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HILLSBOROUGH COUNTY SHERIFF'S OFFICE
MISDEMEANOR PROBATION
Profile Intake
Personal Information
Case #
Offense(s)
Alcohol Monitoring Devices:
Ignition Interlock
SCRAM (Mobile Remote Alcohol Breath Monitor)
CAM (Ankle Alcohol Monitor)
Last Name
First Name
Middle
Date of Birth (mm/dd/yyyy)
Address
City
State
Zip
Phone
Email
Gender
Select
Male
Female
Prefer not to Answer
Race
Select
White
Black
Asian
American Indian
Other
Ethnicity
Select
Hispanic
Non-Hispanic
Language
English
Spanish
Other
Do you have any pending court dates to include other counties? If yes, list them below.
Do you have a prior arrests or charges for any Felony or Misdemeanor Crimes? If yes, list all previous arrests or charges.
Are you presently on any court ordered supervision program (probation or parole)? If yes, provide the name and contact phone number for your Probation Officer.
Do you have a firearm at home?
Yes
No
Employment and Benefits
Are you currently employed?
Yes
No
What is your monthly Gross Income?
Select all that apply:
Do you receive SSI Benefits?
Do you receive VA Benefits?
Do you receive Disability benefits?
Do you receive Court-Ordered Child Support?
Do you receive AFDC assistance?
Do you receive EBT assistance?
What is total income monthly (Add all sources of income)?
How many dependants do you support?
Is assistance needed in any of the following areas?
Employment
Medical
Social Service
If yes, please explain why you are requesting assistance
Have you completed any Community Service Hours? If yes, how many hours, and at what locations(s), were completed? (provide proof of completion)
Have you completed any court-ordered classes?
Yes
No
Have you consumed alcohol/intoxicants? If yes, explain.
Have you used any illegal substances (drugs)? If yes, explain.
Have you had any new arrests or contact with law enforcement? If yes, explain.
Are you on probation for a domestic violence related charge or diversion program?
Yes
No
Name of victim in the case?
What is the victim’s address?
What is the victim’s contact phone number?
What is your relationship to the victim?
Is there a court order reference child custody?
Yes
No
Sign and Submit
I agree that I will return within 48 hours (business days only) for the initial intake appointment.
At today’s appointment, your Monthly Cost of Supervision of $70 is due. Additionally, for court ordered community service hours, a $7 insurance fee is required for every 50 hours of community service.
Signature
Click the box above if you are not a robot
216.73.216.98
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