VIRGINIA: IN THE CIRCUIT COURT OF LOUDOUN COUNTY COMMONWEALTH OF VIRGINIA v. ) ) ) ) ) ) Criminal No. Defendant ORDER RESPECTING PROBATION IT IS THIS DATE ORDERED THAT: The defendant is forthwith placed on probation under the supervision of a Probation Officer of this Court for a period of ________________. The defendant by endorsement, represents the following information to be true and correct: Name: ______________________________________ Address: _____________________________________ Telephone No.: ________________________________ Social Security No.: ____________________________ Bond Status: __________________________________ THIS ORDER will be supplemented by an order reflecting the incidents of trial. You are reminded that your driver's license will be suspended if you fail to make timely payment of Court costs. ENTERED this ____ day of ____________, 200_. Judge American LegalNet, Inc. www.USCourtForms.com