N.Y. Comp. Codes R. & Regs. tit. 9, Appendices, app H-11
DP 2.2(5.74)
COURT ORDER FOR INVESTIGATION AND REPORT
DATE: ________
TO:
NAME OF PROBATION AGENCY
FROM:
JUDGEem; COURT PART (DOCKET# OR
INDICTMENT# OR
PETITION#)
DEFENDANT'S/RESPONDENT'S NAME
LAST FIRST M.I
DATE OF BIRTH/AGE ____________
ADDRESS: ____________
NO. STREET APT. NO. CITY/BOROUGH/VILLAGE
CONVICTED OF
________
(CRIMINAL MATTERS) OR ADJUDICATED AS: ____________
OR (FAMILY COURT MATTERS)
DATE OF CONVICTION/ADJUDICATION: ________/ ________/________
MO. DAY YR.
BY: PLEA [ ] TRIAL [ ] OR ADJUDICATION [ ]
CUSTODY STATUS: ________ BAIL [ ] R.O.R. [ ] DETENTION [ ]
RETURN DATE: ________ /________ / ________
MO. DAY YR.
SPECIFIC INSTRUCTIONS:
[ ] INSTRUCTED TO REPORT TO PROBATION DEPARTMENT ON
_____
date
AT (specify a.m. or p.m.)
_____
time
OR
[ ] TO AWAIT CONTACT BY PROBATION DEPARTMENT
BY: ________
N.Y. Comp. Codes R. & Regs. tit. 9, Appendices, app H-11
PLEASE ATTACH COPY OF INFORMATION/PETITION, STATEMENT, R.O.R REPORT, FINGERPRINT RECORD, ETC.