N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VI, form 15
Form 15
(Elimination or Relaxation of
Conditions of Probation)
1/87
ELIMINATION OR RELAXATION OF SPECIFIED
CONDITIONS OF PROBATION
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 () new information ( ) change in circumstances ____________
____________
____________
____________,
pursuant to C.P.L. §§410.20 and 410.40, the ____________ Department
[County]
of Probation respectfully requests that probationer's conditions of probation be modified as follows ____________
____________
____________
______________
(Signature)
Sworn to before me this
________ day of ________, 19________.
_________
Notary Public
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COURT ORDER
The above application by the ____________ Department
[County]
of Probation is granted to the extent that, effective as of ________
19________, the conditions of probation are modified as follows ____________
____________
____________
______________
Judge (Justice)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
NOTICE TO PROBATIONER
YOU HEREBY ARE NOTIFIED THAT YOUR CONDITIONS OF PROBATION HAVE BEEN MODIFIED AS SET FORTH IN THE ABOVE ORDER, EFFECTIVE AS OF THE DATE SPECIFIED IN SUCH ORDER. Notification mailed () served upon () probationer: ________, 19________
N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. VI, form 15