200-00388 226 Deferred Sentence & Probation Order (10/2018) Page 1 of 4 STATE OF VERMONT SUPERIOR COURT CRIMINAL DIVISION Unit Docket No. STATE OF VERMONT V. Defendant Defendant's DOB DEFERRED SENTENCE and PROBATION ORDER For the following Offense: DEFERRED SENTENCE BY AGREEMENT Pursuant to 13 V.S.A. 247 7041, the State's Attorney and Defendant hereby agree that the State's Attorney does not object to a deferred sentence and that Defendant is willing to abide by the Terms of Deferred Sentence as set forth in this document. A presentence investigation is: waived by the parties. on file in this case. We agree to the terms of the deferred sentence set forth in this document: Date Signature of Defendant Signature of Defendant's Attorney Signature of State's Attorney DEFERRED SENTENCE WITHOUT AGREEMENT The Court makes the following findings of fact: 1. Defendant is 28 years old or younger; 2. The offense that is the subject of the deferred sentence is not a listed crime under 13 V.S.A. 247 5301(7); 3. The victim has been afforded the right to submit a written or oral statement regarding a deferred sentence in this case; 4. The court has reviewed any presentence investigation report and victim impact statement with the parties; 5. A deferred sentence is in the interest of justice. A presentence investigation is: waived by the parties on file in this case. TERMS OF DEFERRED SENTENCE 1. Term of deferred sentence: years months 2. The duration of this deferred sentence agreement is from / /20 to / /20 3. During the period that this deferred sentence is in effect, the Defendant shall abide by Standard Probation Conditions (except as modified on the reverse side of this document) and the following Special Conditions: All applicable conditions (both standard and special) are set forth on the attached probation warrant. Based on the foregoing, a Deferred Sentence is ORDERED pursuant to 13 V.S.A. 2477041. The defendant is placed on probation in the care and custody of the Commissioner of Corrections until further order of the Court. Date Superior Court Judge Defendant acknowledges receipt of this Order, and It is understood by the Defendant and the undersigned that: 1. if Defendant violates the conditions of the deferred sentence, the Court shall impose sentence. 2. if Defendant fulfills the terms of probation and this agreement, the Court shall strike the adjudication of guilty and discharge the defendant. Upon discharge, the record of the criminal proceedings shall be expunged. Date Signature of Defendant Signature of Defendant' Attorney Signature of State's Attorney American LegalNet, Inc. www.FormsWorkFlow.com 200-00388 226 Deferred Sentence & Probation Order (10/2018) Page 2 of 4 STANDARD CONDITIONS OF PROBATION The execution of the sentence is suspended and the defendant is placed on probation in the care and custody of the Commissioner of Corrections for the term(s) as shown above under the following conditions: A. You shall not be convicted of another crime or engage in criminal behavior. B. You shall give your probation officer your home address, mailing address, telephone number, and email address. If any of those change, you must notify your probation officer within 24 hours. C. You shall notify your probation officer within 72 hours if you are arrested or given a citation. D. You must meet with your probation officer at reasonable times as directed by a judge or your probation officer. Upon request, you must allow your probation officer to visit you at reasonable times wherever you are staying. E. Your probation officer may restrict or prohibit travel to any state as required by the Interstate Compact For Adult Offender Supervision. F. You shall provide your probation officer with the location of your job and employment status. If you change or lose your job, you must notify your probation officer within 72 hours. SPECIAL CONDITIONS OF PROBATION 1. You shall not purchase, possess or consume any alcohol unless the use is authorized by a licensed substance abuse counsellor, in writing, as part of substance abuse treatment, and the authorization is provided to your probation officer prior to use. 2. 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. 3. You shall not purchase, possess or consume any alcohol. 4. You shall not purchase, possess or use any regulated drug without a valid prescription. If you have a prescription, you must take your medications only in the dosage and manner prescribed. 5. You shall keep your probation officer advised of all current prescriptions and sign and maintain current waivers or releases to your providers to allow verification of your prescriptions. 6. You shall submit to breath-alcohol testing upon request of your probation officer. 7. You shall submit to random urinalysis testing for drugs or alcohol upon request of your probation officer or designee. 8. You shall not operate a motor vehicle with any alcohol in your system. 9. You shall not operate a motor vehicle within hours of consuming alcohol. American LegalNet, Inc. www.FormsWorkFlow.com 200-00388 226 Deferred Sentence & Probation Order (10/2018) Page 3 of 4 10. You shall submit to a warrantless search of your person, belongings, residence or vehicle if your probation officer has a reasonable suspicion that you possess alcohol, drugs or contraband in violation of these conditions. 11. You shall comply with the requirements of electronic monitoring (e.g. GPS or SCRAM), as directed by your probation officer. 12. Your probation officer may prohibit you from residing or associating with individuals reasonably suspected of consuming or selling illicit regulated substances. 13. You must have a screening for the issues that are marked below. You must complete the screening by the date established by your probation officer. If the screening recommends that counseling or treatment is needed, including residential treatment, you must complete the counseling or treatment as directed by your probation officer. You must attend and comply with the counseling or treatment requirements and satisfy those requirements. (a) Alcohol (b) Substance Abuse (c) Mental Health (d) Anger Management (e) Domestic Violence (Batterer's intervention or approved equivalent) (f) Risk Reduction Programming (g) 14. You must sign any required waivers or releases and allow any treatment or counseling provider to tell your probation officer and the court about your attendance and participation in the counseling or treatment, and about the results of any substance abuse or alcohol urinalyses taken by you in connection with the counseling or treatment. 15. You must complete an approved safe driving program as directed by your probation officer and pay any associated costs. 16. You shall not operate a motor vehicle on a public highway without a valid license. 17. You shall not operate a motor vehicle on a public highway. 18. You shall actively work towards reinstatement of your operator's license. 19. You shall attend and complete the next available session of the Impaired Driver Rehabilitation Program or a similar program. 20. You shall not have contact with , which includes all forms of written, oral, electronic, social media, or other direct contact and all forms of indirect contact through third parties, except . 21. Your probation officer may limit or prohibit contact with during the term of probation based upon the person's request. American LegalNet, Inc. www.FormsWorkFlow.com 200-00388 226 Deferred Sentence & Probation Order (10/2018) Page 4 of 4 22. You shall not abuse or harass . Such conduct includes actions directed at a specific person, or a member of the person's family that would cause a reasonable person to fear unlawful sexual conduct, unlawful restraint, bodily injury or death, including but not limited to verbal threats, written, telephonic or other electronically communicated threats, vandalism, or physical contact without consent. It also includes multiple attempts to communicate with the person after the person has informed the probationer that such contact is not welcome.