Superior Court of Washington County of State of Washington, Plaintiff, vs. ______________________________________, Defendant. SID: If no SID, use DOB: No. Felony Judgment and Sentence (FJS) [ ] Prison [ ] RCW 9.94A.712 Prison Confinement [ ] Jail One Year or Less [ ] RCW 9.94A.712 Prison Confinement [ ] First-Time Offender [ ] Special Sexual Offender Sentencing Alternative [ ] Special Drug Offender Sentencing Alternative [ ] Clerk’s Action Required, para 4.5 (SDOSA), 4.7 and 4.8 (SSOSA) 4.15.2, 5.3, 5.6 and 5.8 I. Hearing 1.1 The court conducted a sentencing hearing this date; the defendant, the defendant's lawyer, and the (deputy) prosecuting attorney were present. II. Findings There being no reason why judgment should not be pronounced, in accordance with the proceedings in this case, the court Finds: 2.1 Current Offenses: The defendant is guilty of the following offenses, based upon [ ] guilty plea [ ] jury-verdict [ ] bench trial: Count Crime RCW Date of Crime (If the crime is a drug offense, include the type of drug in the second column.) [ ] Additional current offenses are attached in Appendix 2.1. The jury returned a special verdict or the court made a special finding with regard to the following: [ ] The defendant is a sex offender subject to indeterminate sentencing under RCW 9.94A.712. [ ] The defendant engaged, agreed, offered, attempted, solicited another, or conspired to engage a victim of child rape or child molestation in sexual conduct in return for a fee in the commission of the offense in Count _____. RCW 9.94A.___. Felony Judgment and Sentence (FJS) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page 1 of _________ American LegalNet, Inc. www.FormsWorkflow.com [ ] The offense was predatory as to Count ______________. RCW 9.94A.836. [ ] The victim was under 15 years of age at the time of the offense in Count ________________ RCW 9.94A.837. [ ] The victim was developmentally disabled, mentally disordered, or a frail elder or vulnerable adult at the time of the offense in Count ________________. RCW 9.94A.838, 9A.44.010. [ ] The defendant acted with sexual motivation in committing the offense in Count_________. RCW 9.94A.835. [ ] This case involves kidnapping in the first degree, kidnapping in the second degree, or unlawful imprisonment as defined in chapter 9A.40 RCW, where the victim is a minor and the offender is not the minor’s parent. RCW 9A.44.130. [ ] The defendant used a firearm in the commission of the offense in Count ______________. RCW 9.94A.602, 9.94A.533. [ ] The defendant used a deadly weapon other than a firearm in committing the offense in Count ____________ _______________________. RCW 9.94A.602, 9.94A.533. [ ] Count _______________________, Violation of the Uniform Controlled Substances Act (VUCSA), RCW 69.50.401 and RCW 69.50.435, took place in a school, school bus, within 1000 feet of the perimeter of a school grounds or within 1000 feet of a school bus route stop designated by the school district; or in a public park, public transit vehicle, or public transit stop shelter; or in, or within 1000 feet of the perimeter of a civic center designated as a drug-free zone by a local government authority, or in a public housing project designated by a local governing authority as a drug-free zone. [ ] The defendant committed a crime involving the manufacture of methamphetamine, including its salts, isomers, and salts of isomers, when a juvenile was present in or upon the premises of manufacture in Count _____________________________. RCW 9.94A.605, RCW 69.50.401, RCW 69.50.440. [ ] The defendant committed [ ] vehicular homicide [ ] vehicular assault proximately caused by driving a vehicle while under the influence of intoxicating liquor or drug or by operating a vehicle in a reckless manner. The offense is, therefore, deemed a violent offense. RCW 9.94A.030. [ ] The defendant has a chemical dependency that has contributed to the offense(s). RCW 9.94A.607. [ ] The crime(s) charged in Count _____________________ involve(s) domestic violence. RCW 10.99.020. [ ] Current offenses encompassing the same criminal conduct and counting as one crime in determining the offender score are (RCW 9.94A.589): [ ] Other current convictions listed under different cause numbers used in calculating the offender score are (list offense and cause number): 2.2 Criminal History (RCW 9.94A.525): Crime Date of Sentence Sentencing Court (County & State) Date of Crime A or J Adult, Juv. Type of Crime 1 2 3 4 5 [ ] Additional criminal history is attached in Appendix 2.2. Felony Judgment and Sentence (FJS) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page 2 of _________ American LegalNet, Inc. www.FormsWorkflow.com [ ] The defendant committed a current offense while on community placement/community custody (adds one point to score). RCW 9.94A.525. [ ] The following prior offenses require that the defendant be sentenced as a Persistent Offender (RCW 9.94A.570): [ ] The following prior convictions are one offense for purposes of determining the offender score (RCW 9.94A.525): [ ] The following prior convictions are not counted as points but as enhancements pursuant to RCW 46.61.520: 2.3 Sentencing Data: Count Offender Serious- Standard No. Score ness Range (not including Level Plus Enhancements* Total Standard Range (including Maximum Term enhancements) enhancements) * (F) Firearm, (D) Other deadly weapons, (V) VUCSA in a protected zone, (VH) Veh. Hom, see RCW 46.61.520, (JP) Juvenile present, (SM) Sexual motivation, RCW 9.94A.533(8), (SCF) Sexual conduct with a child for a fee, RCW 9.94A.533(9). [ ] Additional current offense sentencing data is attached in Appendix 2.3. For violent offenses, most serious offenses, or armed offenders, recommended sentencing agreements or plea agreements are [ ] attached [ ] as follows: ______________________________________________________. 2.4 [ ] Exceptional Sentence. The court finds substantial and compelling reasons that justify an exceptional sentence: [ ] within [ ] below the standard range for Count(s) _______________. [ ] above the standard range for Count(s) _______________. [ ] The defendant and state stipulate that justice is best served by imposition of the exceptional sentence above the standard range and the court finds the exceptional sentence furthers and is consistent with the interests of justice and the purposes of the sentencing reform act. [ ] Aggravating factors were [ ] stipulated by the defendant, [ ] found by the court after the defendant waived jury trial, [ ] found by jury, by special interrogatory. Findings of fact and conclusions of law are attached in Appendix 2.4. [ ] Jury’s special interrogatory is attached. The Prosecuting Attorney [ ] did [ ] did not recommend a similar sentence. 2.5 Ability to Pay Legal Financial Obligations. The court has considered the total amount owing, the defendant's past, present, and future ability to pay legal financial obligations, including the defendant's financial resources and the likelihood that the defendant's status will change. The court finds that the defendant has the ability or likely future ability to pay the legal financial obligations imposed herein. RCW 9.94A.753. [ ] The following extraordinary circumstances exist that make restitution inappropriate (RCW 9.94A.753): Felony Judgment and Sentence (FJS) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page 3 of _________ American LegalNet, Inc. www.FormsWorkflow.com ______________________________________________________________________________________ . III. Judgment 3.1 The defendant is Guilty of the Counts and Charges listed in Paragraph 2.1 and Appendix 2.1. 3.2 [ ] The defendant is found Not Guilty of Counts . [ ] The court Dismisses Counts . IV. Sentence and Order It is Ordered: 4.1a The defendant shall pay to the clerk of this court: JASS CODE $ Restitution to: $ Restitution to: $ Restitution to: $ (Name and Address--address may be withheld and provided confidentially to Clerk of the Court’s office.) Victim assessment RCW 7.68.035 RTN/RJN PCV $_____________Domestic Violence assessment CRC $ RCW 10.99.080 Court costs, including RCW 9.94A.760, 9.94A.505, 10.01.160, 10.46.190 Criminal filing fee Witness costs Sheriff service fees Jury demand fee Extradition costs Other $ $ $ $ $ $ FRC WFR SFR/SFS/SFW/WRF JFR EXT PUB $ Fees for court appointed attorney RCW 9.94A.760 WFR $ Court appointed defense expert and other defense costs RCW 9.94A.760 FCM/MTH $ Fine RCW 9A.20.021; [ ] VUCSA chapter 69.50 RCW, [ ] VUCSA additional fine deferred due to indigency RCW 69.50.430 CDF/LDI/FCD NTF/SAD/SDI $ Drug enforcement fund of ____________________ RCW 9.94A.760 CLF $ Crime lab fee [ ] suspended due to indigency RCW 43.43.690 RTN/RJN $ $ $ Felony DNA collection fee [ ] not imposed due to hardship RCW 43.43.7541 Emergency response costs (Vehicular Assault, Vehicular Homicide only, $1000 maximum) RCW 38.52.430 Other costs for: $ Total RCW 9.94A.760 [ ] The above total does not include all restitution or other legal financial obligations, which may be set by later order of the court. An agreed restitution order may be entered. RCW 9.94A.753. A restitution hearing: [ ] shall be set by the prosecutor. Felony Judgment and Sentence (FJS) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page 4 of _________ American LegalNet, Inc. www.FormsWorkflow.com [ ] is scheduled for [ ] Restitution Schedule attached. RJN . [ ] Restitution ordered above shall be paid jointly and severally with: Name of other defendant Cause Number (Victim’s name) (Amount-$) ____________________________________________________________________________________ ____________________________________________________________________________________ [ ] The Department of Corrections (DOC) or clerk of the court shall immediately issue a Notice of Payroll Deduction. RCW 9.94A.7602, RCW 9.94A.760(8). [ ] All payments shall be made in accordance with the policies of the clerk of the court and on a schedule established by DOC or the clerk of the court, commencing immediately, unless the court specifically sets forth the rate here: Not less than $_____ per month commencing_______________________________. RCW 9.94A.760. The defendant shall report to the clerk of the court or as directed by the clerk of the court to provide financial and other information as requested. RCW 9.94A.760(7)(b). [ ] The court finds that the defendant has the means to pay, in addition to the other costs imposed herein, for the cost of incarceration and the defendant is ordered to pay such costs at the rate of $50 per day, unless another rate is specified here: __________. (JLR) RCW 9.94A.760. The financial obligations imposed in this judgment shall bear interest from the date of the judgment until payment in full, at the rate applicable to civil judgments. RCW 10.82.090. An award of costs on appeal against the defendant may be added to the total legal financial obligations. RCW 10.73.160. 4.1b [ ] Electronic Monitoring Reimbursement. The defendant is ordered to reimburse ________________________________________ (name of electronic monitoring agency) at _________________________________________________________, for the cost of pretrial electronic monitoring in the amount of $______________________. 4.2 DNA Testing. The defendant shall have a biological sample collected for purposes of DNA identification analysis and the defendant shall fully cooperate in the testing. The appropriate agency shall be responsible for obtaining the sample prior to the defendant's release from confinement. RCW 43.43.754. [ ] HIV Testing. The defendant shall submit to HIV testing. RCW 70.24.340. 4.3 No Contact: The defendant shall not have contact with ______________________________________ __________________________________________________________ (name, DOB) including, but not limited to, personal, verbal, telephonic, written or contact through a third party for ________ years (not to exceed the maximum statutory sentence). [ ] Domestic Violence No-Contact Order, Antiharassment No-Contact Order, or Sexual Assault Protection Order is filed with this Judgment and Sentence. 4.4 Other: _______________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________. Felony Judgment and Sentence (FJS) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page 5 of _________ American LegalNet, Inc. www.FormsWorkflow.com Felony Judgment and Sentence (FJS) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page 6 of _________ American LegalNet, Inc. www.FormsWorkflow.com 4.5 Confinement Over One Year. The court sentences the defendant to total confinement as follows: (a) Confinement. RCW 9.94A.589. A term of total confinement in the custody of the Department of Corrections (DOC): months on Count months on Count months on Count months on Count months on Count months on Count [ ] The confinement time on Count(s)___________ contain(s) a mandatory minimum term of __________. [ ] The confinement time on Count __________________________ includes _____________ months as enhancement for [ ] firearm [ ] deadly weapon [ ] sexual motivation [ ] VUCSA in a protected zone [ ] manufacture of methamphetamine with juvenile present [ ] sexual conduct with a child for a fee. Actual number of months of total confinement ordered is:_______________________________________. All counts shall be served concurrently, except for the portion of those counts for which there is an enhancement as set forth above at Section 2.3, and except for the following counts which shall be served consecutively:_________________________________________________________________________. The sentence herein shall run consecutively with the sentence in cause number(s) ____________________ _____________________________________________________________________________________ but concurrently to any other felony cause not referred to in this Judgment. RCW 9.94A.589. Confinement shall commence immediately unless otherwise set forth here:__________________________ _____________________________________________________________________________________. (b) Confinement. RCW 9.94A.712 (Sex Offenses only): The court orders the following term of confinement in the custody of the DOC: Count Count (c) minimum term minimum term maximum term maximum term The defendant shall receive credit for time served prior to sentencing if that confinement was solely under this cause number. RCW 9.94A.505. The jail shall compute time served unless the credit for time served prior to sentencing is specifically set forth here by the court: ____________________________________. 4.6 Community Placement or Community Custody. The court orders community placement or community custody as follows: [ ] Community Placement: Count ______________ for ___________ months; Count ___________for _____________ months; Count _____________ for _________________ months. [ ] Community Custody for count(s) ___________________, sentenced under RCW 9.94A.712, for any period of time the defendant is released from total confinement before the expiration of the maximum sentence. [ ] Community Custody: Count_________ for a range from ___________________ to ____________________months; Count_________ for a range from ___________________ to ____________________months; Count_________ for a range from ___________________ to ____________________months; or for the period of earned release awarded pursuant to RCW 9.94A.728(1) and (2), whichever is longer, and standard mandatory conditions are ordered. [See RCW 9.94A.700 and .705 for community placement offenses, which include serious violent offenses, second degree assault, any crime against a person with a deadly weapon finding and chapter 69.50 or 69.52 RCW offenses not sentenced under RCW 9.94A.660 committed before July 1, 2000. See RCW 9.94A.715 for community custody range offenses, which include sex offenses not sentenced under RCW 9.94A.712 and violent offenses committed on or after July 1, 2000. Use paragraph 4.7 to impose community custody following work ethic camp.] Felony Judgment and Sentence (FJS) (Prison) (RCW 9.94A.500, 9.94A.505 )(WPF CR 84.0400 (7/2007)) Page ________ of _________ American LegalNet, Inc. www.FormsWorkflow.com On or after July 1, 2003, DOC shall supervise the defendant if DOC classifies the defendant in the A or B risk categories; or, DOC classifies the defendant in the C or D risk categories and at least one of the following apply: a) The defendant committed a current or prior: i) Sex offense ii) Violent offense iii) Crime against a person (RCW 9.94A.411) iv) Domestic violence offense (RCW 10.99.020) v) Residential burglary offense vi) Offense for manufacture, delivery or possession with intent to deliver methamphetamine including its salts, isomers, and salts of isomers vii) Offense for delivery of a controlled substance to a minor; or attempt, solicitation or conspiracy (vi, vii) b) The conditions of community placement or community custody include chemical dependency treatment c) The defendant is subject to supervision under the interstate compact agreement, RCW 9.94A.745 While on community placement or community custody, the defendant shall: (1) report to and be available for contact with the assigned community corrections officer as directed; (2) work at DOC-approved education, employment and/or community restitution (service); (3) notify DOC of any change in defendant’s address or employment; (4) not consume controlled substances except pursuant to lawfully issued prescriptions; (5) not unlawfully possess controlled substances while in community custody; (6) pay supervision fees as determined by DOC; (7) perform affirmative acts as required by DOC to confirm compliance with the orders of the court; (8) for sex offenses, submit to electronic monitoring if imposed by DOC; and (9) abide by any additional conditions imposed by DOC under RCW 9.94A.720. The residence location and living arrangements are subject to the prior approval of DOC while in community placement or community custody. Community custody for sex offenders not sentenced under RCW 9.94A.712 may be extended for up to the statutory maximum term of the sentence. Violation of community custody imposed for a sex offense may result in additional confinement. [ ] The defendant shall not consume any alcohol. [ ] The defendant shall have no contact with: ___________________________________________. [ ] The defendant shall remain [ ] within [ ] outside of a specified geographical boundary, to wit: _____________________________________________________________________________________. [ ] The defendant shall not reside within 880 feet of the facilities or grounds of a public or private school (community protection zone). RCW 9.94A.030(8). [ ] The defendant shall participate in the following crime-related treatment or counseling services: _____________________________________________________________________________________. [ ] The defendant shall undergo an evaluation for treatment for [ ] domestic violence [ ] substance abuse [ ] mental health [ ] anger management and fully comply with all recommended treatment. [ ] The defendant shall comply with the following crime-related prohibitions:___________________ _____________________________________________________________________________________. [ ] Other conditions: _____________________________________________________________________________________. [ ] For sentences imposed under RCW 9.94A.712, other conditions, including electronic monitoring, may be imposed during community custody by the Indeterminate Sentence Review Board, or in an emergency by DOC. Emergency conditions imposed by DOC shall not remain in effect longer than seven working days. 4.7 [ ] Work Ethic Camp. RCW 9.94A.690, RCW 72.09.410. The court finds that the defendant is eligible and is likely to qualify for work ethic camp. The court recommends that the defendant serve the sentence at a work ethic camp. Upon completion of work ethic camp, the defendant shall be released on community custody for any remaining time of total confinement, subject to the conditions below. Violation of the conditions of community custody may result in a return to total confinement for the balance of the defendant’s remaining time of total confinement. The conditions of community custody are stated above in Section 4.6. 4.8 Off - Limits Order. (Known drug trafficker). RCW 10.66.020. The following areas are off limits to the defendant while under the supervision of the county jail or Department of Corrections: ___________________ ________________________________________________________________________________________. Felony Judgment and Sentence (FJS) (Prison) (RCW 9.94A.500, 9.94A.505 )(WPF CR 84.0400 (7/2007)) Page ________ of _________ American LegalNet, Inc. www.FormsWorkflow.com 4.5 First-Time Offender Waiver of Standard Sentence. RCW 9.94A.030, RCW 9.94A.650. The defendant is a first-time offender. The court waives imposition of a sentence within the standard sentence range and imposes the following sentence: (a) Confinement. The court sentences the defendant to the following term of total confinement in the custody of the county jail: ____________________________________days total confinement (up to 90 days). RCW 9.94A.650. Other:________________________________________________________________________________. Confinement shall commence immediately unless otherwise set forth here:__________________________ _____________________________________________________________________________________. [ ] Partial Confinement. The defendant may serve the sentence, if eligible and approved, in partial confinement in the following programs, subject to the following conditions:_________________________ _____________________________________________________________________________________. [ ] work crew RCW 9.94A.725 [ ] home detention RCW 9.94A.731, .190 [ ] work release RCW 9.94A.731 [ ] Alternative Conversion. RCW 9.94A.680. _____________ days of total confinement ordered above are hereby converted to ___________ hours of community restitution (service) (8 hours = 1 day, nonviolent offenders only, 30 days maximum) under the supervision of the Department of Corrections (DOC) to be completed: [ ] on a schedule established by the defendant's community corrections officer. [ ] as follows:___________________________________________________________________. [ ] Conversion of Jail Confinement (Nonviolent and Nonsex Offenses). RCW 9.94A.680(3). The county jail is authorized to convert jail confinement to an available county supervised community option and may require the offender to perform affirmative conduct pursuant to RCW 9.94A.607. [ ] Alternatives to total confinement were not used because of: ______________________________ [ ] criminal history [ ] failure to appear (finding required for nonviolent offenders only) RCW 9.94A.680. (b) Community Restitution (Service). RCW 9.94A.505. The defendant shall perform __________ hours of community restitution (service) as approved by the defendant's community corrections officer to be completed: [ ] on a schedule established by the defendant's community corrections officer. [ ] as follows:__________________________________________________________________________. This community restitution is in addition to the ordered total confinement. (c) The defendant shall receive credit for time served prior to sentencing if that confinement was solely under this cause number. RCW 9.94A.505. The jail shall compute time served unless the credit for time served prior to sentencing is specifically set forth here by the court: ____________________________________ ____________________________________________________________________________________. 4.6 Community [ ] Supervision [ ] Custody. RCW 9.94A.650. The defendant shall serve _____________ months in [ ] community supervision [ ] community custody (up to 12 months unless treatment is ordered, in which case the period of community supervision or community custody may include up to the period of treatment but shall not exceed two years), under the supervision of DOC. The defendant shall report to the DOC ___________________________________________ (address of office) not later than 72 hours after release from custody; and the defendant shall comply with the instructions, rules and regulations of DOC for the conduct of the defendant during the period of community supervision or community custody Felony Judgment and Sentence (FJS)(First-Time Offender Waiver) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com shall obey all laws, perform affirmative acts as required by DOC to confirm compliance with the orders of the court, and shall comply with any other conditions of community supervision or community custody stated in this Judgment and Sentence or other conditions imposed by the court or by DOC under RCW 9.94A.720 during community custody: [ ] pay all court-ordered legal financial obligations [ ] undergo available outpatient treatment for a period not to exceed two years, or inpatient [ ] notify the community corrections officer in treatment not to exceed the standard range for advance of any change in defendant’s address or that offense employment [ ] report as directed to a community corrections [ ] remain within prescribed geographical officer boundaries [ ] devote time to specific employment or occupation [ ] pursue a prescribed course of secular study ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________. The conditions of community supervision or community custody shall begin immediately unless otherwise set forth here:_______________________________________________________________________________. Felony Judgment and Sentence (FJS)(First-Time Offender Waiver) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com 4.5 Jail One Year or Less. The court sentences the defendant as follows: (a) Confinement. RCW 9.94A.589. A term of total confinement in the custody of the county jail: months on Count months on Count months on Count months on Count months on Count months on Count Actual number of months of total confinement ordered is: ______________________________________. All counts shall be served concurrently, except for the following which shall be served consecutively: _____________________________________________________________________________________. The sentence herein shall run consecutively with the sentence in cause number(s) ____________________ _____________________________________________________________________________________, but concurrently to any other felony cause not referred to in this Judgment. RCW 9.94A.589. Confinement shall commence immediately unless otherwise set forth here:__________________________ _____________________________________________________________________________________. [ ] Partial Confinement. The defendant may serve the sentence, if eligible and approved, in partial confinement in the following programs, subject to the following conditions:___________________ _____________________________________________________________________________________ [ ] work crew RCW 9.94A.725 [ ] home detention RCW 9.94A.731, .190 [ ] work release RCW 9.94A.731 [ ] Conversion of Jail Confinement (Nonviolent and Nonsex Offenses). RCW 9.94A.680(3). The county jail is authorized to convert jail confinement to an available county supervised community option and may require the offender to perform affirmative conduct pursuant to RCW 9.94A. [ ] Alternative Conversion. RCW 9.94A.680. _______________ days of total confinement ordered above are hereby converted to ________________ hours of community restitution (service) (8 hours = 1 day, nonviolent offenders only, 30 days maximum) under the supervision of the Department of Corrections (DOC) to be completed on a schedule established by the defendant's community corrections officer but not less than ______________ hours per month. [ ] Alternatives to total confinement were not used because of: ______________________________ [ ] criminal history [ ] failure to appear (finding required for nonviolent offenders only) RCW 9.94A.680. (b) Confinement. RCW 9.94A.712 (Sex Offense, only): The defendant is sentenced to the following term of confinement in the custody of the DOC: Count Count (c) minimum term minimum term maximum term maximum term The defendant shall receive credit for time served prior to sentencing if that confinement was solely under this cause number. RCW 9.94A.505. The jail shall compute time served unless the credit for time served prior to sentencing is specifically set forth here by the court: ____________________________________ ____________________________________________________________________________________. Felony Judgment and Sentence (FJS)(Jail One Year or Less) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com 4.6 Community [ ] Supervision [ ] Custody. RCW 9.94A.505, .545. The defendant shall serve __________ months (up to 12 months) in [ ] community supervision or [ ] community custody. The court may order community custody under the jurisdiction of DOC for up to 12 months if the defendant is convicted of a sex offense, a violent offense, a crime against a person under RCW 9.94A.411, or felony violation of chapter 69.50 or 69.52 RCW or an attempt, conspiracy or solicitation to commit such a crime. For offenses committed on or after June 7, 2006, the court shall impose a term of community custody under RCW 9.94A.715 if the offender is guilty of failure to register (second or subsequent offense) under RCW 9A.44.130(11)(a).] [ ] Community Custody for count(s) ___________________, sentenced under RCW 9.94A.712, is ordered for any period of time the defendant is released from total confinement before the expiration of the maximum sentence. The defendant shall report to DOC, ____________________________________ (address of office) not later than 72 hours after release from custody; and the defendant shall perform affirmative acts as required by DOC to confirm compliance with the orders of the court and shall abide by any additional conditions of community custody imposed by DOC under RCW 9.94A.720. For sex offenses, the defendant shall submit to electronic monitoring if imposed by DOC. The defendant shall comply with the instructions, rules and regulations of DOC for the conduct of the defendant during the period of community supervision or community custody and any other conditions of community supervision or community custody stated in this Judgment and Sentence. The defendant shall: [ ] remain in prescribed geographic boundaries [ ] notify the community corrections officer of any specified by the community corrections officer change in defendant’s address or employment [ ] not reside within 880 feet of the facilities and grounds of a public or private school (community protection zone). RCW 9.94A.030(8). [ ] Other conditions: ________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________. [ ] For sentences imposed under RCW 9.94A.712, other conditions, including electronic monitoring, may be imposed during community custody by the Indeterminate Sentence Review Board, or in an emergency by DOC. Emergency conditions imposed by DOC shall not remain in effect longer than seven working days. The community supervision or community custody imposed by this order shall be served consecutively to any term of community supervision or community custody in any sentence imposed for any other offense, unless otherwise stated. The maximum length of community supervision or community custody pending at any given time shall not exceed 24 months, unless an exceptional sentence is imposed. RCW 9.94A.589. The conditions of community supervision or community custody shall begin immediately unless otherwise set forth here:_____________________________________________________________________________. 4.7 Off - Limits Order. (Known drug trafficker). RCW 10.66.020. The following areas are off limits to the defendant while under the supervision of the county jail or Department of Corrections:_________________ _____________________________________________________________________________________. Felony Judgment and Sentence (FJS)(Jail One Year or Less) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com 4.5 Special Sex Offender Sentencing Alternative. RCW 9.94A.670. The defendant is a sex offender who is eligible for the special sentencing alternative and the court has determined that the special sex offender sentencing alternative is appropriate. The court sentences the defendant to a term of confinement as follows: (a) Confinement. RCW 9.94A.589. A term of total confinement in the custody of the county jail or Department of Corrections (DOC): months on Count months on Count months on Count months on Count months on Count months on Count Actual number of months of total confinement ordered is: ______________________________________. All counts shall be served concurrently, except for the following which shall be served consecutively: _____________________________________________________________________________________. The sentence herein shall run consecutively with the sentence in cause number(s) ____________________ _____________________________________________________________________________________ but concurrently to any other felony cause not referred to in this Judgment. RCW 9.94A.589. Confinement shall commence immediately unless otherwise set forth here:__________________________ _____________________________________________________________________________________. (b) Confinement. RCW 9.94A.712: The court sentences the defendant to the following term of confinement in the custody of the DOC: Count Count minimum term minimum term maximum term maximum term (c) The defendant shall receive credit for time served prior to sentencing if that confinement was solely under this cause number. RCW 9.94A.505. The jail shall compute time served unless the credit for time served prior to sentencing is specifically set forth here by the court: ___________________________. (d) Suspension of Sentence. The court suspends execution of this sentence; and places the defendant on community custody under the charge of DOC for the length of the suspended sentence, the length of the maximum term sentenced under RCW 9.94A.712, or three years, whichever is greater. The defendant shall comply with all rules, regulations and requirements of DOC and shall perform affirmative acts as required by DOC to confirm compliance with the orders of the court. The defendant shall abide by any additional conditions of community custody imposed by DOC under RCW 9.94A.720. Community custody for offenses not sentenced under RCW 9.94A.712 may be extended for up to the statutory maximum term of the sentence. Violation of community custody may result in additional confinement. The defendant shall: (1) report as directed to a community corrections officer, (2) pay all legal financial obligations, (3) perform any court ordered community restitution (service) work, (4) submit to electronic monitoring if imposed by DOC, (5) undergo and successfully complete an [ ] outpatient [ ] inpatient sex offender treatment program with ______________________________________________ for a period of _______________. The offender shall not change sex offender treatment providers or treatment conditions without first notifying the prosecutor, community corrections officer and the court and shall not change providers without court approval after a hearing if the prosecutor or community corrections officer object to the change; and (6) be subject to the following terms and conditions or other conditions that may be imposed by the court or DOC during community custody: [ ] Serve ___________________________________ days/months of total confinement. Work Crew and Felony Judgment and Sentence (FJS)(SSOSA) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com Electronic Home Detention are not authorized. RCW 9.94A.725, .734. [ ] Obtain and maintain employment: ______________________________________________________. [ ] Perform ____________________ hours of community restitution (service) as approved by defendant's community corrections officer to be completed: [ ] as follows:___________________________________________________________________. [ ] on a schedule established by the defendant's community corrections officer. RCW 9.94A. [ ] Work release is authorized, if eligible and approved. RCW 9.94A.731. [ ] Reside outside any community protection zone (outside 880 feet of the facilities and grounds of a public or private school). RCW 9.94A.030(8). Other conditions:_______________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________. The conditions of community custody shall begin immediately unless otherwise set forth here: __________ _____________________________________________________________________________________. 4.6 Revocation of Suspended Sentence. At any time during the period of community custody, if the defendant violates the conditions of the suspended sentence or the court finds that the defendant is failing to make satisfactory progress in treatment, the court may revoke the suspended sentence and order execution of the sentence, with credit for any confinement served during the period of community custody, RCW 9.94A.670. 4.7 Review Hearing. The defendant’s first annual progress review hearing is scheduled for ______________ ____________________________________________ [date]. RCW 9.94A.670(7)(b). 4.8 Termination Hearing. A treatment termination hearing is scheduled for _______________________ ______________________________________________________ [date] (three months prior to anticipated date for completion of treatment). RCW 9.94A.670(6). Felony Judgment and Sentence (FJS)(SSOSA) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com 4.5 Special Drug Offender Sentencing Alternative. RCW 9.94A.660. The defendant is a drug offender who is eligible for the special sentencing alternative and the court has determined that the special drug offender sentencing alternative is appropriate. The court waives imposition of a sentence within the standard range and imposes the following sentence: (a) Prison-Based Alternative (effective for sentences imposed on or after October 1, 2005). (1) Confinement. A term of total confinement in the custody of the Department of Corrections (DOC) (half of the midpoint of the standard range, or 12 months, whichever is greater): _____________________ months of total confinement in the custody of DOC on Count ____________. _____________________ months of total confinement in the custody of DOC on Count ____________. _____________________ months of total confinement in the custody of DOC on Count ____________. Confinement shall commence immediately unless otherwise set forth here: _________________________ ____________________________________________________________________________________. Work release is authorized, if eligible and approved. If the midpoint of the standard range is 24 months or less, no more than three months may be served in work release status. RCW 9.94A.731. The defendant shall receive credit for time served prior to sentencing if that confinement was solely under this cause number. RCW 9.94A.505. The jail shall compute time served unless the credit for time served prior to sentencing is specifically set forth here by the court: _________________________________________________________________________________. (2) Community Custody. The defendant shall serve: _____________________ months in community custody on Count ________________. _____________________ months in community custody on Count ________________. _____________________ months in community custody on Count ________________. (The remainder of the midpoint of the standard range.) The defendant shall comply with the community custody conditions in paragraph 4.6. (b) Residential Chemical Dependency Treatment-Based Alternative (effective for sentences imposed on or after October 1, 2005). (1) The defendant shall serve: ___________________ months in community custody on Count ______________. ___________________ months in community custody on Count ______________. ___________________ months in community custody on Count ______________. (A term equal to one-half of the midpoint of the standard range or two years, whichever is greater) under the supervision of the Department of Corrections (DOC), on the condition that the defendant enters and remains in residential chemical dependency treatment certified under chapter 70.96A RCW for ______________________________ months. (2) The defendant shall comply with the community custody conditions in paragraph 4.6. DOC shall make chemical dependency assessment and treatment services available to the defendant during the term of community custody, within available funding. (3) A progress hearing is set for ________________________________ (date). A treatment termination hearing is scheduled for three months before the expiration of the term of community custody, on ___________________________ (date), or to be set later. Felony Judgment and Sentence (FJS)(SDOSA) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com 4.6 Community Custody Conditions. RCW 9.94A.660. The defendant shall report to DOC, ______________________________________________________ (address of office) not later than 72 hours after sentencing or release from custody and the defendant shall comply with the instructions, rules and regulations of DOC for the conduct of the defendant during the period of community custody, shall perform affirmative acts as required by DOC to confirm compliance with the orders of the court, shall not use illegal controlled substances and shall comply with any other conditions of community custody stated in this Judgment and Sentence or other conditions that may be imposed by the court or by DOC under RCW 9.94A.720 during community custody: (a) Undergo and successfully complete a substance abuse treatment program approved by the Division of Alcohol and Substance Abuse of the Department of Social and Health Services. (b) Undergo urinanalysis or other testing to monitor drug-free status. [ ] The defendant shall pay the statutory rate to DOC, while on community custody, to offset the cost of urinanalysis. (c) Additional conditions (choose at least three): [ ] pay all court-ordered legal financial obligations [ ] notify the court or community corrections officer in advance of any change in defendant’s address or employment [ ] perform community restitution (service) work [ ] report as directed to a community corrections officer [ ] remain within or outside of prescribed geographical boundaries [ ] devote time to specific employment or training [ ] stay out of areas designated by the judge Other Conditions:_______________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________. 4.7 (a) Additional Confinement Upon Violation of Sentence Conditions. If the defendant violates any of the sentence conditions in Section 4.6 above, or, for offenses committed on or after June 8, 2000, is found by the United States attorney general to be subject to a deportation order, DOC shall hold a violation hearing, unless waived by the defendant. If DOC finds that the conditions have been willfully violated, the defendant may be reclassified to serve the remaining balance of the original sentence. For offenses committed on or after June 8, 2000, if DOC finds that the defendant is subject to a valid deportation order, DOC may administratively terminate the defendant from the program and reclassify the defendant to serve the remaining balance of the original sentence. DOC shall reclassify a defendant who fails to complete the special drug offender sentencing alternative program or who is administratively terminated from the program to serve the unexpired term of the sentence as ordered by the sentencing judge subject to all rules relating to community custody and earned release time. DOC may sanction a defendant who violates any conditions of supervision as defined by DOC. Sanctions may include, but are not limited to, reclassifying the defendant to serve the unexpired term of sentence as ordered by the sentencing judge. If DOC reclassifies the defendant to serve the unexpired term of the sentence, the defendant shall be subject to all rules relating to earned release time. RCW 9.94A.660. (b) Confinement Ordered at the Treatment Termination Hearing (effective for sentences imposed on or after October 1, 2005). At the treatment termination hearing, the court may impose a term of total confinement equal to one-half of the midpoint of the standard sentence range. Confinement imposed at the hearing shall be followed by the term of community custody in paragraph 4.8. Within available funding, DOC shall make chemical dependency assessment and treatment services available to the defendant during the terms of total confinement and community custody. Felony Judgment and Sentence (FJS)(SDOSA) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com 4.8 Additional Term of Community Custody Upon Failure to Complete or Termination From Alternative Program. (a) For offenses committed on or after June 8, 2000, the court orders the following term of community custody.This community custody shall be imposed upon the defendant’s failure to complete or defendant’s administrative termination from the special drug offender sentencing alternative program. (b) (Effective for sentences imposed on or after October 1, 2005), for a defendant sentenced under the residential chemical dependency treatment-based alternative, the court orders the following term of community custody. This community custody shall be imposed upon the defendant after the term of total confinement imposed at the treatment termination hearing. A range from: ____________ to ____________ months in community custody on Count _____________. ____________ to ____________ months in community custody on Count _____________. ____________ to ____________ months in community custody on Count _____________. While on community custody, the defendant shall comply with conditions set by DOC, including but not limited to: (1) report to and be available for contact with the assigned community corrections officer as directed; (2) work at DOC-approved education, employment and/or community restitution (service); (3) not consume controlled substances except pursuant to lawfully issued prescriptions; (4) not unlawfully possess controlled substances while in community custody; (5) pay supervision fees as determined by DOC; (6) perform affirmative acts necessary to monitor compliance with the orders of the court as required by DOC; (7) obtain prior approval of DOC for residential location and living arrangements. The court orders the following conditions of community custody: [ ] The defendant shall not consume any alcohol. [ ] The defendant shall have no contact with: [ ] The defendant shall remain [ ] within [ ] outside of a specified geographical boundary, to wit: . [ ] The defendant shall participate in the following crime-related treatment or counseling services: . [ ] The defendant shall undergo an evaluation for treatment for [ ] domestic violence [ ] substance abuse [ ] mental health [ ] anger management and fully comply with all recommended treatment. [ ] The defendant shall comply with the following crime-related prohibitions: Other conditions : . Felony Judgment and Sentence (FJS)(SDOSA) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com 4.5 Persistent Offender. The court found the defendant to be a Persistent Offender. RCW 9.94A.570. [ ] Count ____________________ is a most serious offense and the defendant has been convicted on at least two separate occasions of most serious offense felonies, at least one of which occurred before the commission of the other most serious offense for which the defendant was previously convicted. [ ] Count ____________________ is a crime listed in RCW 9.94A.030(33)(b)(i) (e.g., rape in the first degree, rape of a child in the first degree (when the offender was 16 years of age or older when the offender committed the offense), child molestation in the first degree, rape in the second degree, rape of a child in the second degree (when the offender was 18 years of age or older when the offender committed the offense), or indecent liberties by forcible compulsion; or any of the following offenses with a finding of sexual motivation: murder in the first degree, murder in the second degree, homicide by abuse, kidnapping in the first degree, kidnapping in the second degree, assault in the first degree, assault in the second degree, assault of a child in the first degree, assault of a child in the second degree, or burglary in the first degree; or an attempt to commit any crime listed in RCW 9.94A.030(33)(b)(i)), and that the defendant has been convicted on at least one separate occasion, whether in this state or elsewhere, of a crime listed in RCW 9.94A.030(33)(b)(i) or any federal or out-of-state offense or offense under prior Washington law that is comparable to the offenses listed in RCW 9.94A.030(33)(b)(i). The defendant’s prior convictions are included in the offender score as listed in Section 2.2 of this Judgment and Sentence. RCW 9.94A.030(33), RCW 9.94A.525. Confinement. RCW 9.94A.570. The court sentences the defendant to the following term of total confinement in the custody of the Department of Corrections: Life without the possibility of early release on Count months on Count months on Count months on Count Actual number of months of total confinement ordered is: life without the possibility of early release. All counts shall be served concurrently, except for the portion of those counts for which there is a special finding of firearm or other deadly weapon as set forth above at Section 2.3, and except for the following counts which shall be served consecutively: _____________________________________________________________________________________. The sentence herein shall run consecutively with the sentence in cause number(s) ____________________ _____________________________________________________________________________________ but concurrently to any other felony cause not referred to in this judgment. RCW 9.94A.589. Confinement shall commence immediately unless otherwise set forth here:_________________________. 4.6 Other: _________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ___________________________________________________________________________________. Felony Judgment and Sentence (FJS)(Persistent Offender) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com V. Notices and Signatures 5.1 Collateral Attack on Judgment. If you wish to petition or move for collateral attack on this Judgment and Sentence, including but not limited to any personal restraint petition, state habeas corpus petition, motion to vacate judgment, motion to withdraw guilty plea, motion for new trial or motion to arrest judgment, you must do so within one year of the final judgment in this matter, except as provided for in RCW 10.73.100. RCW 10.73.090. 5.2 Length of Supervision. If you committed your offense prior to July 1, 2000, you shall remain under the court's jurisdiction and the supervision of the Department of Corrections for a period up to 10 years from the date of sentence or release from confinement, whichever is longer, to assure payment of all legal financial obligations unless the court extends the criminal judgment an additional 10 years. If you committed your offense on or after July 1, 2000, the court shall retain jurisdiction over you, for the purpose of your compliance with payment of the legal financial obligations, until you have completely satisfied your obligation, regardless of the statutory maximum for the crime. RCW 9.94A.760 and RCW 9.94A.505(5). The clerk of the court has authority to collect unpaid legal financial obligations at any time while you remain under the jurisdiction of the court for purposes of your legal financial obligations. RCW 9.94A.760(4) and RCW 9.94A.753(4). 5.3 Notice of Income-Withholding Action. If the court has not ordered an immediate notice of payroll deduction in Section 4.1, you are notified that the Department of Corrections (DOC) or the clerk of the court may issue a notice of payroll deduction without notice to you if you are more than 30 days past due in monthly payments in an amount equal to or greater than the amount payable for one month. RCW 9.94A.7602. Other income-withholding action under RCW 9.94A.760 may be taken without further notice. RCW 9.94A.7606. 5.4 Restitution Hearing. [ ] I waive any right to be present at any restitution hearing (sign initials):______________. 5.5 Community Custody Violation. (a) If you are subject to a first or second violation hearing and DOC finds that you committed the violation, you may receive as a sanction up to 60 days of confinement per violation. RCW 9.94A.634. (b) If you have not completed your maximum term of total confinement and you are subject to a third violation hearing and DOC finds that you committed the violation, DOC may return you to a state correctional facility to serve up to the remaining portion of your sentence. RCW 9.94A.737(2). 5.6 Firearms. You must immediately surrender any concealed pistol license and you may not own, use or possess any firearm unless your right to do so is restored by a court of record. (The clerk of the court shall forward a copy of the defendant's driver's license, identicard, or comparable identification to the Department of Licensing along with the date of conviction or commitment.) RCW 9.41.040, 9.41.047. Cross off or delete if not applicable: 5.7 Sex and Kidnapping Offender Registration. RCW 9A.44.130, 10.01.200. 1. General Applicability and Requirements: Because this crime involves a sex offense or kidnapping offense involving a minor as defined in RCW 9A.44.130, you are required to register with the sheriff of the county of the state of Washington where you reside. If you are not a resident of Washington but you are a student in Washington or you are employed in Washington or you carry on a vocation in Washington, you must register with the sheriff of the county of your school, place of employment, or vocation. You must register immediately upon being sentenced unless you are in custody, in which case you must register within 24 hours of your release. 2. Offenders Who Leave the State and Return: If you leave the state following your sentencing or release from custody but later move back to Washington, you must register within three business days after moving to this state or within 24 hours after doing so if you are under the jurisdiction of this state's Department of Corrections. If you leave this state following your sentencing or release from custody but later Felony Judgment and Sentence (FJS) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com while not a resident of Washington you become employed in Washington, carry on a vocation in Washington, or attend school in Washington, you must register within three business days after starting school in this state or becoming employed or carrying out a vocation in this state, or within 24 hours after doing so if you are under the jurisdiction of this state’s Department of Corrections. 3. Change of Residence Within State and Leaving the State: If you change your residence within a county, you must send signed written notice of your change of residence to the sheriff within 72 hours of moving. If you change your residence to a new county within this state, you must send signed written notice of your change of residence to the sheriff of your new county of residence at least 14 days before moving and register with that sheriff within 24 hours of moving. You must also give signed written notice of your change of address to the sheriff of the county where last registered within 10 days of moving. If you move out of Washington State, you must send written notice within 10 days of moving to the county sheriff with whom you last registered in Washington State. 4. Additional Requirements Upon Moving to Another State: If you move to another state, or if you work, carry on a vocation, or attend school in another state you must register a new address, fingerprints, and photograph with the new state within 10 days after establishing residence, or after beginning to work, carry on a vocation, or attend school in the new state. You must also send written notice within 10 days of moving to the new state or to a foreign country to the county sheriff with whom you last registered in Washington State. 5. Notification Requirement When Enrolling in or Employed by a Public or Private Institution of Higher Education or Common School (K-12): If you are a resident of Washington and you are admitted to a public or private institution of higher education, you are required to notify the sheriff of the county of your residence of your intent to attend the institution within 10 days of enrolling or by the first business day after arriving at the institution, whichever is earlier. If you become employed at a public or private institution of higher education, you are required to notify the sheriff for the county of your residence of your employment by the institution within 10 days of accepting employment or by the first business day after beginning to work at the institution, whichever is earlier. If your enrollment or employment at a public or private institution of higher education is terminated, you are required to notify the sheriff for the county of your residence of your termination of enrollment or employment within 10 days of such termination. If you attend, or plan to attend, a public or private school regulated under Title 28A RCW or chapter 72.40 RCW, you are required to notify the sheriff of the county of your residence of your intent to attend the school. You must notify the sheriff within 10 days of enrolling or 10 days prior to arriving at the school to attend classes, whichever is earlier. The sheriff shall promptly notify the principal of the school. 6. Registration by a Person Who Does Not Have a Fixed Residence: Even if you do not have a fixed residence, you are required to register. Registration must occur within 24 hours of release in the county where you are being supervised if you do not have a residence at the time of your release from custody. Within 48 hours excluding, weekends and holidays, after losing your fixed residence, you must send signed written notice to the sheriff of the county where you last registered. If you enter a different county and stay there for more than 24 hours, you will be required to register in the new county. You must also report weekly in person to the sheriff of the county where you are registered. The weekly report shall be on a day specified by the county sheriff's office, and shall occur during normal business hours. You may be required to provide a list the locations where you have stayed during the last seven days. The lack of a fixed residence is a factor that may be considered in determining an offender’s risk level and shall make the offender subject to disclosure of information to the public at large pursuant to RCW 4.24.550. 7. Reporting Requirements for Persons Who Are Risk Level II or III: If you have a fixed residence and you are designated as a risk level II or III, you must report, in person, every 90 days to the sheriff of the county where you are registered. Reporting shall be on a day specified by the county sheriff’s office, and shall occur during normal business hours. If you comply with the 90-day reporting requirement with no violations for at least five years in the community, you may petition the superior court to be relieved of the duty to report every 90 days. Felony Judgment and Sentence (FJS) (RCW 9.94A.500, .505)(WPF CR 84.0400 (7/2007)) Page ______ of ______ American LegalNet, Inc. www.FormsWorkflow.com 8. Application for a Name Change: If you apply for a name change, you must submit a copy of the application to the county sheriff of the county of your residence and to the state patrol not fewer than five days before the entry of an order granting the name change. If you receive an order changing your name, you must submit a copy of the order to the county sheriff of the county of your residence and to the state patrol within five days of the entry of the order. RCW 9A.44.130(7). 5.8 [ ] Count ________ is a felony in the commission of which you used a motor vehicle. The clerk of the court is directed to immediately forward an Abstract of Court Record to the Department of Licensing, which must revoke your driver’s license. RCW 46.20.285. 5.9 If you are or become subject to court-ordered mental health or chemical dependency treatment, you must notify DOC and you must release your treatment information to DOC for the duration of your incarceration and supervision. RCW 9.94A.562. 5.10 Other:____________________________________________________________________________. Done in Open Court and in the presence of the defendant this date:______________________________. _______________________________________________ Judge/Print Name: _____________________________ Deputy Prosecuting Attorney WSBA No. Print Name: ____________________________ Attorney for Defendant WSBA No. Print Name: _____________________________ Defendant Print Name: Voting Rights Statement: I acknowledge that my right to vote has been lost due to felony conviction. If I am registered to vote, my voter registration will be cancelled. My right to vote may be restored by: a) A certificate of discharge issued by the sentencing court, RCW 9.94A.637; b) A court order issued by the sentencing court restoring the right, RCW 9.92.066; c) A final order of discharge issued by the indeterminate sentence review board, RCW 9.96.050; or d) A certificate of restoration issued by the governor, RCW 9.96.020. Voting before the right is restored is a class C felony, RCW 92A.84.660. Defendant’s signature: ______________________________________________ I am a certified interpreter of, or the court has found me otherwise qualified to interpret, the ________________ _________________________________ language, which the defendant understands. I translated this Judgment and Sentence for the defendant into that language. Interpreter signature/Print name:________________________________________________________________ I, _______________________________________________, Clerk of this Court, certify that the foregoing is a full, true and correct copy of the Judgment and Sentence in the above-entitled action now on record in this office. Witness my hand and seal of t