State of Vermont District Court of Vermont NOTICE OF PLEA AGREEMENT Form No. 369A Notice of Plea Agreement State of Vermont vs. Date Defendant The State of Vermont and the Defendant named above enter into the following agreement: Charge: Charge: Charge: Docket Number: Docket Number: Docket Number: Amended: Yes No Amended Charge Code: Amended Section No: Amended: Yes No Amended Charge Code: Amended: Yes No Amended Section No: Amended Section No: Amended Charge Code: Guilty Nolo Contendre SENTENCE: Nolo Contendre SENTENCE: FINE $ FINE $ Guilty Guilty & Surcharge $ Nolo Contendre SENTENCE: & Surcharge $ FINE $ & Surcharge $ (Min.) Yr. Mo. Days (Min.) Yr. Mo. Days (Min.) Yr. Mo. Days (Max.) Yr. Mo. Days (Max.) Yr. Mo. Days (Max.) Yr. Mo. Days Concurrent Concurrent Consecutive Suspended with Probation: Yes Suspended with Probation: Yes No Treatment Credit: Concurrent Consecutive Consecutive Suspended with Probation: Yes No No Days Days Treatment Credit: Days Out-of-State Credit: Days Days Treatment Credit: Out-of-State Credit: Out-of-State Credit: Local Lock-up Credit: Days Local Lock-up Credit: Days Local Lock-up Credit: Days Days days months yrs All Suspended except days months yrs All Suspended except days months yrs All Suspended except The parties hereby stipulate that this conviction is a violation of the Defendant's probation and, as part of this Plea Agreement, waive further notice, separate hearing, and agree that the Court impose the following: TOTAL SENTENCE: Total FINE & Surcharges: $ Special Probation Conditions: Cases to be Dismissed by State: Docket # Docket # Docket # Docket # Docket # Charge: Charge: Charge: Charge: Charge: Report Date: PSI Ordered? Yes No Defendant already on probation? Yes Forthwith: No (See Reverse for General Conditions) Other: In addition to any credit to which defendant is entitled by law, the parties agree defendant shall receive credit for treatment, out-of-state, and local lockup as shown above. I have reviewed this agreement and understand it. Defendant This is a binding Rule 11 Agreement. Date Prosecutor Date Defense Attorney Date Judge Date Guardian ad Litem Date Rev. 1/08 SML Distribution: 1st Copy ~ Court; 2nd Copy ~ Computer Operator; 3rd Copy ~ State's Attorney; 4th Copy ~ Defendant; 5th Copy ~ Defense Attorney American LegalNet, Inc. www.FormsWorkflow.com The execution of the sentence is suspended and the defendant is placed on probation in the care and custody of the Commissioner of Corrections until (date) or further order of the court under the following standard conditions: A. B. C. D. E. F. G. H. I. J. K. L. M. N. 0. P. You shall notify your probation officer within 48 hours if you are arrested or given a citation for a new offense. You must not be convicted of another crime. You must regularly work at a job or look for work, if your probation officer tells you to do so. You must get job training if your probation officer tells you to do so. You must regularly work at a community service job if the court orders you to do so. You must support your dependents and meet other family responsibilities. You must meet with your probation officer or designee whenever he/she tells you to do so. If you change your address or move, you must tell your probation officer within two days. If you change or lose your job, you must tell your probation officer within two days You cannot leave the state without written permission from your probation officer. Upon request, and without delay, you must allow the probation officer to visit you wherever your are staying. If the probation officer or the court orders you to go to any counseling or training program, you must do so. You must participate to the satisfaction of your probation officer. You must not buy, have or use any regulated drugs unless they are prescribed by a doctor. Your probation officer or any other person authorized by your probation officer can require you to have random urinalysis testing. Violent or threatening behavior is not allowed at any time. You shall not operate, try to operate or be in actual physical control of a motor vehicle on a public highway unless in possession of a valid Vermont operator's license. You shall not drink alcoholic beverages to the extent they interfere with your employment or the welfare of your family, yourself or any other person. You must submit to any alcosensor test or any other alcohol test when your probation officer or their designee tells you to do so. If restitution is ordered, you must cooperate fully with the Restitution Unit. NOTICE: Under the federal Gun Control Act (18 U.S.C.A. 922), a person who has been convicted of a felony or a qualifying misdemeanor crime of domestic violence, or who is subject to a qualifying final relief from abuse order, may not lawfully possess a firearm. For more information about these prohibitions, please call the Bureau of Alcohol, Tobacco, Firearms and Explosives at 1-800-800-3855 or go to the ATF website at: www.atf.treas.gov. If you have any questions whether these laws make it illegal for you to possess or purchase a firearm, you should consult an attorney. Rev. 1/08 SML American LegalNet, Inc. www.FormsWorkflow.com