200-00369A - Notice of Plea Agreement (1/2018) Page 1 of 2 NOTICE OF PLEA AGREEMENT Date SUPERIOR COURT STATE OF VERMONT CRIMINAL DIVISION Unit Docket No. The State of Vermont and the Defendant named above enter into the following agreement: Charge: Charge: Docket Number: Docket Number: Charge: Docket Number: Amended: Yes No Amended: Yes No Amended: Yes No Amended Charge Code: Amended Charge Code: Amended Charge Code: Amended Section No: Guilty Nolo Contendere SENTENCE: Amended Section No: Guilty Nolo Contendere SENTENCE: Amended Section No: Guilty Nolo Contendere SENTENCE: FINE $ & Surcharge $ FINE $ & Surcharge $ FINE $ & Surcharge $ (Min.) Years Months Days (Min.) Years Months Days (Min.) Years Months Days (Max.) Years Months Days Concurrent Consecutive (Max.) Years Months Days Concurrent Consecutive (Max.) Years Months Days Concurrent Consecutive Suspended with Probation: Yes No Suspended with Probation: Yes No Suspended with Probation: Yes No Term of Probation: Months Years Treatment Credit: Days Out-of-State Credit: Days Term of Probation: Months Years Treatment Credit: Days Out-of-State Credit: Days Term of Probation: Months Years Treatment Credit: Days Out-of-State Credit: Days Local Lock-up Credit: Days Local Lock-up Credit: Days Local Lock-up Credit: Days All Suspended except Days Months Years All Suspended except Days Months Years All Suspended except Days Months Years 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: Cases to be Dismissed by State: Docket # Charge: Docket # Charge: Docket # Charge: Total FINE & Surcharges: $ Special Probation Conditions: Docket # Charge: Docket # Charge: Report Date: Forthwith: PSI Ordered? Yes No Sex offender registration requiredDefendant already on probation? Yes 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. This is a binding Rule 11 Agreement. I have reviewed this agreement and understand it. Defendant Date Prosecutor Date Defense Attorney Date Judge Date Guardian ad Litem Date STATE OF VERMONT v. Defendant's Name DOB / / American LegalNet, Inc. www.FormsWorkFlow.com 200-00369A - Notice of Plea Agreement (1/2018) Page 2 of 2 NOTICE OF THE POTENTIAL COLLATERAL CONSEQUENCES OF A CONVICTION 1.When you plead guilty or are convicted of an offense, you may suffer additional legal consequences beyondjail or prison, home confinement, probation, and fines. These consequences may include: a.Being unable to get or keep some licenses, permits, or jobs;b.Being unable to get or keep benefits such as public housing or education;c.Receiving a harsher sentence if you are convicted of another offense in the future;d.Having the government take your property;e.Being unable to serve in the military or on a jury;f.Being unable to possess a firearm; andg.Being unable to exercise your right to vote if you move to another state.2.If you are not a United States citizen, a guilty plea or conviction may also result in your deportation,removal, exclusion from admission to the United States, or denial of citizenship. 3.The law may provide ways to obtain some relief from these consequences. Contact information fororganizations that may be able to offer assistance to persons seeking relief from collateral consequencesmay be found on the Internet at: http://forms.vermontlaw.edu/criminaljustice/index.cfm . 4.Under Vermont law, a Vermont conviction may be eligible for expungement or sealing. Potentially relevantstatutes include 13 V.S.A Section 7602 and 33 V.S.A. Section 5119(g). These statutes can be found on theInternet at:http://legislature.vermont.gov/statutes/section/13/230/07602 http://legislature.vermont.gov/statutes/section/33/051/05119 5.Further information about the consequences of conviction is available on the Internet at:http://www.ago.vermont.gov/divisions/criminal-division/collateral-consequences-of-conviction.php . 6.Conviction of a crime in Vermont does not prohibit an individual from voting in Vermont. STANDARD CONDITIONS OF PROBATION 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 emailaddress. 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 probationofficer. Upon request, you must allow your probation officer to visit you at reasonable times wherever youare staying. E.Your probation officer may restrict or prohibit travel to any state as required by the Interstate Compact ForAdult Offender Supervision. F.You shall provide your probation officer with the location of your job and employment status. If you changeor lose your job, you must notify your probation officer within 72 hours. American LegalNet, Inc. www.FormsWorkFlow.com