Judgment and Sentence Form (JS) - Page 1 of 3 CrRLJ 07.0110 (06/2018) CrRLJ 7.2, 7.3 C ourt of Washington for No . Plaintiff, vs. Defendant . Judgment and Sentence (JS) Clerk222s Action Required: DOL notice The defendant pled guilty, or pled not guilty and the verdict of the jury was guilty, or the finding of the court was guilty of: Count Crime RCW or Ordinance (with subsection) 1. 2. GV For the crime(s) charged in count(s) , domestic violence 226 intimate partner was pled and proved. RCW 9A.36.041(4). GV For the crime(s) charged in count(s) , domestic violence (other) was pled and proved. RCW 10.99.020. Therefore, the defendant is adjudged guilty and sentenced as follows: Sentence is suspended (susp.)/deferred (def.) for months/years on the following conditions: Count 1) days of jail, susp./def. days; and a fine of $ with $ susp./def. Count 2) days of jail, susp./def. days; and a fine of $ with $ susp./def. Serve a total of days in jail with credit for days served, and serve a total of days of electronic monitoring home detention/electronic monitoring with credit for days served. Other alternative means of confinement Jail sentences are concurrent/consecutive with all other commitments . This crime is an offense which requires sex or kidnapping offender registration, or is one of the following offenses, assault in the fourth degree domestic violence, assault in the fourth degree with sexual motivation, communication with a minor for immoral purposes, custodial sexual misconduct in the second degree, failure to register, harassment, patronizing a prostitute, sexual misconduct with a minor in the second degree, stalking, or violation of a sexual assault protection order granted under chapter 7.90 RCW. Therefore, the defendant shall have a biological sample collected for purposes of DNA identification analysis. This paragraph does not apply if it is established that the Washington State Patrol crime laboratory already has a sample from defendant for a qualifying offense. RCW 43.43.754. The defendant is indigent as defined in RCW 10.101.010(3)(a) 226 (c). Defendant shall pay to the clerk of this court: fine $ criminal conviction fee $ 43.00 assessments $ criminal traffic fee $ 102.50 costs $ probation/monitoring fee $ bench warrant fee $ booking fee $ jail recoupment fee $ public defender recoupment $ DNA fee (RCW 43.43.7541) $ 100.00 DPO Assessment for DV conviction $ 15.00 Waived. DNA previously collected. domestic violence assessment $ 100.00 PPIA (RCW 9A.88.120) $ DPR fee (RCW 26.50.110) $ 30.75 other $ American LegalNet, Inc. www.FormsWorkFlow.com Judgment and Sentence Form (JS) - Page 2 of 3 CrRLJ 07.0110 (06/2018) CrRLJ 7.2, 7.3 restitution of $ (set by separate order.) restitution to be left open for days. Total: $ Financial obligations are due and payable immediately unless the court has set a payment schedule. Pay total financial obligations at $ per month starting on . Pay schedule set by separate order. $ of this total is converted to hours of community restitution (service) which must be completed by . Proof of completion shall be provided to the court/probation department. The defendant is ordered to reimburse (name of electronic monitoring agency) at , for the cost of pretrial electronic monitoring in the amount of $. Additional Conditions of Sentence: No criminal violations of law or alcohol related infractions. Not drive a motor vehicle without a valid license and proof of insurance. Probation for months. Supervised probation for months, with probation department and abide by all rules and regulations of probation department. Pay a $ pre- sentence fee and a $ monthly probation fee unless the fee is reduced by the probation department. Supervised probation to end upon completion of Certified domestic violence treatment and/or . Begin the following within days and complete within days and file proof of timely enrollment. Certified Domestic Violence Program Anger Management Victim Awareness Education Consumer Awareness (theft) Other. Obtain an alcohol/drug evaluation from a Washington State-approved agency a psycho-sexual evaluation from a state certified provider a mental health evaluation from a state licensed mental health provider, and file a copy of the evaluation within days. Begin any recommended treatment or education within days and file proof of timely enrollment and completion. Begin the following within days and complete within months, and file proof of timely enrollment and completion: DUI Victim222s Panel Alcohol/Drug Information School One Year Alcohol/Drug Treatment Two Year Alcohol/Drug Treatment Alcohol/Drug Treatment for the period of Driver Improvement School. Use no alcoholic beverages or non-prescribed controlled drugs. Attend Alcoholics Anonymous Narcotics Anonymous Other self-help program () meetings times a week for months or as recommended by treatment provider. Do not go upon the property of and have no contact with . Other: . This crime involves a sex offense, or a kidnapping offense involving a minor, as defined in RCW 9A.44.130. The defendant is required to register with the county sheriff as described in the 223Offender Registration224 Attachment. Department of Licensing Notice 226 Violation of RCW 9.41.270. Count is (a) a violation of RCW 9.41.270 (unlawful carrying or handling of weapons), a gross misdemeanor for which the penalty includes loss of the defendant222s concealed pistol license, if any. American LegalNet, Inc. www.FormsWorkFlow.com Judgment and Sentence Form (JS) - Page 3 of 3 CrRLJ 07.0110 (06/2018) CrRLJ 7.2, 7.3 Clerk222s Action 226The clerk shall forward a Notice of Revocation of Concealed Pistol License to DOL. Department of Licensing Notice 226 Defendant under age 21 only. Count is (a) a violation of RCW chapter 69.41 [Legend drug], 69.50 [VUCSA], or 69.52 [Imitation drugs], and the defendant was under 21 years of age at the time of the offense OR (b) a violation under RCW 9.41.040 (unlawful possession of firearm), and the defendant was under the age of 18 at the time of the offense OR (c) a violation under RCW chapter 66.44 [Alcohol], and the defendant was under the age of 18 at the time of the offense AND the court finds that the defendant previously committed an offense while armed with a firearm, an unlawful possession of a firearm offense, or an offense in violation of chapter 66.44, 69.41, 69.50, or 69.52 RCW. Clerk222s Action 226The clerk shall forward an Abstract of Court Record (ACR) to the DOL, which must revoke the Defendant222s driver222s license. RCW 46.20.265. Return for a review hearing: . Bail or Bond is Exonerated Forfeited. I have read the rights, conditions and warnings. Dated: Defendant222s Signature Date of Birth Judge/Commissioner/Pro Tem Defendant222s Address and Telephone P rosecuting Attorney WSBA No. D efense Attorney WSBA No. Written Waiver of Counsel is filed. American LegalNet, Inc. www.FormsWorkFlow.com