Form Ao 245D PDF Details

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Form NameForm Ao 245D
Form Length19 pages
Fillable?No
Fillable fields0
Avg. time to fill out4 min 45 sec
Other namesAO245D ao 245d form

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Date of Imposition of Judgment
Signature of Judge
Name and Title of Judge
Date

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations

Sheet 1

UNITED STATES DISTRICT COURT

__________ District of __________

UNITED STATES OF AMERICA

Judgment in a Criminal Case

v.

(For Revocation of Probation or Supervised Release)

Case No.

USM No.

THE DEFENDANT:

Defendant’s Attorney

Gadmitted guilt to violation of condition(s)

Gwas found in violation of condition(s)

The defendant is adjudicated guilty of these violations:

of the term of supervision. after denial of guilt.

Violation Number

 

Nature of Violation

 

Violation Ended

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The defendant is sentenced as provided in pages 2 through

 

 

of this judgment. The sentence is imposed pursuant to

the Sentencing Reform Act of 1984.

 

 

 

G The defendant has not violated condition(s)

 

 

and is discharged as to such violation(s) condition.

It is ordered that the defendant must notify the United States attorney for this district within 30 days of any

change of name, residence, or mailing address until all fines, restitution, costs, and special assessments imposed by this judgment are fully paid. If ordered to pay restitution, the defendant must notify the court and United States attorney of material changes in economic circumstances.

Last Four Digits of Defendant’s Soc. Sec. No.:

Defendant’s Year of Birth:

City and State of Defendant’s Residence:

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations

Sheet 1A

Judgment—Pageof

DEFENDANT:

CASE NUMBER:

ADDITIONAL VIOLATIONS

 

 

 

 

Violation

Violation Number

 

Nature of Violation

 

Concluded

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations

Sheet 2— Imprisonment

Judgment — Page

of

DEFENDANT:

CASE NUMBER:

IMPRISONMENT

The defendant is hereby committed to the custody of the United States Bureau of Prisons to be imprisoned for a total term of :

GThe court makes the following recommendations to the Bureau of Prisons:

GThe defendant is remanded to the custody of the United States Marshal.

GThe defendant shall surrender to the United States Marshal for this district:

G at

 

G a.m. G p.m. on

 

.

Gas notified by the United States Marshal.

GThe defendant shall surrender for service of sentence at the institution designated by the Bureau of Prisons:

G before 2 p.m. on

 

.

Gas notified by the United States Marshal.

Gas notified by the Probation or Pretrial Services Office.

RETURN

I have executed this judgment as follows:

 

Defendant delivered on

 

 

to

 

at

 

 

with a certified copy of this judgment.

UNITED STATES MARSHAL

By

DEPUTY UNITED STATES MARSHAL

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 2A — Imprisonment

DEFENDANT: CASE NUMBER:

Judgment—Pageof

ADDITIONAL IMPRISONMENT TERMS

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 3 — Supervised Release

DEFENDANT: CASE NUMBER:

Judgment—Pageof

SUPERVISED RELEASE

Upon release from imprisonment, the defendant shall be on supervised release for a term of :

The defendant must report to the probation office in the district to which the defendant is released within 72 hours of release from the custody of the Bureau of Prisons.

The defendant shall not commit another federal, state or local crime.

The defendant shall not unlawfully possess a controlled substance. The defendant shall refrain from any unlawful use of a controlled substance. The defendant shall submit to one drug test within 15 days of release from imprisonment and at least two periodic drug tests thereafter as determined by the court.

GThe above drug testing condition is suspended, based on the court’s determination that the defendant poses a low risk of future substance abuse. (Check, if applicable.)

GThe defendant shall not possess a firearm, ammunition, destructive device, or any other dangerous weapon. (Check, if

GThe defendant shall cooperate in the collection of DNA as directed by the probation officer. (Check, if applicable.)

GThe defendant shall register with the state sex offender registration agency in the state where the defendant resides, works, or is a student, as directed by the probation officer. (Check, if applicable.)

GThe defendant shall participate in an approved program for domestic violence. (Check, if applicable.)

If this judgment imposes a fine or restitution, it is be a condition of supervised release that the defendant pay in accordance with the Schedule of Payments sheet of this judgment.

The defendant must comply with the standard conditions that have been adopted by this court as well as with any additional conditions on the attached page.

STANDARD CONDITIONS OF SUPERVISION

1)the defendant shall not leave the judicial district without the permission of the court or probation officer;

2)the defendant shall report to the probation officer in a manner and frequency directed by the court or probation officer;

3)the defendant shall answer truthfully all inquiries by the probation officer and follow the instructions of the probation officer;

4)the defendant shall support his or her dependents and meet other family responsibilities;

5)the defendant shall work regularly at a lawful occupation, unless excused by the probation officer for schooling, training, or other acceptable reasons;

6)the defendant shall notify the probation officer at least ten days prior to any change in residence or employment;

7)the defendant shall refrain from excessive use of alcohol and shall not purchase, possess, use, distribute, or administer any controlled substance or any paraphernalia related to any controlled substances, except as prescribed by a physician;

8)the defendant shall not frequent places where controlled substances are illegally sold, used, distributed, or administered;

9)the defendant shall not associate with any persons engaged in criminal activity and shall not associate with any person convicted of a felony, unless granted permission to do so by the probation officer;

10)the defendant shall permit a probation officer to visit him or her at any time at home or elsewhere and shall permit confiscation of any contraband observed in plain view of the probation officer;

11)the defendant shall notify the probation officer within seventy-two hours of being arrested or questioned by a law enforcement officer;

12)the defendant shall not enter into any agreement to act as an informer or a special agent of a law enforcement agency without the permission of the court; and

13)as directed by the probation officer, the defendant shall notify third parties of risks that may be occasioned by the defendant’s criminal record or personal history or characteristics and shall permit the probation officer to make such notifications and to confirm the defendant’s compliance with such notification requirement.

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 3A — Supervised Release

DEFENDANT: CASE NUMBER:

Judgment—Pageof

ADDITIONAL SUPERVISED RELEASE TERMS

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 3B — Supervised Release

DEFENDANT: CASE NUMBER:

Judgment—Pageof

ADDITIONAL STANDARD CONDITIONS OF SUPERVISION

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 3C — Supervised Release

DEFENDANT: CASE NUMBER:

Judgment—Pageof

SPECIAL CONDITIONS OF SUPERVISION

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 4— Probation

DEFENDANT: CASE NUMBER:

Judgment—Pageof

PROBATION

The defendant is hereby sentenced to probation for a term of :

The defendant shall not commit another federal, state, or local crime.

The defendant shall not unlawfully possess a controlled substance. The defendant shall refrain from any unlawful use of a controlled substance. The defendant shall submit to one drug test within 15 days of placement on probation and at least two periodic drug tests thereafter as determined by the court.

GThe above drug testing condition is suspended, based on the court’s determination that the defendant poses a low risk of future substance abuse. (Check, if applicable.)

GThe defendant shall not possess a firearm, ammunition, destructive device, or any other dangerous weapon. (Check, if applicable.)

GThe defendant shall cooperate in the collection of DNA as directed by the probation officer. (Check, if applicable.)

GThe defendant shall register with the state sex offender registration agency in the state where the defendant resides, works, or is a student, as directed by the probation officer. (Check, if applicable.)

GThe defendant shall participate in an approved program for domestic violence. (Check, if applicable.)

If this judgment imposes a fine or restitution, it is be a condition of probation that the defendant pay in accordance with the Schedule of Payments sheet of this judgment.

The defendant shall comply with the standard conditions that have been adopted by this court as well as with any additional conditions on the attached page.

STANDARD CONDITIONS OF SUPERVISION

1)the defendant shall not leave the judicial district without the permission of the court or probation officer;

2)the defendant shall report to the probation officer in a manner and frequency directed by the court or probation officer;

3)the defendant shall answer truthfully all inquiries by the probation officer and follow the instructions of the probation officer;

4)the defendant shall support his or her dependents and meet other family responsibilities;

5)the defendant shall work regularly at a lawfuloccupation, unless excused by the probation officer for schooling,training, or other acceptable reasons;

6)the defendant shall notify the probation officer at least ten days prior to any change in residence or employment;

7)the defendant shall refrain from excessive use of alcohol and sh all not purchase, possess, use, distribute, or administer any controlled substance or any paraphernalia related to any controlled substances, except as prescribed by a physician;

8)the defendant shall not frequent places where controlled substances are illegally sold, used, distributed, or administered;

9)the defendant shall not associate with any persons engaged incriminal activity and shall not associate with any person convicted of a felony, unless granted permission to do so by the probation officer;

10)the defendant shall permit a probation officer to visit him or her at any time at home or elsewhere and shall permit confiscation of any contraband observed in plain view of the probation officer;

11)the defendant shall notify the probation officer within seventy-two hours of being arrested or questioned by a law enforcement officer;

12)the defendant shall not enter into any agreement to act as an informer or a special agent of a law enforcement agency without the permission of the court; and

13)as directed by the probation officer, the defendant shall notify third parties of risks that may be occasioned by the defendant’s criminal record or personal history or characteristics and sha ll permit the probation officer to m ake such notifications and to confirm the defendant’s compliance with such notification requirement.

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 4A — Probation

DEFENDANT: CASE NUMBER:

Judgment—Pageof

ADDITIONAL PROBATION TERMS

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 4B — Probation

DEFENDANT: CASE NUMBER:

Judgment—Pageof

ADDITIONAL STANDARD CONDITIONS OF SUPERVISION

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 4C — Probation

DEFENDANT: CASE NUMBER:

Judgment—Pageof

SPECIAL CONDITIONS OF SUPERVISION

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations

Sheet 5 — Criminal Monetary Penalties

Judgment — Page

 

of

DEFENDANT:

 

 

CASE NUMBER:

 

 

CRIMINAL MONETARY PENALTIES

 

 

The defendant must pay the following total criminal monetary penalties under the schedule of payments set forth on Sheet 6.

 

Assessment

 

Fine

Restitution

TOTALS

$

$

$

G The determination of restitution is deferred until

 

. An Amended Judgment in a Criminal Case (AO 245C) will be

entered after such determination.

 

 

 

GThe defendant shall make restitution (including community restitution) to the following payees in the amount listed below.

If the defendant makes a partial payment, each payee shall receive an approximately proportioned payment, unless specified otherwise

in the priority order or percentage payment column below. However, pursuant to 18 U.S.C. § 3664(i), all nonfederal victims must

be paid before the United States is paid.

 

 

 

Name of Payee

Total Loss*

Restitution Ordered

Priority or Percentage

TOTALS

$

 

 

$

 

 

 

 

 

 

 

G Restitution amount ordered pursuant to plea agreement

$

 

 

 

GThe defendant must pay interest on restitution or a fine more than $2,500, unless the restitution or fine is paid in full before the fifteenth day after the date of the judgment, pursuant to 18 U.S.C. § 3612(f). All of the payment options on Sheet 6 may be subject to penalties for delinquency and default, pursuant to 18 U.S.C. § 3612(g).

GThe court determined that the defendant does not have the ability to pay interest and it is ordered that:

G

the interest requirement is waived for the

G fine

G restitution.

G

the interest requirement for the

G fine

G restitution is modified as follows:

*Findings for the total amount of losses are required under Chapters 109A, 110, 110A, and 113A of Title18 for offenses committed on or after September 13, 1994, but before April 23, 1996.

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 5A — Criminal Monetary Penalties

DEFENDANT: CASE NUMBER:

Judgment—Pageof

ADDITIONAL TERMS FOR CRIMINAL MONETARY PENALTIES

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 5B — Criminal Monetary Penalties

DEFENDANT: CASE NUMBER:

Judgment—Pageof

ADDITIONAL TERMS FOR CRIMINAL MONETARY PENALTIES

 

 

 

 

 

 

Priority or

Name of Payee

 

Total Loss*

 

Restitution Ordered

 

Percentage

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Findings for the total amount of losses are required by Chapters 109A, 110, 110A, and 113A ofTitle 18 for offenses committed on or after September 13, 1994, but before April 23, 1996.

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations

Sheet 6 — Schedule of Payments

Judgment — Page

of

DEFENDANT:

CASE NUMBER:

SCHEDULE OF PAYMENTS

Having assessed the defendant’s ability to pay, payment of the total criminal monetary penalties shall be due as follows:

AG

BG

CG

DG

Lump sum payment of $

 

 

due immediately, balance due

 

 

 

G not later than

 

 

 

 

, or

 

 

 

 

 

G in accordance with G C,

G D, G

E, or

G F below); or

 

 

 

Payment to begin immediately (may be combined with

G C,

G D, or

G F below); or

 

Payment in equal

 

 

(e.g., weekly, monthly, quarterly) installments of $

 

over a period of

 

(e.g.,

months or years), to commence

 

 

(e.g., 30 or 60 days) after the date of

this judgment; or

Payment in equal

 

 

(e.g., weekly, monthly, quarterly) installments of $

 

over a period of

 

(e.g.,

months or years), to commence

 

 

(e.g., 30 or 60 days) after release from imprisonment to a

term of supervision; or

 

 

 

 

 

 

 

 

 

E

G

Payment during the term of supervised release will commence within

 

(e.g., 30 or 60 days) after release from

 

 

imprisonment. The court will set the payment plan based on an assessment of the

defendant’s ability to pay.

F

G

Special instructions regarding the payment of criminal monetary penalties:

 

Unless the court has expressly ordered otherwise in the special instruction above, if this judgment imposes imprisonment, payment of criminal monetary penalties is due during the period of im prisonment. All criminal monetary penalties, except those payments made through the Federal Bureau of Prisons’ Inmate Financial Responsibility Program, are made to the clerk of the court.

The defendant shall receive credit for all payments previously made toward any criminal monetary penalties imposed.

GJoint and Several

Defendant and Co-Defendant Names and Case Numbers (including defendant number), Joint and Several Amount and corresponding payee, if appropriate.

GThe defendant shall pay the cost of prosecution.

GThe defendant shall pay the following court cost(s):

GThe defendant shall forfeit the defendant’s interest in the following property to the United States:

Payments shall be applied in the following order: (1) assessment, (2) restitution principal, (3) restitution interest, (4) fine principal,

(5) fine interest, (6) community restitution, (7) penalties, and (8) costs, including cost of prosecution and court costs.

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 6A — Schedule of Payments

DEFENDANT: CASE NUMBER:

Judgment—Pageof

ADDITIONAL DEFENDANTS HELD JOINT AND SEVERAL

Case Number

 

 

 

Joint and

 

 

Defendant and Co-Defendant Names

 

 

 

Several

 

Corresponding Payee,

(including defendant numbers)

 

Total Amount

 

Amount

 

if appropriate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AO 245D (Rev. 09/11) Judgment in a Criminal Case for Revocations Sheet 6B — Schedule of Payments

DEFENDANT: CASE NUMBER:

Judgment—Page of

ADDITIONAL FORFEITED PROPERTY

AO 245D (Rev. 09/11) Judgment in a Criminal Case Personal Identification Attachment

DEFENDANT:

CASE NUMBER:

DISTRICT:

Judgment in a Criminal Case Personal Identification Attachment

(Not for Public Disclosure)

The following unredacted personal identifiers are included with the judgment transmitted to the Attorney General per 18 U.S.C. § 3612(b). A copy of this attachment shall also be provided to the attorney for the defendant, the Probation and Pretrial Services Office, and the U.S. Sentencing Commission.

Pursuant to Rule 49.1 of the Federal Rules of Criminal Procedure, however, the personal data in this attachment are not for public disclosure and must not be filed with the Clerk of the Court unless redacted or under seal, as provided in the rule.

Defendant’s Soc. Sec. No.:

Defendant’s Date of Birth:

Defendant’s Residential Address :

Defendant’s Mailing Address: (if different)