STATE OF INDIANA
IN THE WASHINGTON CIRCUIT /SUPERIOR COURT
COUNTY OF WASHINGTON
TERMS AND CONDITIONS FOR RELEASE ON BOND
NAME: ______________________________ |
DATE OF BIRTH: ________________ |
ADDRESS: _________________________________ |
S.S.#: __________________ |
__________________________________________ |
EMPLOYER: ________________________________ |
ALIASES: ___________________________ |
ADDRESS: _________________________________ |
PHONE: ___________________ |
EMPLOYER'S PHONE: _________________ |
1. You SHALL NOT violate any law.
2. You SHALL obey any and all terms and conditions.
3. You SHALL notify the Court of any change of address within 72 hours.
4. You SHALL NOT leave INDIANA without permission from the Court. If granted
permission to leave Indiana, you shall agree to waive extradition to Indiana
and agree to voluntarily return to Indiana, at your own expense, when ordered
to do so by the Court.
5. You SHALL notify the Court of any change of employment.
6. If you are: in a public place, place of public resort, or on private property
without permission, between midnight and 5:00 a.m. (Washington County Time),
or if you are in the Washington Superior Court or the Washington Circuit Court
at any time while free on bond, you SHALL, upon request of any Law Enforcement
Officer:
..........A. Submit to a breathalyzer test to determine intoxication.
..........B. Submit to drug screening, at your expense, to determine illegal
drug usage.
7. If you refuse testing (as set out in #6), or if such testing indicates intoxication
(or blood alcohol content of .10% or moreby weight) or illegal drug usage,
you SHALL IMMEDIATELY lose the right to remain free on bond.
8. I agree to these conditions and I understand that upon probable cause to
believe that there has been a violation I maybe arrested and held without bond
until a Judge reviews the circumstances of my arrest, (within 48 hours).
9. OTHER:_______________________________________________________________________________________
I swear or affirm, under penalties of perjury, that the information
provided is true to the best of my information or belief.
DATED:_______________________________ |
__________________________________
Defendant's signature
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_____________________________________
Jail Dispatcher / Jailer on duty as witness
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