[ ] ISLAND COUNTY DISTRICT COURT [ ] OAK HARBOR MUNICIPAL COURT [ ] State of Washington ) [ ] City of Oak Harbor ) Cause Number: ______________ ) Plaintiff, ) PETITION FOR ) DEFERRED PROSECUTION vs. ) {Alcohol/Drug Driving Related} ) [ADP:PFDP] ) RCW 10.05 ) Defendant. ) ) COMES NOW the above-named Defendant, [ ] without counsel, [ ] by , and makes this Petition for and through counsel of record, Deferred Prosecution pursuant to RCW 10.05 et seq. stating as follows: 1. GROUNDS. The wrongful conduct charged is the result of or caused by [ ] alcoholism, [ ] drug addiction, for which the defendant is in need of treatment and unless treated the probability of future reoccurrence is great. The defendant has never previously been granted a Deferred Prosecution. 2. COSTS. The defendant agrees to pay or arrange for the payment of the costs of a diagnosis and treatment of the problem or problems. 3. FILING FEE. [] [] The filing fee of $150.00 accompanies this Petition. The defendant is indigent and unable to pay the $150.00 filing fee and therefore requests that the court authorized community service at minimum wage as a method of paying the filing fee. 4. BAC FEE. The BAC fee of $125.00 accompanies this Petition or will be paid on the date set for the hearing of this Petition. American LegalNet, Inc. www.USCourtForms.com 5. CASE HISTORY. The case history and written assessment prepared by one of the following is attached hereto and incorporated herein by this reference as though fully set forth herein: [ ] Alcoholism treatment program as designated in chapter 70.96A [ ] Drug treatment program as designated in chapter 71.24 RCW 6. ACKNOWLEDGMENT OF RIGHTS The defendant has been advised and fully understands that the defendant has the following rights: (a) (b) the right to a speedy trial by jury within 90 days of arraignment. (e) the right now and at trial to testify or remain silent. If the right to remain silent is exercised, there cannot be any inference of guilt drawn from the defendant’s silence, and the Judge or Jury must decide the case on the evidence presented at trial. (f) the right to compel witnesses to testify on behalf of the defendant at no cost. The court, however, may require reimbursement for the costs of securing the attendance of witnesses. (g) the defendant is presumed innocent until a charge is proved by the plaintiff by the standard of beyond a reasonable doubt or until the defendant enters a plea of guilty. (h) 7. the right to have a lawyer represent the defendant and that if the defendant cannot afford to pay for a lawyer one will be provided at no expense to the defendant. The court may, however, order the defendant to reimburse the plaintiff for the cost of the court appointed attorney. the right to appeal a conviction and sentence after trial. WAIVER OF RIGHTS AND STIPULATION TO POLICE REPORTS [10.05.020(2).] As a condition of receiving treatment the defendant acknowledges and waives the right to testify, the right to a speedy trial, the right to call witnesses to testify, the right to present evidence in defense to the charge, and the right to a jury trial. The defendant further understands if the defendant proceeds to trial and is found guilty, the defendant may be allowed to seek suspension of some or all of the fines; that incarceration may be ordered upon the condition that the defendant seeks treatment; that the defendant may seek treatment from public and private agencies at any time without regard to whether or not the defendant is found guilty of the offense(s) charged. Having a American LegalNet, Inc. www.USCourtForms.com complete understanding of rights as an accused the defendant stipulates to the admissibility and sufficiency of the facts contained in the written police report, including but not limited to the BAC test result (if any), witness statements and driving record. A copy of the police report is attached to this Petition. The defendant understands and agrees that the attached police report will be entered and used to support a finding of guilty if the court finds cause to revoke the order granting deferred prosecution. The defendant is aware that the Court will not accept a petition for deferred prosecution from a person who sincerely believes that he or she is innocent of the charges or sincerely believes that he or she does not, in fact, suffer from alcoholism or drug addiction. 8. ACKNOWLEDGMENT OF CONDITIONS OF DEFERRED PROSECUTION a. The defendant understands that an approved Deferred Prosecution treatment plan must contain minimum requirements which are set forth RCW 10.05.150 2. The defendant accepts and agrees to comply with these requirements as well as those which are contained in the written evaluation which was prepared by an approved treatment facility and filed herewith. The defendant has signed the evaluation acknowledging the 2 RCW 10.05.150 A deferred prosecution program for alcoholism shall be for a two-year period and shall include, but not be limited to, the following requirements: (1) Total abstinence from alcohol and all other nonprescribed mind-altering drugs; (2) Participation in an intensive inpatient or intensive outpatient program in a state-approved alcoholism treatment facility; (3) Participation in a minimum of two meetings per week of an alcoholism self-help recovery support group, as determined by the assessing agency, for the duration of the treatment program; (4) Participation in an alcoholism self-help recovery support group, as determined by the assessing agency, from the date of court approval of the plan to entry into intensive treatment; (5) Not less than weekly approved outpatient counseling, group or individual, for a minimum of six months following the intensive phase of the treatment; (6) Not less than monthly outpatient contact, group or individual for the remainder of the two-year deferred prosecution period; (7) The decision to include the use of prescribed drugs, including disulfiram, as a condition of treatment shall be reserved to the treating facility and the petitioner’s physician; (8) All treatment within the purview of this section shall occur within or be approved by a state-approved alcoholism treatment facility as described in chapter 70.96A RCW; (9) Signature of the petitioner agreeing to the terms and conditions of the treatment program. American LegalNet, Inc. www.USCourtForms.com defendant’s commitment to treatment which is also filed herewith. b. The defendant understands that as a condition of the Deferred Prosecution, the Court will require that the defendant not operate a motor vehicle without possession of a valid driver’s license and liability insurance in an amount which may be set by the court. The defendant further understands that the defendant will be required to show proof of a valid license and liability insurance with acceptable limits before the defendant can drive and that failure to do so will constitute grounds for revocation of the Deferred Prosecution. c. The defendant understands that the Court may place the defendant on supervised probation during the deferral period to monitor the defendant’s progress in treatment and compliance with the other conditions imposed by the Court. Probation will include, but not be limited to monthly contacts between the Probation Department and treatment facility and a semiannual review of the defendant’s driving record as maintained by the Department of Licensing. The defendant further understands that a probation supervision fee for the deferred prosecution will be imposed at a rate of $50.00 per month for the entire two year treatment period and $10.00 per month for the remainder of the probationary period of an additional three years which is a total of $1,560.00. d. The defendant further understands that the court will order the defendant not operate a motor vehicle unless it is equipped with functioning ignition interlock device for the duration of the treatment program if: (a) the defendant was previously convicted of a violation of RCW 46.61.502 (DUI) or RCW 46.61.504 (Physical Control) or an equivalent local ordinance, or (b) if in this case the defendant had an alcohol concentration of at least .15, or (c) by reason of the defendant’s refusal to take a test offered pursuant to RCW 46.20.308. e. The defendant understands that the court may order the defendant to not operate a motor vehicle unless it is equipped with a functioning ignition interlock device for a period of time as the court in the exercise of its discretion deems appropriate regardless of the defendant’s alcohol concentration in this case. f. The defendant understands that if the defendant is convicted of a subsequent similar offense within seven years from the date American LegalNet, Inc. www.USCourtForms.com the defendant is granted a Deferred Prosecution, the defendant understands that the Deferred Prosecution may be considered as a prior DUI conviction for the purpose of enhancement of punishment when imposing mandatory penalties and suspensions under RCW 46.61.515. OTHER ______________________________________________________ _____________________________________________________________ _____________________________________________________________ This Petition is based upon the records and files herein and upon the following Declaration of the Defendant. day of DATED this , 20__ [ ] Attorney for Defendant [ ] Defendant DECLARATION OF DEFENDANT I declare under penalties of perjury under the Laws of the State of Washington that I have read the forgoing Petition for Deferred Prosecution, that the contents thereof are true and correct to the best of my knowledge and information. Dated this day of (day) , (month) (year) __________________________ Defendant [ ] ISLAND COUNTY DISTRICT COURT [ ] OAK HARBOR MUNICIPAL COURT [ ] State of Washington [ ] City of Oak Harbor ) ) Cause Number: American LegalNet, Inc. www.USCourtForms.com