Proof Of Enrollment Or Completion Alcohol Or Drug Program {MC-400}

NAME AND ADDRESS OF COURT: FOR COURT USE ONLY NAME OF DEFENDANT: STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: DATE OF COURT ORDER: (check one) PROOF OF ENROLLMENT IN ALCOHOL OR DRUG PROGRAM CASE NUMBER: PROOF OF COMPLETION OF ALCOHOL OR DRUG PROGRAM DESCRIPTION OF ALCOHOL OR DRUG PROGRAM Name of Program: Address of Program: Program License Number: Program Telephone Number: PROOF OF ENROLLMENT 1. Defendant (name): enrolled in the alcohol or drug education program described above on (specify date of enrollment): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: ................................................................................................ (TYPE OR PRINT NAME) (SIGNATURE OF DEFENDANT) Date: (TYPE OR PRINT NAME) (SIGNATURE OF PROGRAM DIRECTOR OR INSTRUCTOR) (TITLE) PROOF OF COMPLETION successfully completed the alcohol or drug 2. Defendant (name): education program described above on (specify date of completion): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: ................................................................................................ (TYPE OR PRINT NAME) (SIGNATURE OF DEFENDANT) Date: ................................................................................................ (TYPE OR PRINT NAME) (SIGNATURE OF PROGRAM DIRECTOR OR INSTRUCTOR) (TITLE) -- INSTRUCTIONS -- YOU NEED TWO OF THESE FORMS: 1. UPON ENROLLMENT IN A COURT-ORDERED ALCOHOL OR DRUG EDUCATION PROGRAM, FILL OUT THE PROOF OF ENROLLMENT PORTION OF ONE COPY OF THIS FORM AND FURNISH IT TO THE SENTENCING COURT WITHIN THE TIME AND IN THE MANNER SPECIFIED BY THE COURT. 2. UPON SUCCESSFUL COMPLETION OF THE PROGRAM, FILL OUT THE PROOF OF COMPLETION PORTION OF A SECOND COPY OF THIS FORM AND FURNISH IT TO THE SENTENCING COURT WITHIN THE TIME AND IN THE MANNER SPECIFIED BY THE COURT. FAILURE TO COMPLY WITH THESE REQUIREMENTS MAY RESULT IN THE REVOCATION OF YOUR PROBATION. Sl USTED NO CUMPLE CON ESTOS REQUISITOS, SU INCUMPLIMIENTO PUEDE RESULTAR EN LA REVOCACION DE SU LIBERTAD CONDICIONAL. Form Approved by the Judicial Council of California MC-400 [Rev. January 1, 1986] PROOF OF ENROLLMENT OR COMPLETION ALCOHOL OR DRUG PROGRAM Veh. Code, §23205 2001 © American LegalNet, Inc.