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Sheet 1

UNITED STATES DISTRICT COURT

Northern District of California

UNITED STATES OF AMERICA

v.











) JUDGMENT IN A CRIMINAL CASE
) (For Revocation of Probation or Supervised Release)
)
) USDC Case Number:
) BOP Case Number:
) USM Number:
)


Defendant’s Attorney:








THE DEFENDANT:

??admitted guilt to violation of condition(s) _____________________________________________ of the term of supervision.
? was found in violation of conditions(s) _______________________________________________________after denial of guilt.

The defendant is adjudicated guilty of these violations:

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.

? 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:





(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)(cid:3)Date






Date of Imposition of Judgment

Signature of Judge

Name & Title of Judge













DEFENDANT:
CASE NUMBER:




Judgment - Page ________ of ________

ADDITIONAL VIOLATIONS









Violation Number Nature of Violation
























Violation
Concluded








DEFENDANT:
CASE NUMBER:





Judgment - Page ________ of ________

IMPRISONMENT

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



?

The Court makes the following recommendations to the Bureau of Prisons:





?

?

The defendant is remanded to the custody of the United States Marshal. The appearance bond is hereby exonerated.

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

?

?

at _________ ? am ? pm on __________________ (no later than 2:00 pm).

as notified by the United States Marshal.

The appearance bond shall be deemed exonerated upon the surrender of the defendant.

?

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

?

?

?

at _________ (cid:31) am (cid:31) pm on __________________ (no later than 2:00 pm).

as notified by the United States Marshal.

as notified by the Probation or Pretrial Services Office.

The appearance bond shall be deemed exonerated upon the surrender of the defendant.

RETURN

I have executed this judgment as follows:















Defendant delivered on ______________________________ to _______________________________________ at
___________________________________ , with a certified copy of this judgment.








By

UNITED STATES MARSHAL

DEPUTY UNITED STATES MARSHAL




DEFENDANT:
CASE NUMBER:





Judgment - Page ________ of ________

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


SUPERVISED RELEASE









?

?

?
?

?

The 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.)
The defendant shall not possess a firearm, ammunition, destructive device, or any other dangerous weapon.
(Check, if applicable.)
The defendant shall cooperate in the collection of DNA as directed by the probation officer. (Check, if applicable.)
The defendant shall comply with the requirements of the Sex Offender Registration and Notification Act (42 U.S.C. § 16901,
et seq.) as directed by the probation officer, the Bureau of Prisons, or any state sex offender registration agency in which he
or she resides, works, is a student, or was convicted of a qualifying offense. (Check, if applicable.)
The defendant shall participate in an approved program for domestic violence. (Check, if applicable.)
If this judgment imposes a fine or restitution, it is 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

The defendant shall not leave the judicial district without the permission of the court or probation officer;
The defendant shall report to the probation officer and shall submit a truthful and complete written report within the first five
days of each month;
The defendant shall answer truthfully all inquiries by the probation officer and follow the instructions of the probation
officer;
The defendant shall support his or her dependents and meet other family responsibilities;
The defendant shall work regularly at a lawful occupation, unless excused by the probation officer for schooling, training, or
other acceptable reasons;
The defendant shall notify the probation officer at least ten days prior to any change in residence or employment;
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;
The defendant shall not frequent places where controlled substances are illegally sold, used, distributed, or administered;
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;
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;
The defendant shall notify the probation officer within seventy-two hours of being arrested or questioned by a law
enforcement officer;
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
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.



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DEFENDANT:
CASE NUMBER:




Judgment - Page ________ of ________

SPECIAL CONDITIONS OF SUPERVISION

(cid:31) All conditions as previously imposed