Michigan > Local County > Jackson > Probation
Monthly Supervision Report - Michigan
| Monthly Supervision Report Form. This is a Michigan form and can be used in Probation Jackson Local County . |
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Michael J. Dillon MONTHLY SUPERVISION REPORT Probation Officers: Edward Alexander Court Administrator TH 12 DISTRICT COURT PROBATION Ken Ashenfelter Tammy Barrett Tamara J. Bates 312 South Jackson Street Lisa Grzesek Chief Probation Officer Jackson, Michigan 49201 DaNeese Merritt (517) 788-4280 Philip Rutledge www.d12.com Karen Taylor Jim Hunt, ISP, Scott Vitale, ISP TODAYS DATE: ___________________________ PROBATION OFFICER : ____________________________ NAME: ______________________________________________ HOME PHONE: ______________________ ADDRESS:___________________________________________ OTHER PHONE: _____________________ CITY, STATE & ZIP: __________________________________ Persons living with you: ________________ ____________________________________________________ Mailing address (if different than above) ____________________________________ Name and Address of Employer: Employer Phone Number: Name of Supervisor: Normal Work Day and Hours: Monthly Income: If Unemployed, how long have you been unemployed: List vehicles owned and/or driven by you: List year, make, model color a nd license plate: Have you had any contact with a law enforcement officer/agency since you r last report? yes no If yes, list the date _____________ and agency _________________________ _ Reason: Have you been ordered to attend one of the following: alcohol counseling , substance abuse counseling, mental health counseling and/or the Aggressive Intervention Program (AIM)? yes ) no If yes, have you been attending? yes no If no, what is your reason for not attending: <<<<<<<<<********>>>>>>>>>>>>> 2 Have you been ordered to complete community service? yes no If yes, have you been attending and how many days are remaining : ________________ If no, what is your reason for not attending? Have you been ordered to attend high school and/or obtain a G.E.D. Certi ficate? yes no If yes, have you been attending yes no If no, what is your reason for not attending? Did you make a payment today? yes no If yes, how much:_________________ If no, when will you make your next payment? I need to schedule an appointment with my proation officer: b yes no Additional comments for my probation officer: I CERTIFY THAT ALL OF THE INFORMATION GIVEN BY ME IN THIS REPORT IS TRU E AND TO THE BEST OF MY KNOWLEDGE AND BELIEF: Signed: ______________________________________ FOR OFFICIAL USE ONLY: Probation Officer notes: D12PB 1 (5/01)
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