"Monthly Report Form" - Yamhill County, Oregon

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Monthly Report Form is a legal document that was released by the Community Justice Department - Yamhill County, Oregon - a government authority operating within Oregon. The form may be used strictly within Yamhill County.

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YAMHILL COUNTY

MAIL OR GIVE TO YOUR

AND

PAROLE/PROBATION

STATE OF OREGON

OFFICER

ANY STATEMENTS MADE BELOW WHICH ARE LATER

FOUND TO BE UNTRUE MIGHT RESULT IN YOUR BEING DECLARED A VIOLATOR.

_________________________________________________________________

____________________________________________

Print Name

Date

_________________________________________________________________

Client’s Signature

THE FOLLOWING INFORMATION IS FOR ________________________, 19 _____

FOR ________________________________________________

Month

Probation/Parole Officer’s Name

1. EMPLOYMENT/INCOME ___________________________________________

2. EDUCATION/TRAINING

Employer __________________________________________________________

__ Attending College

Address

__________________________________________________________

__ GED Classes

Phone

________________ Name of Supervisor _________________________

__ Vocational Training

Job Duties ___________________________________________________________

Where _____________________________________

Days Worked During Month _______ Work Hours ________ Rate of Pay $_______

____________________________________________

Net Income for Month $_______________ How Many Others Do You Support ____

Source of Funding ____________________________

Other Income $___________ Source _____________________________________

____________________________________________

3. ACTIVITIES

Were you contacted by the police, arrested, jailed, cited and/or appeared in court during this month? __ Yes __ No.

If yes, explain what for, when, where, and why on back of this report.

If not working or attending school, how do you spend your spare time? ________________________________________________________________________

Did you travel during the month? ___ Yes ___ No If yes, where? ___________________________________________________________________________

WHERE YOU WERE PLACED ON PROBATION/PAROLE, CERTAIN CONDITIONS WERE PLACED ON YOU. IF ANY OF THE FOLLOWING

ARE CHECKED AND/OR APPLY TO YOU, THEN YOU MUST FURNISH THE APPROPRIATE INFORMATION!

Attending alcohol/drug/therapy ___ Yes ___ No

You were ordered to pay

Where __________________________________________

Amount Paid

Balance

Last Payment

Counselor _______________________________________

__ Restitution

___________

_________

___________

Date last attended _________________________________

__ Fine

___________

_________

___________

Taking monitored antabuse

___ Yes ___ No

__ Attorney Fees

___________

_________

___________

Pharmacy _______________________________________

__ Probation Fees

___________

_________

___________

Dosage _________________________________________

Community Service

Comments _______________________________________

__ Complete

___ Not complete, ______ Balance to be completed

________________________________________________

5. FINANCIAL

6. TRANSPORTATION

Balance on debts $___________________________________

Do you have a valid license? ___ Yes ___ No

Amount paid during month $___________________________

Driver’s license number __________________________________

Cash on hand $___________ Amount in savings $__________

Source of transportation ___ bus ___ car ___ other

Amount in checking $________________________________

If car: 1. Make _______________ 2. Make __________________

Paying child support? ____ Yes ___ No

Model _________________ ____

Model __________________

Monthly payment $__________________________________

Year ______________________

Year ___________________

Are you current? ___ Yes ___ No

Color ______________________

Color ___________________

If behind, how long? _________________________________

License No. _________________

License No. ______________

PRESENT LIVING SITUATION

___ House ___ Apartment ___ Other _____________________________________________________________________________________________________

I am ___ Renting ___ Leasing ___ Boarding ___ Buying ___ Other

With whom do you live? ______________________________________________

Relationship ___________________________________________________

Current Address _____________________________________________________

Mailing Address (if different) _____________________________________

City ___________________________ State _______________________ ______

City _________________________ State ___________________________

Zip _____________________ Phone ___________________________________

Zip ___________________ Phone ________________________________

MCMINNVILLE, OREGON (503) 434-7513