lil.

Appt:

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*

* .
.

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STANDARD RtlT ITS Qg YOUR PROBATION ANB/OJEt PAROT.R

NAME:
ADDRESS;

. .

OFFENSE:__^

CC-

SENTENCE:^

COURT DATE;

'

RELEASE DATE:

GENERAL INSTRUCTIONS

You have been placed ori either proJ?ati6n orparole.' Your future conduct will be governed by the rules and conditions which follow/these generaHnstructions. It is very important that you understand these rules and conditions and it will be youri^ponsibility to understand and follow themj Ignorance will not excuse
violations. Ifthere is anything you d.a not understand,- ask for an explanation.

There is am impdrt^nt distinction between probation and.parole. If you viblate conditions of parole,you wouldbe subject tojail forthe rest of yoursentence. Yoursentence could be extended.by adding bad time; that is, in time which you did. notcomply with your'rules and conditions;
If you violate probation; ypu are subject to complete resentencing. There are certain" requirements for reporting. AH reports must.be made within a reasonable time.

Ordinarily, forty-eight hours Will be considered a reasonable time. If you fail to report, for example, an arrest or being fired from a job within,fprty-eight hours it will be your burden,to show that,you made the report within a

reasonable time. The jongOT the period beyond forty-ejght ho.urs, the. greater will be the'presumption that the
time is .unreasonable. '

Any condition that may be waived pr changed by the Probation Office-will reqiiire written permission. You may not rely uponor^ permission or waiverby yourProbation Officer.

Ifweapons are prohibit^, you are notified that iffound to be inpossession ofany type offirearm, the
weapon will be confiscated for, an Ord.er ofDestnictipn. You have 15 .days from today's date to provide proof of disposal of any weapon cuCTently held in your possession. These Court-Ordered conditions are in addition to any State and Federal .Law how currently enforced and does not relieve your obligation to comply with these laws as defined in 18 Pa.C.S.A. Section 6105 (i). Keep in mind that the purpose ofprobationandp^ole relate not only to your rehabilitation but to

community awareness of intervention of the criminal-justice system. You must comply With all conditions, identified as standard by an asterisk (*) and all special conditions which have been checked. You have; ^have not been classified as a sex.ual offender and are; ^are not required to complywith SO conditions.

Defendant

Date

ALCOHOL. CONTROLLED SUBSTANCES AND COTTNSF.T.TNf^

1. YOU MUST NOT:

*a.

Usenon-prescribed cpntfoUed substances.

*b. Become drunk, or publicly intoxicated, or have aBAG of.05 or greater.

*0.

*d. Enter or remain in any bar, tavern, or other drinking establishment, or any
establishment selling alcoholic or malt beverages including State Liquor

Be in a building, vehicle orother property where alcohol and/or nonprescribed controlled substances are present orwhere it isplainly visible.
Stores, without the consent from the Probation 0Bce.

*e. Possess or consume alcoholic beverages or have it present in your residence until this condition (e)
has beenwaived in writing by theProbation Ofl&ce.
2. YOU MUST:

*a. A^ee to have your person, blood, breath, or ujfine tested as directed by the Probation Office or
Prison Officials to deteimine ifyou axe alcohol and/or drug free. ^b. Attend counseling or therapy sessions related to- drug and alcohol abuse as directed by the Probation Office, and comply with conditions ofany

c.
d.
e.

Successfully complete the alcohol safe driving program or otihier program

required by law.

treatment program recommended.

Attend and comply with mental health counseling and therapy programs as directed by the Probation Office aiid comply with conditions, ofthat program. Attend and comply with any counseling or treatment program rel^^ed
to domestic violence as directed by the Probation Office.
PERSONAL CONDUCT

3.

YOU MUST:

*a.

Not commit any violation ofthe law.

*b. Report any contact with law enforcement official or agency to the Probation"

Office within the next court business day. This includes any arrest, xeceipt of

*c. Not associate with persons, having serious criminal records and reputations
for criminal conduct

cnminal complaint, citation or summons.

*d.

Report to the Probation Office when directed.

*e.

Obey all directions given by any Probation/Parole Officer.

*f
*g.
*h.
i.

Not commit any action which might cause fear, annoyance, oralarm tothe victim ofany case where charges have been filed against you. Beinside your home and obey any curfew established bytheProbation
Office.

Obey all Prison andhouse arrest rules, including those imposed while
participating in the work release program.

Abide by the terms and conditions of all active Orders of Protection issuedby any
court and provide a copy of any existing Order of Protection to the Probation
Office.

Witness

Defendant

Date

EMPLOYMENT

4.

YOU MUST:

*a.
*b. *0.

Obtain employment as soon as possible as directed by your Probation/Parole

Officerand maintain steadyemployment. Not cause the loss ofanyjob you get l^otifythe Probation Office ofany change in your employment status within the- next courtbusiness day.
FINANCIAL OBLIGATIONS

5.

YOU MUST;

*a. Pay your debts^ especially court ordered for the support ofany person. *b. Pay court costs, fine, and restitution on such payment plan as may be
established by the Probation Office.

*c.

Pay the costs of required counseling, therapy, treatment, and electronic

monitoring programs.
PUBLIC/COMMDNITYSERVTCT.

6.

YOU MUST:

*a.

Perform pubhc/community service unless this condition is waived bya judge. If no other period is designated, you must perform forty (40) hours. If another period is designated, you must perform that amount. Service shall be arranged by the Public/Conamunity Service Coordinator for Adams County.
Perform hours ofPublic Service.
RESIDENCE

b.

7.

YOU MUST:

*a.
*b.

NotilytheProbation Office in advance of any changes of mailing address

or physical residence or if advance notice is not possible,within the next
court business day.

Obtain prior written permission from the Probation Office to leave Adams County or county of legal residence for any period of time in excess of twenty-four (24) hours unless prior permissionis obtained by the Probation
Office.

*c.

Consent to the entry by a Probation Officer into your home at any time. .
WEAPONS

8.

YOU MUST NOT:

*a.

Possess a fireairm orany other deadly weapon if:

i.
ii. iii.

You have been convicted of a misdemeanor (1) or felony (any grade) and/or are
prohibited by Federal and State Law. Your current offense"is for a firearm or deadly weapons violation. Possession is prohibited by a court order.

Witaess

Defendant

Date

EXTRAPmON
9. YOU MUST:
a.

Waive extradition procedures and ri^ts, including the right tobetaken before ajudge inanother state, with respect t{) violations ofprobation or
parole conditions.
SEXUAL OFFENDER CONPITIQNS

All conditions

Paragraphs 10 and 11, below, apply except

10:

YOU MUST NOT POSSESS ANY OF THE FOLLOWING ITEMS,

WITHOUT THE APPROVAL OF YOUR PROBATION OFFICER:

i. ii.
iii. iv.

Badges, uniforms, weapons orother indication ofof&cial authority. Chains, handcuffs, ropes,, orlines intended ordesigned as restraints.
Children's clothing. Masks and disguises.

V.
vi. vii. viii.

Photographs, videos, DVD's, orfilms depicting or showing nudity.

Photographs ofthe victim. Pornography. Computer or Internetaccess. Thisincludes access to the internetat
any location outside your residence.

11.

YOU l^ST NOT WTHOUT YOUR PROBATION OFFICER'S APPROVAL:

i.
ii.

Use fictitious names, other than those registered for legitimate business
purposes.

Have any contact with children, other than tiiose specifically authorized by your Probation OfiBcer, and subject to conditions imposed by your
Probation Officer.

iii. Enter orremain upon school property, playgrounds orplaces where

ciuldren congregate.

. iv.

Linger, loiter, or prowl in the vicinity ofschools, playgrounds orplaces

where children congregate.

V.
vi.

Use apublic street or sidewalk that passes such alocation, except for legitimate purposes of travel, or movement. In such acase, your us shall be limited in time and purpose to
expeditiously traveling from onelegitimate location to another.

Rent ormaintain a post office box, orreceive mail at any location that
does not identify your actual residence, without authorizationfrom
your Probation Officer.
NOTICE

You are hereby notified thatwhile you areonprobation, parole or intermediate punishment any Probation/Parole Officer is permitted bylawto conduct a warrantiess search of your residence if saidofficer has a reasonable suspicion that the residence contains contraband or other evidence of probation, parole or intermediate punishment
violations.

Witness

Defendant

Date

Defendant's Name:.
Case fr:

NOTTCF. AND AnRff.l?MP|s^-r

K You are being considered for

.ProbaUon.

Parole

ART)

rPD

4.. You must submit to periodic tests ofyour blood, breath nr ,mV

your case being placed back on the trial list

balance ofyourunexpired sentence. Revocation ofyour en^ into^

^

parole wiU result m yourbeing comniitted to Adams CountyPnfon t^se^el^hr'

approved by the Adams County Board ofJudges. ' ' nequipment 5. ^aconditionofyouradmissionorpaittcipationinARD,PrDbation,IPP oryour rele^e fom mipnsoiment on fiarole, you toust agree thatthe results ofte^ts ^ be '

ap^y and lie results wiUjusbfyyourremoval fipm theprogram orpunishment

mrevocation propepdings without supporting evidence estabfishing ffie'

penod. the ^ecunen sample shaU.be de^yed.and your right to an independent '
analysis Will be lost *. " f .

laboratory. Ifno request for an independent analysis is made within flie ten day

Pr^^fnn Of?^ be retained for 10 days by the Probation Office. You will have the nghtprovide to havewill an independent analysis ofUie' ^pleby^a la^mory ofour choice ifyou request this within the ten (10) dayperiod The ProbabOT Office wUl, as acourtesy, provide you with the name and' address ofa' aboratoiy toat does tiug type ofworlc, but you will not be confined to thatparticular

You must sign the foIJowing conisent and acknowledgement.

showing reliability ^d that the results shall be sufScient cause for revocation and
removal from ARjD, IPP, Probation, or Parole,
S7

results shall be admissible in revocation proceedings without supporting evidence

Ihave read and understand the foregoing: information. I understiid and agree that test

. Defendant

Search and Seizure Acloiowledgemeiit

subject to the provisions ofAct 35 of1995. Act 35 of1995 gives county probation and parole officers the
of 1995.

You are hereby notified that upon being granted hitennediate Punishment; Probation, or Parole you are

authority to search the property ofcounty offenders inaccordance with the provisions ofsection 27.2 ofAct 35

The following paragraphs outline when and how a search may be conducted.

1.

Apersonal search ofan offender may be conducted by any intensive Supervision, Parole, or Probation
Officer:

Ifthere is areasonable suspicion to believe the offender possesses contraband orother evidence ofviolations oftheconditions ofsupervision. When an offender istransported ortaken into custody. Upon entering or leaving the securing enclosure ofa correctional institution, jail, or detention
facility.

2,

Aproperty search may be conducted by any officer ifthere is reasonable suspicion to believe that the
real orother-property in the position oforunder the control ofthe offender contains contraband or other evidence of the conditions of supervision.

Prior approval ofasupervisor shall be obtained for aproperty search absent exigent circumstances. No prior approval shall be required for apersonal search. The offends may be detained ifhe ispresent during aproperty search. Ifthe offender is not
. present during aproperty search, the officer incharge ofthe search make reasonable effort to

provide anotice ofthe search, including aHst ofthe items seized, ^er the search is completed.

I aclmowledge that I have been made aware ofthe Search and seizure provisions ofAct 35 of1995.1 understand
that my person orproperty may besearched atany time under the provisions of the act.

Defendant/Date

Witness/Date

IN THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIA

CRMNAL ACTIONS

Commonwealth of Pennsylvania
vs.

CC#
Charge_

approved the 19'" of June, 1911 .*

defendant onprobation, under the Provisions of the Act ofAssembly

probation for aperiod of

he/she should not be classed as acriminal, to this end imposition ofsentence is postponed, and he/she is placed on
^months on the following terms and conditions:-

good conduct ofthe defendant,- and the Court being satisfied that the defendant should be given an opportunity to show that

i^dnow,

,after an investigation ofthe circumstances in the above case and the former

THAT he/she will accept supervision ofhis/her conduct by and under the advice ofthe Adams County Probation Office for said period of to whom he/she will report as ordered, and who will aid him/her in his/her purpose
to lead an industrious and reputable life.

will not depart from the territorial limits ofthe jurisdiction ofCounty ofAdams without the leave ofsaid Court.
will keep good company and indulge in no bad habits.

THAT he/she will immediately seek and obtain reputable employment, and continue in steady employment, and

THAT he/she will abstain from the use ofintoxicating liquors during the terms ofthis probation, and that he/she THAT the above name defendant will obey the rules and regulations hereto attached (Standard Conditions).

THAT he/she is to pay atotal of$

fees imposed by law.

plus $.50 installment fee with each payment made plus any other

THAT, ifat the end ofthe probationary period the Court, after investigation and after having areport ofhis/her conduct from the Probation Officer, shall find that he/she has complied with the terms and conditions ofthis probation
he/she will be entitled to an honorable discharge from the probation and allowed to go free ofthe charge in this case made
against him/her. But, if at any time during the term ofprobation, orat the termination thereof, the Court finds that he/she

has violated the terms and conditions ofthis probation, aprocess will be issued for his/her arrest, and upon being brought
into Court, sentence will be imposed.

THAT the proposed sentence in the above case is as the Court may then determine.
By the Court,

Judge

And now, , I, order of probation, that I understand and accept the conditions thereof.

do hereby certify that I have read the foregoing

Signature

Date

Address

Witness