Application For Furlough From 24-7 Program And Order

STATE OF SOUTH DAKOTA) :SS COUNTY OF MINNEHAHA ) IN CIRCUIT COURT SECOND JUDICIAL CIRCUIT STATE OF SOUTH DAKOTA, Plaintiff, vs. __________________________, Defendant. DOB: ____________ CRI. ______________ APPLICATION FOR FURLOUGH FROM 24/7 PROGRAM AND ORDER I have been ordered by the court to participate in the 24/7 Sobriety Program for the following reason(s) (please check all that apply): My case is pending, and the 24/7 program is a condition of my bond. I have been sentenced in my case, and the 24/7 program is condition of my court-issued restricted driver's permit. I have been sentenced in my case, and the 24/7 program is a condition of my suspended sentence/probation. Have you ever violated the 24/7 program? Yes No I am requesting a furlough from the 24/7 program for the following reasons (please be detailed- if you are requesting the furlough so that you may travel, please list all of the destinations and dates that you will be arriving/departing from those destinations): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Before the requested furlough would begin, the last session of the 24/7 program that I would be able to attend and submit to the required alcohol/drug testing is ___/___/___ (fill in the date) during the evening/morning (circle one) session. After the requested furlough would end, the first session of the 24/7 program that I would be able to attend and submit to the required alcohol/drug testing is ___/___/___ (fill in the date) during the evening/morning (circle one) session. In making this application, I understand that if the requested furlough is approved by the court, and I am excused from the scheduled alcohol/drug testing during the furlough period, I am still required to abide by all of the remaining rules and regulations of the 24/7 Sobriety Program, including abstention from the use/possession of any prohibited substance and substances containing alcohol. In addition, if my privilege to drive a vehicle is conditioned upon participation in the 24/7 program, or if I have been issued a restricted driver's permit which is conditioned upon participation in the 24/7 program, I understand that during the period of any approved furlough, I am prohibited from driving a vehicle. I understand that violation of any of these terms could result in the same consequences as a violation of the court's original order placing me on the 24/7 Sobriety Program, including, if applicable, revocation of bond, imposition of any suspended sentence and cancellation of any restricted driver's permit. Dated this __ day of ________________, 20__. __________________________ Defendant's Signature American LegalNet, Inc. www.FormsWorkFlow.com It is hereby ordered that the defendant's Application for Furlough from the 24/7 Sobriety Programs is: DENIED, for the following reasons: ________________________________________________________________________ ________________________________________________________________________ GRANTED, subject to the following terms and conditions: ________________________________________________________________________ ________________________________________________________________________ The furlough shall commence after the alcohol/drug test scheduled for ___/___/___ during morning/evening session. Upon the conclusion of the furlough, the defendant shall report for the alcohol/drug test scheduled for ___/___/___ during the morning/evening session and all required sessions thereafter. Any violation of the terms and conditions of this furlough or the 24/7 Sobriety Program, including failure to re-start the 24/7 Sobriety Program on the date ordered, will result in the same consequences as a violation of the court's original order placing the defendant on the 24/7 Sobriety Program, including, if applicable, revocation of bond, imposition of any suspended sentence and cancellation of any restricted driver's permit. Dated this___ day of _______________, 20___. Circuit/Magistrate Judge ATTEST: Angelia M. Gries, Clerk of Court By __________________, Deputy American LegalNet, Inc. www.FormsWorkFlow.com