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71B District Court Probation Basic Information Sheet
Instructions:
1. This form must be answered by the probationer.
2. Answer all questions completely and to the best of your ability.
3. Please be honest and accurate.
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* Indicates required question
Today's Date
*
MM
/
DD
/
YYYY
Date of Birth
*
MM
/
DD
/
YYYY
Name (Last, First, middle)
*
Your answer
Other names used
Your answer
What is your Current Address?
*
Your answer
Is this address new since the date of your arrest?
*
Yes
No
Cell, Home, and Work Phone numbers (Must enter one)
*
Your answer
Juvenile History (Include Offense, County and Year)
*
Your answer
Adult History (Include Offense, County and Year)
*
Your answer
Do you have any charges pending besides the offense you are here for today?
*
Yes
No
If you answered Yes to the previous question explain.
Your answer
Are you presently on probation or parole?
*
Yes
No
What county?
Your answer
Did you Graduate High School?
*
Yes
No
If not, What was the highest grade completed?
9
10
11
12
Clear selection
Have you attended any additional schooling? (explain)
Your answer
Are you currently in school?
*
Yes
No
If Yes, Where and what grade?
Your answer
Are you able to read and write English well?
*
Yes
No
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