Name

County Attorney

Address

City, State, Zip

Telephone Number

Attorney for Plaintiff

MONTANA JUDICIAL DISTRICT COURT, COUNTY

*

STATE OF MONTANA, * CAUSE NO.

*

Plaintiff, * JUDGE

*

vs. * RECEIPT FOR ORDER *

, * SUSPENDING IMPOSITION

*

Defendant. * OF SENTENCE

* * * * * * * * * * * * * * * *

I, , the above-named Defendant, acknowledge receipt of a copy of the foregoing Order Suspending Imposition of Sentence. I have read (or have heard read) and understand all of the terms and conditions of this Order which was explained to me by the Court.

I agree to comply fully with rules and regulations established by the Court and with the terms and conditions of probation set forth in the foregoing Order and to accept supervision by the .

Dated this day of , 19 .

Defendant

Witness