Fillable Form 200 00390 (Vermont Judiciary)

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Form 200 00390 (Vermont Judiciary)

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Page 1 of 4
200-00390 – Probation Order (11/2018)
STATE OF VERMONT
SUPERIOR COURT
CRIMINAL DIVISION
Unit
Docket No.
STATE OF VERMONT v.
TO THE COMMISSIONER OF CORRECTIONS:
STANDARD CONDITIONS OF PROBATION
The execution of the sentence is suspended, and the defendant is placed on probation in the care and
custody of the Commissioner of Corrections until (date) or
further order of the court under the following standard conditions:
A. You shall not be convicted of another crime or engage in criminal behavior.
B. You shall give your probation officer your home address, mailing address, telephone number, and email
address. If any of those change, you must notify your probation officer within 24 hours.
C. You shall notify your probation officer within 72 hours if you are arrested or given a citation.
D. You must meet with your probation officer at reasonable times as directed by a judge or your probation
officer. Upon request, you must allow your probation officer to visit you at reasonable times wherever
you are staying.
E. Your probation officer may restrict or prohibit travel to any state as required by the Interstate Compact
For Adult Offender Supervision.
F. You shall provide your probation officer with the location of your job and employment status. If you
change or lose your job, you must notify your probation officer within 72 hours.
SPECIAL CONDITIONS OF PROBATION
In addition to these standard conditions, the Court orders these additional conditions:
1. You shall not purchase, possess or consume any alcohol unless the use is authorized by a licensed
substance abuse counsellor, in writing, as part of substance abuse treatment, and the authorization is
provided to your probation officer prior to use.
2. You shall not drink alcoholic beverages to the extent they interfere with your employment or the welfare
of your family, yourself or any other person.
3. You shall not purchase, possess or consume any alcohol.
4. You shall not purchase, possess or use any regulated drug without a valid prescription. If you have a
prescription, you must take your medications only in the dosage and manner prescribed.
Page 2 of 4
200-00390 – Probation Order (11/2018)
5. You shall keep your probation officer advised of all current prescriptions and sign and maintain current
waivers or releases to your providers to allow verification of your prescriptions.
6. You shall submit to breath-alcohol testing upon request of your probation officer.
7. You shall submit to random urinalysis testing for drugs or alcohol upon request of your probation officer
or designee.
8. You shall not operate a motor vehicle with any alcohol in your system.
9. You shall not operate a motor vehicle within _______ hours of consuming alcohol.
10. You shall submit to a warrantless search of your person, belongings, residence or vehicle if your
probation officer has a reasonable suspicion that you possess alcohol, drugs or contraband in violation of
these conditions.
11. You shall comply with the requirements of electronic monitoring (e.g. GPS or SCRAM), as directed by
your probation officer.
12. Your probation officer may prohibit you from residing or associating with individuals reasonably
suspected of consuming or selling illicit regulated substances.
13. You must have a screening for the issues that are marked below. You must complete the screening by
the date established by your probation officer. If the screening recommends that counseling or
treatment is needed, including residential treatment, you must complete the counseling or treatment as
directed by your probation officer. You must attend and comply with the counseling or treatment
requirements and satisfy those requirements.
(a) Alcohol
(b) Substance Abuse
(c) Mental Health
(d) Anger Management
(e) Domestic Violence (Batterer's intervention or approved equivalent)
(f) Risk Reduction Programming
(g) ____________________________________________________________________________
14. You must sign any required waivers or releases and allow any treatment or counseling provider to tell
your probation officer and the court about your attendance and participation in the counseling or
treatment, and about the results of any substance abuse or alcohol urinalyses taken by you in
connection with the counseling or treatment.
15. You must complete an approved safe driving program as directed by your probation officer and pay
any associated costs.
16. You shall not operate a motor vehicle on a public highway without a valid license.
17. You shall not operate a motor vehicle on a public highway.
18. You shall actively work towards reinstatement of your operator's license.
Page 3 of 4
200-00390 – Probation Order (11/2018)
19. You shall attend and complete the next available session of the Impaired Driver Rehabilitation Program
or a similar program.
20. You shall not have contact with ____________________, which includes all forms of written, oral,
electronic, social media, or other direct contact and all forms of indirect contact through third parties,
except ________________________.
21. Your probation officer may limit or prohibit contact with ____________________ during the term of
probation based upon the person's request.
22. You shall not abuse or harass _____________________. Such conduct includes actions directed at a
specific person, or a member of the person's family that would cause a reasonable person to fear
unlawful sexual conduct, unlawful restraint, bodily injury or death, including but not limited to verbal
threats, written, telephonic or other electronically communicated threats, vandalism, or physical
contact without consent. It also includes multiple attempts to communicate with the person after the
person has informed the probationer that such contact is not welcome.
23. You shall not engage in violent or threatening behavior. Violent behavior includes physical contact
with another without consent, unlawful restraint of another, or physical contact by mutual affray.
Threatening behavior is conduct that would cause a reasonable person to fear unlawful sexual conduct,
unlawful restraint, bodily injury, or death, including verbal threats, written, telephonic, or other
electronically communicated threats, vandalism, or physical contact without consent.
24. You must abide by a curfew as directed by your probation officer.
25. Your probation officer may impose reasonable restrictions on the location of your residence.
26. Your probation officer may restrict those with whom you associate.
27. You shall not buy, have or use any firearms, muzzleloaders or other deadly weapons, regardless of
whether they are operational or loaded. Other deadly weapons include any other weapon, device,
instrument, material or substance, whether animate or inanimate, that, in the manner it is used or is
intended to be used, is known to be capable of producing death or serious bodily injury.
28. You must complete ______ hours of community service at the direction and to the satisfaction of your
probation officer.
29. If restitution is ordered, you must cooperate fully with the Restitution Unit.
30. You shall maintain employment, actively pursue employment, or actively pursue a course of study or
vocational training that will equip you for suitable employment.
31. You shall attend and participate in Restorative Justice programming and complete the program within
______ month(s).
Page 4 of 4
200-00390 – Probation Order (11/2018)
Order of the Court:
I received a copy of this Probation Order. ___________________________
Defendant’s Signature
I understand these conditions and I agree to follow them. I understand that if I do not follow
these conditions, the court may require me to serve my full sentence in jail.
__________________________ __________ __________________________ __________
Probation Officer
Date
Defendant
Date
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Completed 15 July 2020

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