INMATE NAME: DOB:

CASE # DATE:

SELECTED NONVIOLENT SENTENCED INMATES:

Inmate is nonviolent/sentenced and meets the criteria for the County Maintenance Program (Trustee). Inmate will report back to the (name of detention facility) on the day of 200 to complete the remainder of their sentence or receive further instructions.

SELECTED NONVIOLENT INMATES MEETING FAILURE TO PAY PURGE CRITERIA:

Inmate has spoken with the Detention Facility/Jail Pre-trial Release representative PRIOR to release and will be places on the Partial Payment Plan.

SELECTED NONVIOLENT INMATES MEETING FAILURE TO PAY FINE CRITERIA:

Inmate must report to the (name of county) Clerk of Courts within 5 days to make arrangements for paying a fine, schedule a court date or receive further instructions. In the event the Clerk of Courts is not open and/or operational, the inmate will report to the (name of detention facility or jail) for further instructions.

I have read, understand, and agree to abide by all rules applying to my release. If I violate the conditions of my release, I understand that I will be subject to Violation of Release and that a Warrant/Capias could be issued for my arrest.

Inmate Signature Witness

Date: