IN THE GENERAL SESSIONS CRIMINAL COURT SHELBY COUNTY, TENNESSEE DIVISION ___________________ ________________________________________________________________________ ____________________________________ STATE OF TENNESSEE BOOKING NO. _________________________________________ VS. CHARGE: _____________________________________________ ________________________ ______________________________________________________ DEFENDANT ________________________________________________________________________ ____________________________________ SUPPLEMENTAL ORDER OF PROBATION ________________________________________________________________________ ____________________________________ This cause came on to be heard before the undersigned Judge, the above named defendant having entered a ng been plea of guilty or haviconvicted of an offense defined in Tennessee Code Annotated, Title 38, Chapter 13, in which the victim of tlyhe of or householfense is a fd amimember, as defined in Tennessee Code Annotated, Section 36-3-601. It appearing that the above named defendantate t io have s a good candidall or part of the term of incarceration suspended and to be placed on probation. In consideration of the safn of tethe viy and prctim otofect such iooffense and of any other member of the victims family or household, this probation is conditioned upon commorple ofiance the with one or following conditions in addition to the conditions normally imposed with probation. _______The probationer is enjoined from threatening to commit or committing acts of violence against the violctd mim orem otberhers; househ _______The probationer is prohibited from harassing, annoying, telephoning, contacting or otherwise communitly orcat iing,ndi eirecttherly, di recwith the victim; _______The probationer is required to stay away from the residence, school, place of employment or a speci rfied plegularace fly by trequenthe edvictim and by any designated family or household member; _______The probationer is prohibited from possessing or consuming alcohol or controlled substances, and; _______The probationer is prohibited from using or possessing a firearm or any other specified weapon and deris and frequirored feito t any surrenweapon currently possessed; _______The probationer shall abide by the following special conditions of probation:_______________________ ________________________________________________________________________ ____________________________________ ________________________________________________________________________ ____________________________________ Entered this the _________day of ________________, yr.____________. ______________________________________________________ J UDGE ________________________________________________________________________ ____________________________________ I, the above named defendant, have read or have had read to me the foregoing Supplemental Order of Probatd tion.he O I frderull under and stanagree to comply with the terms and conditions set forth therein during my probationary period. ___________________________________________ ______________________________________________________ ATTORNEY FOR PROSECUTION PROBATIONER ___________________________________________ __________________________________________________ ATTORNEY FOR DEFENDANT ADDRESS ___________________________________________ __________________________________________________ B. P. R. NUMBER PHONE NUMBER