Name of Tribe	)

)

vs.	)	Tribal Docket No.: Docket #

)

)

First Middle Last	)

)

Prepared for:	The Honorable Tribal Court Judge Name of Judge

Tribal Jurisdiction:	Tribal Jurisdiction

Tribal Court Address:	Address 1

Address 2

City, State Zip

Prepared by:	Report Writer
Title

Number Street

City, State Zip

Office: Office Phone

Cellular: Cell Phone

Date Report Prepared:	Date Report Submitted

Attorney	Defense Counsel

Name	Name
Address	Address

City, State Zip	Address Zip

Phone	Phone

Sentence Date:	Sentence Date

Offense:	Crime

Statute.
Max Custody Time/$Max Fine Amount fine
(Felony Class)

Release Status:	Release Status

Detainers:	Detainers

Codefendants:	(Codefendants)

Related Cases:	(Related Cases)

Identifying Data:

Date of Birth:	Click or tap to enter a date.

Age:	Age in Years

Place of Birth:	City, State, Country

Sex:	Sex

Height:	Height

Weight:	Weight

Color of Eyes:	Eye Color

Color of Hair:	Hair Color

Tribal Affiliation:	Click or tap here to enter text.

SSN:	###-##-####

FBI:	*********

USM/BOP:	#####-###

State ID:	#####

Education:	Choose an item.

Dependents:	Number of Dependents

Address:	Address

City, State Zip

Alias(es):	Alias Names

Alternate IDs:	Tattoos: Location: Description

Scars: Location: Description

PART A. THE OFFENSE

Charge(s) and Conviction(s)

Click or tap here to enter text.

[List offense or indicate “None” if not applicable]

The Offense Conduct

Click or tap here to enter text.

Victim Impact

Click or tap here to enter text.

Acceptance of Responsibility

Click or tap here to enter text.

Institution Adjustment at Current Correction Facility

Click or tap here to enter text.

PART B. THE DEFENDANT’S CRIMINAL HISTORY

Juvenile Adjudication(s)

Date of Arrest	Conviction/Court	Date Sentence Imposed/Disposition

Arrest Date (Age Age at time of arrest)	Conviction Counts Court of Conviction Court City, State Docket: Docket #	Dispo date Sentence Imposed
Description of Arrest
Arrest Date (Age Age at time of arrest)	Conviction Counts Court of Conviction Court City, State Docket: Docket #	Dispo date Sentence Imposed
Description of Arrest

Adult Criminal Conviction(s)

Date of Arrest	Conviction/Court	Date Sentence Imposed/Disposition

Arrest Date (Age Age at time of arrest)	Conviction Counts Court of Conviction Court City, State Docket: Docket #	Dispo date Sentence Imposed
Description of Arrest

Other Criminal Conduct

Date of Arrest	Conviction/Court	Date Sentence Imposed/Disposition

Arrest Date (Age Age at time of arrest)	Conviction Counts Court of Conviction Court City, State Docket: Docket #	Dispo date Sentence Imposed
Description of Arrest

Pending Charges

Click or tap here to enter text.

Other Arrests/Escape History

Click or tap here to enter text.

PART C. OFFENDER CHARACTERISTICS

Personal and Family Data

Click or tap here to enter text.

Physical Condition

Click or tap here to enter text.

Mental and Emotional Health

Click or tap here to enter text.

Substance Abuse

Click or tap here to enter text.

Educational, Vocational and Special Skills

Click or tap here to enter text.

Employment Record

Click or tap here to enter text.

Financial Condition: Ability to Pay

Click or tap here to enter text.

SENTENCING RECOMMENDATION

Name of Tribe TRIBAL COURT
Defendant Full Name
TRIBAL COURT DOCKET: Docket #

Tribal Code Provisions	Plea Agreement Provisions	Recommended Sentence
CUSTODY:	# Years to # Years	# Months	# Months
PROBATION:	# Years to # Years	# Years	Click or tap here to enter text.
FINE:	Up to $ Dollar Amount or Range	$Dollar Amount	$Dollar Amount
RESTITUTION:	$Dollar Amount	$Dollar Amount	$Dollar Amount

Justification:

Click or tap here to enter text.

Voluntary Surrender:

Click or tap here to enter text.

Recommendation:

It is respectfully recommended the sentence in this case be imposed as follows:

Pursuant to the Tribal Court Code Tribal Code, it is the judgment of the Court that Defendant Full Name is hereby Sentence Imposed.

Respectfully,

Submitted By:

________________________________

Report Writer’s Name

Report Writer’s Title

Approved By:

____________________________

Supervisor Name

Supervisor Title