N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VI, form 13
Sec. 410.40 C.P.L. FORM 13
(Judicial Reprimand
of Probationer)
1/87
JUDICIAL REPRIMAND OF PROBATIONER
APPLICATION
STATE OF NEW YORK)
) ss.:
COUNTY OF ________)
________, being duly sworn, deposes and says:
I am a probation officer with the ____________ Department of Probation. I am responsible for
[County]
supervising the probation of ____________
[Name of Probationer]
who was convicted of (adjudicated a youthful offender for the act of)
[Date of conviction],
on
______
[Name of Court] by the ________, and was sentenced by
[Name of Judge/Justice]
to ________.
Based upon the following petitioner's failure to ____________
____________
____________,
pursuant to C.P.L. §§410.20
______
[County] Department of Probation requests the Court to
order probationer personally to appear before the Court at the time and place set forth below.
______________
(Signature)
Sworn to before me this
________ day of ________, 19________.
______________
Notary Public
COURT ORDER
The above application by the ____________ Department of
[County]
Probation is granted. The probationer is directed to appear before the Court on ________ at ________ (a.m.) (p.m.) in Part ________ at ________. This order shall be (mailed to) (served personally upon) the probationer.
______________
Judge (Justice)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
NOTICE TO PROBATIONER
YOU HAVE BEEN ORDERED TO APPEAR BEFORE THE COURT AT THE ABOVE TIME AND PLACE. FAILURE TO APPEAR AS ORDERED WITHOUT REASONABLE CAUSE THEREFOR CONSTITUTES A VIOLATION OF THE CONDITIONS OF YOUR SENTENCE OF PROBATION, AND MAY RESULT IN REVOCATION OF YOUR PROBATION AND ISSUANCE OF A WARRANT DIRECTING THAT YOU BE TAKEN INTO CUSTODY AND BROUGHT BEFORE THE COURT.
Date mailed () served upon () probationer:________, 19 ________
N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VI, form 13