’s signature Date Witness Defendant(s) : ...................................................... Date CONDITIONS GOVERNING HOUSE ARREST WITH ELECTRONIC MONITORING THE PEOPLE OF THE STATE OF NEW YORK 1. You shall not leave your residence for work, medical appointments, or for any other reason unless approved by an Order of Court. The motion for any such leave must be entered by you or your attorney. No work release will be granted unless it was approved by theTO sentencing judge. 2. In an emergency, you must contact the Adult Probation Office immediately. After normal office hours, on weekends and on holidays, page the on-call probation officer at 412/280-5540. 3. You will not move or unplug your monitoring unit for any reason, unless otherwise specified by your probation officer. You will not remove or in any way tamper with your bracelet. 4. Upon request, you will verify on a monthly basis that you only have basic telephone service. The telephone service must not the Honorable at the Court include: call forwarding, call waiting, three-way calling, caller ID, answering service, or party-line. You cannot have any type of fax Countycomputer modems, answeringlocated at etc. connected to the telephone line that the electronic monitoring unit is of machines, machines, in room , that the day monitoring unit is 20 , hooked,up on must o'clock in the telephone and preferably a nonat noon, and at any recessed attached. The telephoneon the electronic of be a touch-tone cordless phone. There to testify and give evidenceso that the electronic monitoring unit can be plugged into it. or adjourned date, must be a jack on your phone as a witness in this action on the part of the 5. You will limit the use of your telephone to 10 minutes for each ½ hour throughout the day. If you hear the monitor or beeping sound while on the telephone, you must hang up and wait 10 minutes before calling your party back. GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before 6. Your failure to comply with this subpoena is punishable as a contempt of before being released from your You will submit a schedule in writing to your probation officer detailing all Court-approved leavescourt and will make you liable to the party on whose behalf this subpoena was issued changes one week prior to the proposed release. residence. You are responsible for requesting any scheduling for a maximum penalty of $50 and all damages sustained as a 7. If attending any type of treatment, you must provide written verification of your attendance of those appointment(s). 8. Witness, Honorable , one of the Justices route and as soon You will go directly to your scheduled events and return to your residence from those events by the most direct of the as Court in possible. County, day of , 20 9. You will abstain from the use of alcohol and/or other prohibited drugs while on the electronic monitoring unit, and for the entire length of your probation or parole status. 10. (Attorney must sign above and type name below) You will be subject to random urine and/or breath testing at any time during your electronic monitoring period. Any failure to comply will be considered unacceptable. Furthermore, a refusal will be considered a technical violation of your probation or parole status. 11. Attorney(s) has You shall not be removed from the electronic monitoring unit unless all of your behavior for been appropriate. If applicable, your time on the electronic monitoring unit can be extended at the discretion of your probation officer, with Court approval. 12. You must return the electronic monitor unit and all accessories to the Adult Probation Office no later than the first business day after you successfully complete electronic monitoring. You are responsible for repair or replacements costs of any damaged/lost units and/or equipment. You will be charged with theft if you do not return Office and P.O. Address the equipment. 13. You will make minimum monthly payments on your electronic monitoring costs. Individual costs per day vary and will be explained to you by your probation officer. All transfer cases involving individuals sentenced to house arrest with electronic monitoring will be required to pay $10.00 per day. Furthermore, these individuals will be required to make the first months’ payment before the actual Telephone No.: electronic monitoring hook-up occurs. result of your failure to comply. 14. Facsimile No.: Any failure to maintain regular payments on the electronic monitoring costs may result in incarceration for the length of time that E-Mail Address: you were originally sentenced to serve on house arrest with electronic monitoring. Tel.all transfer cases, your case will be Mobile For No.: immediately transferred back to the county that the offense occurred in for sanctioning before the sentencing judge. American LegalNet, Inc. www.USCourtForms.com ,