Juv # Referral # Counsel and Release (CWR) - Page 1 of 1 WPF JU 06.0140 (06/2018) - RCW 13.40.080 COUNTY JUVENILE COURT COUNSEL AND RELEASE (CWR) Name: DOB: Mailing Address: Telephone: ( ) Physical Address: Offense(s): Offense Date: A Juvenile accused of committing a criminal offense or violation who is diverted by the prosecuting attorney may be eligible for counsel and release provided the Diversion Unit determines that (1) the juvenile222s act(s) or omission(s) involved no victim, or (2) the juvenile has no prior criminal history, the alleged offense did not involve threat of or instance of actual physical harm, the alleged offense did not involve more than $50 in property loss or damage, and there is no loss outstanding to the person or firm suffering damage or loss. I am eligible for counsel and release and I understand: 1. If I sign this Counsel and Release, even if no conditions are required of me, it will constitute a part of my criminal history. 2. Upon successful completion, the records in this case will be automatically destroyed within 90 days of becoming eligible for destruction. Records in this case become eligible for destruction when all of the following conditions exist: (a) I am 18 years or older; (b) The records consist of successfully completed diversion agreements or counsel and release agreements, or both, completed on or after June 7, 2018; and, (c) I have paid all restitution in full. 3. Regardless of whether I qualify to have my diversion records destroyed, I can always file a motion asking the court to seal my records in accordance with the law at the time I make the motion. I fully understand the above and agree to a Counsel and Release for the offense or violation of which I am accused. COMMENTS: Date: Juvenile: Diversion Parent Fee: $ Fee paid Fee will be paid by: Other Parent/Guardian: Parent/Guardian: Date: Counselor: CAB Member: CAB Member: CAB Member: CAB Member: American LegalNet, Inc. www.FormsWorkFlow.com