Here is the text we could read:
STATE OF MICHIGAN
JUDICIAL CIRCUIT - Family Division
COUNTY
ORDER OF PROBATION
(DESIGNATED CASE)
(Part 1)
CASE NO. and JUDGE
ORI
MI-
Court address
Court telephone no.
In the matter of
First and last name(s), alias(es)
Juvenile’s address and telephone no.
Probation officer
Term
Offense(s)
Sentence delayed under MCL 712A.18(1)(o)
Pursuant to 18 USC 922(g)(8), the court found, at a hearing, that the juvenile represents a credible threat to the physical
safety of one or more persons as defined in 18 USC 922(g)(8) and 18 USC 921(a)(32) and named in item 8.
**Needed for NCIC entry.
IT IS ORDERED that the juvenile is placed on probation under the supervision of the probation officer named above for the
term indicated, and the juvenile shall
6. pay the following to the court.
1. not violate any criminal law of any unit of government.
2. not leave the state without the consent of this court.
Fine ................................. $
3. make a truthful report to the probation officer monthly, or as often Costs ............................... $
Restitution ....................... $
as the probation officer may require, either in person or in
writing, as required by the probation officer.
Crime Victim Assessment. $
4. notify the probation officer immediately of any change of address State minimum costs ....... $
Supervision fee ................ $
or employment status.
5. not purchase or possess a firearm. **Needed for NCIC entry. DNA assessment ............. $
Other ................................ $
Total ................................. $
7.
a. The total amount due shall be paid in installments of $
per
starting on
Date
and paid in full by the due date on the judgment of sentence or order delaying sentence, or by
Date
b. The due date for payment is
Date
.
.
The supervision fee is payable immediately and applies to all delayed sentences.
Fines, costs, and fees not paid within 56 days of the date owed are subject to a 20% late penalty on the amount owed.
Page 1 of 2
Approved, SCAOForm JC 74, Rev. 9/22MCL 600.4803, MCL 712A.18, MCL 712A.18(1)(o), MCR 3.955, 18 USC 922(g)(8)(c)Distribute form to:CourtProbation department (Part 1)Juvenile (Part 1)Prosecutor (Part 1)Law enforcement agency (Part 2)Court LEIN copy (Part 2)JIS Code: OOPCTN/TCNSID Order of Probation (Designated Case) (Part 1)
Page 2 of 2
(9/22)
Case No.
8. Other: (Use this space for conditions for the protection of one or more named persons - also complete the LEIN order on Part 2 of this form. See
last page of form for required language when conditions are ordered pursuant to 18 USC 922[g][8].)
Failure to comply with this order may result in a revocation of probation and incarceration. If the juvenile is not able to pay
due to financial hardship, contact the court immediately to request a payment alternative. MCR 6.425(D)(3).
Judge signature and date
I have read or heard the above order of probation and have received a copy. I understand and agree to comply with this
order. I also understand that federal and/or state law may prohibit me from possessing or purchasing ammunition or a firearm
(including a rifle, pistol, or revolver) if the court found I represent a credible threat to the physical safety of a named person
and/or explicitly prohibited (in item 8) the use, attempted use, or threatened use of physical force that would reasonably be
expected to cause bodily injury to that named person.
Date
Juvenile signature
If sentence is delayed as stated above, the clerk of the court shall advise the Michigan State Police Criminal Justice Information Center
of the disposition as required by MCL 769.16a.
STATE OF MICHIGAN
JUDICIAL CIRCUIT - Family Division
COUNTY
ORDER OF PROBATION
(DESIGNATED CASE)
(Part 2)
CASE NO. and JUDGE
ORI
MI-
Court address
Court telephone no.
In the matter of
First and last name(s), alias(es)
Juvenile’s address and telephone no.
Probation officer
Term
Offense(s)
Sentence delayed under MCL 712A.18(1)(o)
Pursuant to 18 USC 922(g)(8), the court found, at a hearing, that the juvenile represents a credible threat to the physical
safety of one or more persons as defined in 18 USC 922(g)(8) and 18 USC 921(a)(32) and named in item 8.
**Needed for NCIC entry.
IT IS ORDERED that the juvenile is placed on probation under the supervision of the probation officer named above for the
term indicated, and the juvenile shall
6. pay the following to the court.
1. not violate any criminal law of any unit of government.
2. not leave the state without the consent of this court.
Fine ................................. $
3. make a truthful report to the probation officer monthly, or as often Costs ............................... $
Restitution ....................... $
as the probation officer may require, either in person or in
writing, as required by the probation officer.
Crime Victim Assessment. $
4. notify the probation officer immediately of any change of address State minimum costs ....... $
Supervision fee ................ $
or employment status.
5. not purchase or possess a firearm. **Needed for NCIC entry. DNA assessment ............. $
Other ................................ $
Total ................................. $
7.
a. The total amount due shall be paid in installments of $
per
starting on
Date
and paid in full by the due date on the judgment of sentence or order delaying sentence, or by
Date
b. The due date for payment is
Date
.
.
The supervision fee is payable immediately and applies to all delayed sentences.
Fines, costs, and fees not paid within 56 days of the date owed are subject to a 20% late penalty on the amount owed.
Page 1 of 2
Approved, SCAOForm JC 74, Rev. 9/22MCL 600.4803, MCL 712A.18, MCL 712A.18(1)(o), MCR 3.955, 18 USC 922(g)(8)(c)Distribute form to:CourtProbation department (Part 1)Juvenile (Part 1)Prosecutor (Part 1)Law enforcement agency (Part 2)Court LEIN copy (Part 2)JIS Code: OOPCTN/TCNSID Order of Probation (Designated Case) (Part 2)
Page 2 of 2
(9/22)
Case No.
8. Other: (Use this space for conditions for the protection of one or more named persons - also complete the LEIN order on Part 2 of this form. See
last page of form for required language when conditions are ordered pursuant to 18 USC 922[g][8].)
Failure to comply with this order may result in a revocation of probation and incarceration. If the juvenile is not able to pay
due to financial hardship, contact the court immediately to request a payment alternative. MCR 6.425(D)(3).
Judge signature and date
TO LOCAL LAW ENFORCEMENT: The protective conditions in item 8 and the following identifying information of the juvenile
must be entered on the LEIN system. The court will notify local law enforcement of any amendments to or revocation of this order.
Height
Weight
Race*
Sex*
Date of birth*
Driver’s license number
Hair color
Eye color
Other identifying information
*These items must be filled in for the police/sheriff to enter on LEIN; the other items are not required but are helpful.
Effective date of conditions in item 8.
Expiration date of order
Judge signature and date
Required Language When Conditions are Issued Pursuant to 18 USC 922(g)(8):
Use the following language when the conditions involve an intimate partner of the defendant or child of the intimate partner or
defendant as defined in 18 USC 922(g)(8) and 18 USC 921(a)(32).
Defendant is restrained from harassing, stalking, or threatening, or engaging in other conduct that would place
[insert name(s)] in reasonable fear of bodily injury.
For details about these conditions, see SCAO Administrative Memorandum 2008-02.
