Presentence Investigation Report Form PDF Details

The Presentence Investigation Report form serves as a comprehensive document used to gather detailed information about individuals awaiting sentencing in criminal cases. Completed under the auspices of the Division of Parole and Probation, it encompasses a broad spectrum of questions starting from basic identification information to deep inquiries about family background, employment status, financial assets and liabilities, and past criminal history. Persons going through the judicial process are required to fill out the questionnaire with utmost honesty as any deliberate falsehoods or misrepresentations are reported directly to the court. The form also outlines necessary documents to be presented at the time of the interview such as identification, proof of residence, and educational degrees, among others. Additionally, it details the fees associated with sentencing and probation, including DNA testing and court administrative fees, and sets clear expectations regarding the payment of these fees. The document indicates the no-cash policy for fee transactions and highlights the process for those planning to move out of Nevada for probation supervision in another state. Corrections to this extensive report adhere to specific legal provisions, ensuring accuracy and accountability throughout the sentencing process. This form is a crucial step in the justice system, offering a detailed perspective of a defendant's life, which aids in determining the appropriate sentence.

QuestionAnswer
Form NamePresentence Investigation Report Form
Form Length11 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 45 sec
Other namespresentence investigation questionnaire, nv presentence report, psi report template, nevada presentence investigation online

Form Preview Example

 

 

 

Division of Parole and Probation

 

 

 

Presentence Investigation Questionnaire

 

Interviewed by Specialist:

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

Name:

 

 

 

Criminal Case No:

 

 

 

 

 

 

 

 

 

 

 

Sentence Date:

 

Time:

 

 

NPP OFCPhone No:

 

 

 

 

 

 

 

 

 

 

 

 

 

A Presentence Investigation has been ordered by the Court. Please complete this questionnaire accurately and completely. Deliberate falsehoods or misrepresentation will be reported to the Court.

Office Address

NPP Fax Phone No:

E-mail:

At the time of your interview, please bring the following documents (in the event of a phone interview, please mail copies ASAP):

• Driver's License/ID Card

• Educational Degrees

• Proof of Residence

• Most recent paycheck stub

• Alien Registration Card

• Proof of Mental Health/Substance abuse program attendance

• Armed Forces Papers (DD214)

 

Be prepared to pay the following fees to the Clerk of Court on the date of sentencing:

•$25 Court and $3 DNA Administrative Assessment Fee (all cases)

•$35 Domestic Battery or $60 Chemical Analysis Fee, if applicable

•$150 Genetic Marker Testing Fee (if your offense mandates DNA testing)

IMPORTANT: Children (under 18) are not allowed inside a Nevada Parole and Probation office

•You will be required to pay $30 per month supervision fees for the entire term of probation

•The first two months fees ($60) must be paid within the first 30 days of the probation grant

•Fees must be paid by check or money order - CASH IS NOT ACCEPTED

•Make the check or money order payable to: Nevada Division of Parole and Probation

•Name and social security no. must be printed clearly on the check or money order

•It may take two, or over fifty (50) business days to receive reporting instructions, please plan accordingly

•Reporting instructions may be denied by the receiving state, delaying the process

•Reporting instructions must be accepted by the receiving state prior to being permitted to leave Nevada

•The first two months fees ($60) must be paid in advance, and prior to leaving the state

•Once formally accepted in the receiving state for supervision, no new Nevada supervision fees are paid

•You may be required to pay supervision fees by the receiving state in amount determined by that state

NOTE: Corrections to this report are in accordance with NRS 176.156 (refer to page 11.)

NPP JSF0005 (B) PSIQ

Page 1 of 11

09/10/2019

 

Division of Parole and Probation

Presentence Investigation Questionnaire

Defendant Information

Name:

 

 

 

 

 

 

 

 

Social Security No.:

 

 

 

 

 

 

 

 

Residence address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number

Street

 

 

City

State

 

 

Zip

(If homeless enter "none" )

 

 

 

 

 

Mailing address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number

Street

 

 

City

State

 

 

Zip

 

 

 

 

 

 

 

 

 

Years/months at current residence:

 

 

 

Have you ever been homeless?

Yes

 

No

 

 

 

 

 

 

 

 

 

Nevada resident?

Yes

No

How long have you lived in Nevada in years/months?

 

 

 

 

 

Drivers License/Identification Number:

 

 

 

 

 

State issued from:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Cell):

 

 

 

 

 

 

 

 

Phone No. (Home):

 

 

 

 

 

(Work):

 

 

 

 

 

 

 

 

 

 

 

E-mail Address(s):

Alias (Maiden name):

Alias (Prior married):

Alias (Other):

 

Place of Birth:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth:

 

 

 

 

 

Age:

 

 

 

 

Are you a U.S. Citizen?

Yes

 

No

If not, of what Country?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you applied for U.S. citizenship?

Yes

No

 

Are you married to a U.S. citizen?

Yes

No

 

Alien Registration Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Permanent

 

Temporary

 

 

 

Are you seeking political asylum in the U.S.?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Language:

 

 

 

 

 

 

Other Languages:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Height:

 

 

 

 

 

 

 

 

 

Weight:

 

 

 

 

Hair Color:

 

 

 

 

 

 

 

 

 

Eye Color:

 

 

 

 

Sex:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Race:

White-Non Hispanic

 

 

Black-Non Hispanic

 

 

Hispanic

 

Asian

Native American

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Distinguishing Marks

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar or Tattoo

 

Location

 

 

 

Description

 

 

Scar or Tattoo

 

 

Location

 

 

 

 

Description

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

 

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

 

 

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

 

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

 

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

 

 

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

 

 

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

 

 

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

 

 

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tattoo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attorney Name:

 

 

 

 

 

 

 

 

 

Phone:

 

 

 

 

 

 

 

 

 

 

Retained

Appointed

Public Defender

NPP JSF0005 (B) PSIQ

Page 2 of 11

09/10/2019

Division of Parole and Probation

Presentence Investigation Questionnaire

Family Information

Briefly describe your childhood. For example: Did your mother and father live together? Did you have regular contact with other extended family members, such as grandparents, cousins, aunts and uncles? Were you abused or neglected? Was there any drug or alcohol abuse present? Was either parent ever incarcerated? Was Social Services involved in your family? Include any information you think explains why you developed into the person you are:

Have any members of your immediate family ever been in prison or on probation?

No

Yes

If you answered yes above, please complete the following:

 

 

Name

Relationship

Crime

When

Where

Where did you grow up?

List immediate family members and relationship (ie: mother, sister, brother,) contact (yes or no):

Name

Relationship

Contact

Address

Phone No.

Marital status, are you currently (select one):

Single

Married

Separated

Divorced

Name of current spouse/partner:

 

 

 

 

 

 

Do you live together?

Yes

No

How many years/months have you been together?

 

Prior spouse/partner relationships (please complete below. Note: for time together use years/months)

Name

Together (y/m)

Address

Phone No. (if known)

 

Page 3 of 11

NPP JSF0005 (B) PSIQ

09/10/2019

Division of Parole and Probation

Presentence Investigation Questionnaire

Family Information (continued)

Information on Children (please complete below)

Name

Date of Birth Gender

Age

Address

Custody1

Relation2

1

2List the legal custodian (who has legal custody?)

List the child's relation to you, i.e., biological/natural child, stepchild, adopted child

Have you been court ordered to pay child support for any of your children? Yes No

If yes, what is the monthly payment amount required?

Are your wages being garnished for child support?

Yes

No

Is any child support past due?

Yes

No

If yes, explain

 

 

 

 

 

 

 

 

Are any of your dependents or their guardians receiving welfare benefits?

Yes

No

 

 

If yes, from where? (county, state, SNAP, etc.)

Does anyone other than your spouse/partner or children listed above live with you now? Yes No If yes, complete the following:

Name

Date of Birth

Are there any weapons in your home? Yes No If yes, complete the following:

Weapon type

Location

Owner

With whom do you keep contact other than family?

Name

Address

Phone

Years/Months known

 

 

NPP JSF0005 (B) PSIQ

Page 4 of 11

09/10/2019

Division of Parole and Probation

Presentence Investigation Questionnaire

Employment

Your employment status is:

Employed

Unemployed

 

Retired

Disabled

Homemaker

Were you employed at the time of the instant offense?

No

Yes

 

 

If you selected employed or unemployed above, please provide how long in years and months:

Current Employer:

 

 

 

 

Supervisor:

 

 

 

 

 

Address:

 

 

 

 

 

 

Phone No.:

 

 

 

 

 

 

Job Title:

 

 

 

Hours per week:

 

 

Salary per month:

 

 

 

Date Started:

 

Date terminated:

 

 

 

Reason for leaving:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Former Employer:

 

 

 

 

 

Supervisor:

 

 

 

 

 

 

Address:

 

 

 

 

 

Phone No.:

 

 

 

 

 

 

Job Title:

 

 

 

Hours per week:

 

 

Salary per month:

 

 

 

Date Started:

 

Date terminated:

 

 

 

Reason for leaving:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Former Employer:

 

 

 

 

 

Supervisor:

 

 

 

 

 

 

Address:

 

 

 

 

 

Phone No.:

 

 

 

 

 

 

Job Title:

 

 

 

Hours per week:

 

 

Salary per month:

 

 

 

Date Started:

 

Date terminated:

 

 

 

Reason for leaving:

 

 

 

 

 

Financial

Assets and Liabilities

Assets: List assets below. Include real estate, vehicles, jewelry, collectibles, electronics, savings, cash, etc. In the description, provide the address for real estate; provide make, model, license and state for vehicles; provide the bank/ credit union and account type (savings, checking, retirement, etc.) for accounts

Asset

Description

Value

Total Asset Value:

Liabilities: List liabilities below. Include loans, child support, medical bills, legal fees, credit cards, etc.

Liability

Description

Value

Total Liabilities:

NPP JSF0005 (B) PSIQ

Page 5 of 11

09/10/2019

Division of Parole and Probation

Presentence Investigation Questionnaire

Financial (continued)

Income and Expenses

List income and expenses below. Do not report cents.

Mo nthly Inco m e ( appro xim ate )

Mo nthly Expe ns e s ( appro xim ate )

 

 

 

 

Regular Job (+ tips)

 

Ren t/ House Paym en t

 

 

 

 

 

Par t Tim e Job

 

Utilities

 

Spouse's In com e

 

Food/ Clothin g

 

 

 

 

 

Un em ploym en t Com p

 

Car Paym en t

 

 

 

 

 

Wor km an 's Com p

 

Gasolin e

 

 

 

 

 

Social Secur ity

 

Car In sur an ce

 

Child Suppor t/ Alim on y

 

Health In sur an ce

 

 

 

 

 

Feder al Ben efits

 

Child Car e

 

 

 

 

 

Gen er al Assistan ce

 

Child Suppor t/ Alim on y

 

 

 

 

 

Food Stam ps

 

Fees/ Fin es

 

 

 

Salar y Gar n ishm en t

 

 

 

 

 

 

 

Medical Bills

 

 

 

 

 

 

 

Cr edit Car ds

 

 

 

 

 

 

 

Loan s

 

 

 

Cell Phon e/ Pager

 

 

 

 

 

 

 

Cable/ Satellite TV

 

 

 

 

 

 

 

Coun selin g

 

Inco m e To tal =

 

Expe ns e To tal =

 

 

 

 

 

Education

Do you have a high school diploma?

No

Yes

 

If no, highest grade completed:

 

 

If yes, list school:

 

 

Year:

 

Do you have a GED? No

Yes

 

 

 

 

 

 

 

 

 

Did you attend college? No Yes If you attended college, list school:

If you have a college degree, list type:

Do you have a degree? No Yes

No. of years completed:

Professional licenses, certificates:

Special education classes?

No

Yes

Any learning disabilities?

No

Yes

 

 

Were you ever suspended or expelled from school?

 

No

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Military Service

 

 

 

 

 

Did you serve?

No

Yes

If no, did you register for selective service (draft)?

No

Yes

Start date:

 

 

End date:

 

 

Military branch:

 

 

Country:

 

 

Rank at discharge:

 

 

 

 

 

 

Type of discharge:

 

 

 

 

 

Duties/training:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Awards/Medals:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NPP JSF0005 (B) PSIQ

Page 6 of 11

09/10/2019

 

Division of Parole and Probation

Presentence Investigation Questionnaire

 

 

 

Health

How would you rate your health?

Good

Fair

Poor

Have you now, or in the past, had any diagnosed or known serious, chronic, medical or mental health issues ? If yes, please explain:

Are you receiving medical treatment now?

No

Yes If yes, for what?

List all medications you take:

Do you possess a valid medical marijuana card?

No

Yes If yes, what state?

For what ailment?

 

 

 

 

 

 

 

 

Have you ever participated in mental health counseling?

No

Yes

When & where?

 

 

 

 

 

 

 

 

Did you receive a diagnosis?

No

Yes

 

 

 

 

 

If yes, please explain (include diagnosis/treatment):

Name of Therapist, Doctor, Psychologist:

List medications if applicable:

Have you ever attempted or thought seriously about, suicide?

No

Yes

 

 

If yes, when, how, why?

 

 

 

 

 

 

 

 

 

Have mental health and/or physical disabilities contributed to problems in your life?

No

Yes

If yes, please explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you believe mental health and/or physical disabilities negatively affect your employment?

No

Yes

If yes, please explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page 7 of 11

NPP JSF0005 (B) PSIQ

09/10/2019
Alcohol
Marijuana
Cocaine/Crack
PCP
Meth/Speed/Crank
Hallucinogens
(LSD/Acid/Mushrooms)
Ecstasy
Heroin
Prescription pills
Inhalants
Other (please list)

Division of Parole and Probation

Presentence Investigation Questionnaire

Substance Abuse History

Indicate your use of controlled substances below:

 

Substance

Age at first use

How often do you use?

Last used?

Arrested/Sold?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are drugs a problem for you?

No

Yes

 

 

 

Is alcohol a problem for you?

No

Yes

 

 

 

Approximately how much do you spend on alcohol and/or drugs per week?

 

Has drugs or alcohol ever caused a problem for you?

No

Yes

 

If yes, how recent?

 

 

 

 

 

 

Has drug or alcohol use ever caused a problem with employment?

No

Yes

If yes, how recent?

 

 

 

 

 

 

Have you ever been in substance abuse treatment ?

No

Yes

 

If yes, please explain (when? where? what substance(s)? etc.):

What are you doing to address these issues now?

Were you under the influence when you committed the instant offense?

No

Yes

Is gambling a problem for you?

No

Yes

 

 

 

 

Approximately how much do you spend gambling per week?

 

 

 

 

Have you ever been in treatment for gambling?

No

Yes

 

 

NPP JSF0005 (B) PSIQ

Page 8 of 11

09/10/2019

 

Division of Parole and Probation

Presentence Investigation Questionnaire

Criminal History

Age at first arrest:

 

Offense:

 

 

 

 

 

 

 

 

 

Were you ever on juvenile probation or parole?

No

Yes If yes, complete the following:

 

Date:

 

 

 

Location:

 

 

 

 

Phone:

 

 

Name of last supervising officer:

 

 

 

 

 

 

 

 

 

Did you have any violations on juvenile probation/parole?

No

Yes If yes, please explain below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Were you ever on adult probation?

 

No

Yes

If yes, complete the following:

 

Date:

 

 

Location:

 

 

 

Phone:

 

 

Name of last supervising officer:

 

 

 

 

 

 

Discharge type:

 

 

 

 

 

 

 

 

 

 

Did you have any violations while on probation?

No

Yes If yes, please explain below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you ever been sentenced to a jail/prison as an adult?

No

Yes

Have you ever been in prison?

No

Yes

If yes, complete the following:

Date:

 

Name of jail/prison and State:

 

 

 

 

 

 

 

 

Date:

 

Name of jail/prison and State:

 

 

 

 

 

 

 

 

Date:

 

Name of jail/prison and State:

 

 

 

 

 

 

 

 

 

 

Have you ever been found guilty of official misconduct while incarcerated as an adult?

No

Yes

 

If yes, please explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Were you ever on adult parole?

No

Yes If yes, complete the following:

 

 

 

 

 

Date:

 

Location:

 

 

 

Phone:

 

 

 

 

 

Name of last supervising officer:

 

 

 

 

 

 

 

 

 

 

Did you have any violations while on parole?

 

No

Yes If yes, please explain below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Are you in a gang, or do you socialize with gang members?

No

Yes

If yes, gang name and your moniker:

 

 

 

 

Are you a registered sex offender?

No

Yes

 

 

NPP JSF0005 (B) PSIQ

Page 9 of 11

09/10/2019

 

Division of Parole and Probation

Presentence Investigation Questionnaire

Present Offense

Briefly describe the offense committed:

Why did you commit the offense?

Thinking back to the date of your criminal activity which resulted in this case, what, if anything would you have done differently?

In your opinion, how do you believe this crime affected the victim?

How did this crime affect you?

What do you feel would be an appropriate penalty/consequences for your actions?

Defendant Statement

If you are eligible for and granted probation, what is your plan? (residence, employment, etc.)

Address:

 

 

 

 

Phone No.:

 

 

 

With whom do you plan to reside?

 

 

 

 

 

 

 

Employment:

 

 

Address:

 

 

 

 

Is your current or potential employer aware of your current legal issues:

No

Yes

What would be your goals? (treatment, programs, schooling, etc.)

Page 10 of 11

NPP JSF0005 (B) PSIQ

09/10/2019

Division of Parole and Probation

Presentence Investigation Questionnaire

Defendant Statement

Explain in your own words the circumstances of your offense, why you committed the offense, your present feelings about your situation, and why you may be suitable for probation. A copy of this statement will be sent to the judge. Write or print clearly. If using a pencil, please write as dark as possible. If you do not want to submit a written statement, you must still initial that you acknowledge when and how changes to the PSI may be made. Case#

In accordance with NRS 176.156, you will have an opportunity to object to factual errors, and after sentencing the court may order changes to your Presentence Investigation Report under certain circumstances. The information used in your Presentence Investigation Report may be reviewed by federal, state and/or local agencies and used for future determinations to include, but not limited to; mental health, parole consideration, pardon investigation Initials

Defendant Signature

Date

NPP JSF0005 (B) PSIQ

Page 11 of 11

09/10/2019

 

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