CCAP Case Number: _____________________________ Sentencing Date: _______________________ County: _____________________________________ Offender Age: __________________________ Forgery & Forgery Uttering, Wis. Stat. § 943.38 (1)(a) (1)(b) (1)(c) (1)(d) (2) THIS WORKSHEET ONLY APPLIES TO: Sentencing Hearings Held On or After 7/1/2005, for TIS–II Offenses (Offenses Committed On or After 2/1/2003). NOTE A: Where several options are presented, circle one and check Mitigating or Aggravating. [EX. Minimal / Leader ] NOTE B: Only check Mitigating or Aggravating for those factors that apply. Otherwise, leave the boxes unchecked. OFFENSE SEVERITY Characteristics of the Offense Value of Loss: $ .................................................................................................................................. Motivated by Need for Basic Necessities ........................................................................................... Motivated by Greed ............................................................................................................................ Conduct More Serious than Offense of Conviction............................................................................. Other, specify: ................................................................................................................................... Degree of Preparation None or Spontaneous / Some / Extensive.......................................................................................... Method of Access to Property Borrowed with Permission .................................................................................................................. Took without Permission..................................................................................................................... Obtained Through Burglary or Robbery.............................................................................................. Other, specify: ................................................................................................................................... Type of Harm None ................................................................................................................................................... Extreme Emotional Harm.................................................................................................................... Economic Harm: $ .............................................................................................................................. Other, specify: ................................................................................................................................... Aggravating Factors, Wis. Stat. § 973.017 N/A Concealed or Altered Appearance...................................................................................................... Gang-Related Offense........................................................................................................................ Crime Committed to Influence Governmental Policy .......................................................................... Other, specify: .................................................................................................................................. Penalty Enhancers, Wis. Stat. § 939 N/A Repeat Offender (§ 939.62) ......................................................... Pleaded and Proved ..................... Dangerous Weapon (§ 939.63).................................................... Pleaded and Proved ..................... Hate Crime (§ 939.645)................................................................ Pleaded and Proved ..................... Role in Offense Minimal / Leader ................................................................................................................................. Defendant was Manipulated or Pressured.......................................................................................... Abused Position of Trust / Authority ................................................................................................... Other, specify: .................................................................................................................................. Vulnerable Victim N/A Mentally Ill........................................................................................................................................... Cognitively Deficient ........................................................................................................................... Elderly Victim ...................................................................................................................................... Otherwise Vulnerable, specify: ......................................................................................................... RISK FACTORS Education Grade Completed, circle one: –9 9 10 11 12 12+ .......................................................... Degree Obtained: None GED/HSED High School College Currently Enrolled Employment History Usually Employed .............................................................................................................................. Same Employer for Extended Period of Time ................................................................................... Employed When Offense was Committed or at Time of Sentencing................................................. Lengthy or Frequent Periods of Unemployment ................................................................................ Wisconsin Sentencing Guidelines Worksheet §943.38 Mitigating Aggravating .............................. .............................. .............................. .............................. .............................. ............................. ............................. ............................. ............................. ............................. .............................. ............................. .............................. .............................. .............................. .............................. ............................. ............................. ............................. ............................. .............................. .............................. .............................. .............................. ............................. ............................. ............................. ............................. .............................. .............................. .............................. .............................. ............................. ............................. ............................. ............................. .............................. .............................. .............................. ............................. ............................. ............................. .............................. .............................. .............................. .............................. ............................. ............................. ............................. ............................. .............................. .............................. .............................. .............................. Mitigating ............................. ............................. ............................. ............................. Aggravating .............................. .............................. .............................. .............................. .............................. ............................. .............................. ............................. .............................. ............................. .............................. ............................. Effective Date of this Revision: 7/1/2005 SEND TO: Wisconsin Sentencing Commission, P.O. Box 7856, Madison, WI 53707-7856 American LegalNet, Inc. www.FormsWorkflow.com Criminal Record Criminal Record Not a Factor, check here No Criminal Record .......................................................................................................................... Prior Misdemeanor(s), total number ................. Assaultive Misdemeanors, total number ............. Prior felony or felonies, total number ............... Assaultive Felonies, total number ....................... Prior Offense(s) Similar to Current Offense....................................................................................... Previously Placed on Community Supervision .................................................................................. Criminal History Understates / Overstates Risk................................................................................. On Legal Status / Not on Legal Status when Crime was Committed ................................................ Time Since Most Recent Conviction / Incarceration: months / yrs......................................... Mental and Physical Health Mental Health Problem(s) / Physical Health Problem(s).................................................................... Treatment for Health Problems.......................................................................................................... Alcohol and Drug Abuse Under the Influence When the Offense was Committed.................................................................... Frequent Prior Abuse......................................................................................................................... Prior Treatment ................ Never Treated For Alcohol/Drug Abuse ....................................... Social Factors Married or Long-Term Relationship ................................................................................................... Resides With or Supports Children.................................................................................................... Family Support or Other Support Network......................................................................................... Defendant Suffered Prior Abuse........................................................................................................ Attitude Remorse ............................................................................................................................................ Accepts Responsibility....................................................................................................................... Detailed Rehabilitative Plan in Progress............................................................................................ Cooperated with Authorities / Prosecution......................................................................................... Other, specify: .................................................................................................................................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. ............................. ............................. ............................. .............................. .............................. .............................. .............................. ............................. ............................. ............................. ............................. .............................. .............................. .............................. .............................. .............................. ............................. ............................. ............................. ............................. ............................. OFFENSE INFORMATION Percent of Offenders Given Probation for the Offense since 2/2003 (TIS II effective date): Penalty Classification Level: 80% Class H Felony Permissible Penalties: Probation Fine ņ Maximum $10,000 Maximum Imprisonment ņ 6 Years x Initial Confinement ņ Maximum 3 Years x Extended Supervision ņ Maximum 3 Years RECOMMENDED SENTENCE RANGE RISK FACTORS OFFENSE SEVERITY Lesser Medium High Mitigated ____ Probation ____ Prob. – 1 yr confinement ____ Prob. – 2 yrs confinement Intermediate ____ Probation ____ Prob. – 2 yrs confinement ____ 1 – 2½ yrs confinement Aggravated ____ Prob. – 1½ yrs confinement ____ 1 – 2½ yrs confinement ____ 2 – 3 yrs confinement OTHER FACTORS THAT MAY WARRANT SENTENCE ADJUSTMENT PSI Recommendation ................................................................................................................................ Read-In Offense(s)..................................................................................................................................... Effect of Multiple Counts ............................................................................................................................ Victim Statement ........................................................................................................................................ Restitution Paid Before Sentencing ........................................................................................................... District Attorney (DA) Recommendation .................................................................................................... Defense Attorney Recommendation .......................................................................................................... Other, specify:........................................................................................................................................... Mitigating .............................. .............................. .............................. .............................. .............................. .............................. .............................. .......................... Aggravating .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. Wisconsin Sentencing Guidelines Worksheet §943.38 Effective Date of this Revision: 7/1/2005 SEND TO: Wisconsin Sentencing Commission, P.O. Box 7856, Madison, WI 53707-7856 American LegalNet, Inc. www.FormsWorkflow.com