Fillable 200-00245 0 STATE OF VERMONT

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200-00245 0 STATE OF VERMONT

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200-00245 – Restitution Judgment Order (09/2019) Page 1 of 2
STATE OF VERMONT
SUPERIOR COURT
CRIMINAL DIVISION
Unit
Docket No.
STATE OF VERMONT v. DOB
RESTITUTION JUDGMENT ORDER
D
EFENDA
NT
Defendant’s Name
Phone Number
Social Security Number
Mailing Address
Town
Zip
EMPLOYER
Employer’s Name
Phone Number
Address
Town
Zip
VICTIM
Victim’s Name
Findings of Fact
1. The victim incurred an uninsured material loss in the amount of $____________________.
2. Defendant’s ability to pay:
☐ Defendant has the current or reasonably foreseeable ability to make restitution payments.
☐ Defendant has no ability to make payments at this time.
Therefore, it is hereby ORDERED:
1. Defendant shall pay restitution in the amount of $____________. Judgment is against Defendant
individually for the entire amount and jointly with the following persons:
Name: _________________________ Docket No.: __________________________
Name: _________________________ Docket No.: __________________________
Name: _________________________ Docket No.: __________________________
2. Defendant shall make payment by cash, certified check, credit/debit card or money order payable to the
State of Vermont Restitution Unit as follows:
☐ Defendant shall pay $__________________ to the Restitution Unit within 2 weeks of date of the order.
☐ Defendant shall pay $ ________________ per ☐ week ☐ 2 weeks ☐ ½ month ☐ month,
beginning _______________ to: State of Vermont Restitution Unit, P.O. Box 10, Waterbury VT
05676-0010 (Phone: 1-800-584-3485; Outside Vermont 802-241-4688)
☐ Defendant shall return the following property to the victim within ________ days:
________________________________________________________________________________.
If the property is not returned by the agreed upon date, the defendant shall be ordered to pay
$___________ to be collected and enforced by the State of Vermont Restitution Unit.
☐ Defendant shall make the following payments in kind to the victim within _________ days:
________________________________________________________________________________.
If the agreed upon payments have not been received by the date indicated, the defendant shall be
ordered to pay $__________ to be collected and enforced by the State of Vermont Restitution Unit.
200-00245 – Restitution Judgment Order (09/2019) Page 2 of 2
3. Defendant remains liable for the judgment until paid in full. Until the judgment due is paid in full,
Defendant shall notify the Vermont Restitution Unit in writing of any change of home address or
employment within 30 days of such change including the name, address and phone number of any new
employer.
4. The Restitution Unit shall have the authority to Collect from an offender subject to a restitution judgment
order all fees and direct costs, including reasonable attorney’s fees, incurred by the Restitution Unit as a
result of enforcing the order and investigating and locating the offender.
Dated
_____________________________ ___________________________________
Superior Court Judge
This Order is Entered into by Stipulation. The parties agree that the victim incurred the uninsured material
loss noted above and that Defendant has the ability to pay noted above. The parties waive any further hearing
regarding restitution understanding that both parties have a right to a hearing regarding the amount of
restitution and the ability to pay restitution. Both parties knowingly and voluntarily waive their right to appear
in person before the court.
We agree to the terms of this Stipulation to Waive a Restitution Hearing in this action.
Dated
_____________________________ ___________________________________
Signature of the State
Dated
_____________________________ ___________________________________
Signature of the Defendant
Dated
_____________________________ ___________________________________
Signature of the Defendant’s Attorney (if any)
Dated
_____________________________ ___________________________________
Superior Court Judge
IM
PORTANT NOTICES TO DEFENDANT
F
AILURE TO PAY: If you fail to pay as ordered, the Vermont Restitution Unit may file a motion to enforce which may
result in suspension of recreational licenses, trustee process against your earnings and other enforcement remedies
as provided by law.
TAX REFUND, UNCLAIMED PROPERTY, LOTTERY WINNINGS: Any monies owed to the State by the defendant who is
under a restitution order, including lottery winnings and tax refunds, shall be used to discharge the restitution order to
the full extent of the unpaid total financial losses, and regardless of the payment schedule established by the court.
A
cceptance of Service by Defendant
I
accept service of a copy of this Restitution Judgment Order.
Dated
_____________________________ ___________________________________
Signature of the Defendant
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200-00245 0 STATE OF VERMONT

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Completed 3 July 2020

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