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Supervision Report

  1. Are you employed?*

  2. Do you posses a valid driver's license? *

  3. If "yes" is license:*

  4. Are you attending treatment program(s)?*

  5. Have you paid all your Fines, Costs and Probation Oversight fees?*

  6. If no check with District Court Records Department on First Floor for balance and due date.

  7. Since your last report have you had ANY contact with Police?*

  8. Check all that apply*

  9. Do you have any special problems, concerns or comments?*

  10. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. I have reviewed this document and the statements it contains are true to the best of my knowledge, information, and belief.

  11. Leave This Blank:

  12. This field is not part of the form submission.