Court of Washington
For No.
Judgment and Sentence for:
Plaintiff, 1) Driving Under The Influence
Physical Control
vs. .08 -.14 .15+ Refusal No BAC
Defendant. Drug related Non-alcohol related
Passenger under age 16
2) Reckless Driving (RCW 46.61.500(3)
Negligent Driving - 1st Degree
(RCW 46.61.5249(4))
3) ___________________________________
(DUIJS)
The defendant pled guilty, or pled not guilty and the verdict of the jury was guilty, or the finding of the
court was guilty; and the court verified the defendant’s criminal history and driving record and made
findings orally or as follows:
____________________________________________________________________
___________________________________________________________________________________
_; therefore, the defendant is adjudged guilty and sentenced as follows:
Sentence is suspended for a period of months/years on the following conditions:
Count 1) ____ days of jail and suspends____ days; and a fine of $________ with $ _______
suspended
Count 2) ____ days of jail and suspends____ days; and a fine of $_________ with $ ______
suspended
Jail: Serve a total of ____________ days in jail with credit for ___________ days served, and
serve a total of _______ days of electronic home monitoring with credit for ______ days served
other alternative means of confinement: _________________________________________.
Jail sentences are concurrent/consecutive with all other commitments
____________________________.
Fine: pay fine of $____________ plus BAC fee $___________
plus assessments $____________ plus criminal traffic fee $___________
plus costs $____________ plus probation/monitoring fee $___________
plus bench warrant fee $____________ plus booking fee $___________
plus jail recoupment fee $____________ plus public defender recoupment $___________
plus other __________ $ plus DUI emergency response fee $
plus criminal conviction fee $
plus restitution to: $
(All payments shall be made through the clerk of this court, including restitution.) Total: $___________
$ _________ of this total is converted to ______ hours of community restitution (service) which must
be completed by _________. Proof of completion shall be provided to the court/probation
department.
Mandatory Conditions of Sentence - DUI/Physical Control
DUI Judgment and Sentence Form (DUIJS) - Page 1 of 4
CrRLJ 07.0100 - (09/2011) CrRLJ 7.2, 7.3; RCW 46.20.720, 46.61.5055
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(a) The defendant shall not drive a motor vehicle without a valid license and proof of insurance. (b)
The defendant shall not drive a motor vehicle with an alcohol concentration of .08 or more within two
hours after driving. (c) The defendant shall submit to a breath or blood alcohol test upon the
reasonable request of a law enforcement officer. If you violate (a), (b), or (c) within this state, the court
shall order you confined for no less than 30 days and your driving privilege will be suspended for 30
days.
No criminal violations of law or alcohol related infractions.
Comply with mandatory ignition interlock device requirements as imposed by the Department of
Licensing.
Comply with the requirement to apply for an ignition interlock driver’s license and to install an ignition
interlock device on all vehicles operated by the defendant as required by the Department of Licensing.
(RCW 46.20.720(2), 46.20.385, and RCW 46.61.5055(5), (6).)
The court has ordered the defendant to refrain from consuming any alcohol and has required the
defendant to apply for an ignition interlock driver’s license. The defendant says he or she does
not operate a vehicle or the defendant is not eligible to obtain an ignition interlock driver’s
license. Therefore, the defendant shall comply with alcohol monitoring requirements through
alcohol detection breathalyzer device transdermal sensor device, other:
___________________________, as imposed by the court for the period of the mandatory license
suspension or revocation as ordered by DOL. (RCW 46.61.5055(5)).
The court waives the requirement that the defendant apply for an ignition interlock driver’s license
because:
The defendant lives out-of-state and has provided proof on state letterhead that ignition interlock
devices are not reasonably available in the defendant’s local area, or
The defendant does not operate a vehicle, or
The defendant is not eligible to receive an ignition interlock driver’s license under RCW 46.20.385
because the defendant is not a resident of Washington; is a habitual traffic offender; has
already applied for or is already in possession of an ignition interlock driver’s license; has been
certified under Ch. 74.20 RCW as noncompliant with a child support order; is subject to any
other condition or circumstance that makes the person ineligible to obtain an ignition interlock
driver’s license.
Unless otherwise stated, the calibration level for any ignition interlock requirement imposed under this
order shall be .025% __________.
Mandatory Conditions of Sentence – Reckless Driving/Negligent Driving – 1st Degree
(a) The defendant shall not drive a motor vehicle without a valid license and proof of insurance. (b)
The defendant shall not drive a motor vehicle with an alcohol concentration of .08 or more within two
hours after driving.
No criminal violations of law or alcohol related infractions.
Comply with mandatory ignition interlock device requirements as imposed by the Department of
Licensing.
Additional Conditions of Sentence - Discretionary Ignition Interlock - RCW 46.20.720(1)
Comply with discretionary ignition interlock device requirements (when defendant provides
employment affidavit to the Department of Licensing, this order shall not apply to vehicles owned,
leased, or rented by defendant’s employer or to those vehicles whose care and/or maintenance is the
temporary responsibility of the employer and driven at the direction of the defendant’s employer as a
requirement of employment during working hours):
For a period of _________ years following the period of driver’s license suspension, revocation, or
denial, drive only a motor vehicle equipped with a functioning ignition interlock device.
DUI Judgment and Sentence Form (DUIJS) - Page 2 of 4
CrRLJ 07.0100 - (09/2011) CrRLJ 7.2, 7.3; RCW 46.20.720, 46.61.5055
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From _____________________ (date) to ____________________________ (date), do not drive
any motor vehicle unless it is equipped with an ignition interlock device (this does not authorize
you to drive without a valid license).
Unless otherwise stated, the calibration level for any ignition interlock requirement imposed under
this order shall be .025% _______.
DUI Judgment and Sentence Form (DUIJS) - Page 3 of 4
CrRLJ 07.0100 - (09/2011) CrRLJ 7.2, 7.3; RCW 46.20.720, 46.61.5055
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Additional Conditions of Sentence
Probation for _________ months. Supervised probation for ________________ months with
probation department and abide by all rules and regulations of probation department. Pay a pre-
sentence fee and a monthly probation fee as set by the probation department.
Obtain an alcohol/drug evaluation from a Washington State-approved agency and file a copy of the
evaluation within ________ days. Begin any recommended treatment or education within ______
days and file proof of timely enrollment and completion.
Begin the following within ________days, complete within ______________ days, and file proof of
timely enrollment and completion: DUI Victim’s Panel Alcohol/Drug Information School One
Year Alcohol/Drug Treatment Two Year Alcohol/Drug Treatment Alcohol/Drug Treatment for a
period of ________________ Driver Improvement School Other _________________________.
Use no alcoholic beverages or non-prescribed controlled drugs.
Attend Alcoholics Anonymous Narcotics Anonymous Other self-help program (____________)
meetings _____ times a week for _____ months or as recommended by treatment provider.
Other: ___________________________________________________________________________.
Return for a review hearing: . Bail or Bond is Exonerated
Forfeited.
Dated:
I have read the rights, conditions, and warnings.
Defendant’s Signature Date of Birth Judge/Court Commissioner/Pro Tem
Prosecuting Attorney WSBA No.
Defense Attorney WSBA No.
Defendant’s Address and Telephone Written Waiver of Counsel is filed.
DUI Judgment and Sentence Form (DUIJS) - Page 4 of 4
CrRLJ 07.0100 - (09/2011) CrRLJ 7.2, 7.3; RCW 46.20.720, 46.61.5055
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