N.Y. Comp. Codes R. & Regs. Tit. 9 MM app H-11

DP 2.2(5.74)

COURT ORDER FOR INVESTIGATION AND REPORT

DATE: ________

TO:

NAME OF PROBATION AGENCY

FROM:

JUDGEem; COURT PART (DOCKET# OR

INDICTMENT# OR

PETITION#)

DEFENDANT'S/RESPONDENT'S NAME

LAST FIRST M.I

DATE OF BIRTH/AGE ____________

ADDRESS: ____________

NO. STREET APT. NO. CITY/BOROUGH/VILLAGE

CONVICTED OF

________

(CRIMINAL MATTERS) OR ADJUDICATED AS: ____________

OR (FAMILY COURT MATTERS)

DATE OF CONVICTION/ADJUDICATION: ________/ ________/________

MO. DAY YR.

BY: PLEA [ ] TRIAL [ ] OR ADJUDICATION [ ]

CUSTODY STATUS: ________ BAIL [ ] R.O.R. [ ] DETENTION [ ]

RETURN DATE: ________ /________ / ________

MO. DAY YR.

SPECIFIC INSTRUCTIONS:

[ ] INSTRUCTED TO REPORT TO PROBATION DEPARTMENT ON

_____

date

AT (specify a.m. or p.m.)

_____

time

OR

[ ] TO AWAIT CONTACT BY PROBATION DEPARTMENT

BY: ________

Notes

N.Y. Comp. Codes R. & Regs. Tit. 9 MM app H-11

PLEASE ATTACH COPY OF INFORMATION/PETITION, STATEMENT, R.O.R REPORT, FINGERPRINT RECORD, ETC.