Deferred Prosecution Reporting Form

YAKIMA COUNTY DISTRICT COURT
PROBATION SERVICES

MONTHLY REPORTING FORM/
DEFERRED PROSECUTION

This report is due by the 15th day of each month. If this report is not received by that date, a violation may be filed with the Court.

Print Completed Form


Type of report being submitted: Deferred Prosecution
Reporting Month/Year
Defendant's Name:			Date of Birth:
E-mail Address:
Mailing Address:
Street	City	State	Zip	Is this a new address: Yes No
Is this were you live? Yes No If no, what is your physical address?
Street	City	State	Zip

Phone:			Message Phone:
Employer:			Phone:
Are you current with your Probation fee payments? Yes No
If not current please contact Heather Sides to make payment arrangements at 574-1879.


Have you been arrested/cited since the last report? Yes No
If yes, please explain:
Have you consumed alcohol since your last monthly report? Yes No
Have you consumed illegal drugs since your last monthly report? Yes No
Do you have a valid driver's license? Yes No

This report must be filled out completely and correctly to be valid. Failure to do so will be considered a violation of your Probation.
Questions or Comments:
	By checking the box to the left, I hereby certify or affirm under penalty of perjury of the laws of the State of Washington that the foregoing is true.		Date:
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