200-00245 Restitution Judgment Order (10/2015) Page 1 of 2 STATE OF VERMONT SUPERIOR COURT CRIMINAL DIVISION Unit Docket No. STATE OF VERMONT v. DOB RESTITUTION JUDGMENT ORDER D EFENDA N T Phone Number Social Security Number Mailing Address Town State Zip EMPLOYER Phone Number Address Town State Zip VICTIM Findings of Fact 1. The victim incurred an uninsured material loss in the amount of $. 2. Defendant has the current or reasonably foreseeable ability to make restitution payments. Defendant has no ability to make payments at this time. Therefore, it is hereby ORDERED: 1. Defendant shall pay restitution in the amount of $. Judgment is against Defendant individually for the entire amount and jointly with the following persons: Name: Docket No.: Name: Docket No.: Name: Docket No.: 2. Defendant shall make payment by cash, certified check, credit/debit card or money order payable to the State of Vermont Restitution Unit as follows: Defendant shall immediately pay $ Defendant shall pay $ per week 2 weeks 275 month month, beginning to: State of Vermont Restitution Unit, P.O. Box 10, Waterbury VT 05676-0010 (Phone: 1-800-584-3485; Outside Vermont 802-241-4688) Defendant shall return the following property to the victim within days: Defendant shall make the following payments in kind to the victim within days: American LegalNet, Inc. www.FormsWorkFlow.com 200-00245 Restitution Judgment Order (10/2015) Page 2 of 2 3. Defendant remains liable for the judgment until paid in full. Until the judgment due is paid in full, Defendant shall notify the Vermont Restitution Unit in writing of any change of home address or employment within 30 days of such change including the name, address and phone number of any new employer. 4. The Restitution Unit shall have the authority to Collect from an offender subject to a restitution judgment order all fees and direct costs, including reasonable result of enforcing the order and investigating and locating the offender. Dated Superior Court Judge IMPORTANT NOTICES TO DEFENDANT FAILURE TO PAY: If you fail to pay as ordered, the Vermont Restitution Unit may file a motion to enforce which may result in suspension of recreational licenses, trustee process against your earnings and other enforcement remedies as provided by law. TAX REFUND AND LOTTERY WINNINGS: Any monies owed to the State by the defendant who is under a restitution order, including lottery winnings and tax refunds, shall be used to discharge the restitution order to the full extent of the unpaid total financial losses, and regardless of the payment schedule established by the court. Acceptance of Service by Defendant I accept service of a copy of this Restitution Judgment Order. Dated Signature of Defendant American LegalNet, Inc. www.FormsWorkFlow.com