Application For Disposition Under Program Of Accelerated Rehabilitative Disposition/probation Without Verdict
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1
2COMMONWEALTH OF PENNSYLVANIA
:
IN THE COURT OF COMMON PLEAS
:
OF ERIE COUNTY, PENNSYLVANIA
:
CRIMINAL DIVISION
v.
:
:
NO.: _____________ OF 20_______
________________________________________
:
OTN: _________________________
APPLICATION FOR DISPOSITION UNDER PROGRAM OF ACCELERATED
REHABILITATIVE DISPOSITION/PROBATION WITHOUT VERDICT
Application is hereby made for disposition of this case under the Accelerated Rehabilitative Disposition/Probation Without
Verdict Program. To assist the District Attorney=s Office in evaluating the suitability of this case for the ARD/PWOV
Program, the following information is provided:
INSTRUCTIONS:
Answer all questions that apply. If a question does not apply, answer it with the initials AN.A.@
1.
Full Name of the defendant: ___ ________________________________________________________________
2.
Maiden Name of defendant; or other names previously used: ___________________________________________
3.
Date of Birth: ______________________ Social Security Number: ___________________________
4.
Driver License Number: ___________________________ State Issued:________________________
5.
Present Address: _____________________________________________________________________________
City: ____________________________ State: ______________ Zip Code: _______________
Phone (Home) (
) __
_____
(Work) (
)____________________
6.
Previous Addresses and length of time at each (go back 10 years): _________________________________________
_______________________________________________________________________________________________
7.
Present Employment:
___________________________________________________________________________________________
Education-Schools and Highest Year attained:
8.
___________________________________________________________________________________________
9A. Have you ever been found guilty or pleaded guilty or no contest to any criminal violation of any kind in any court other
than summery offenses, whether in Pennsylvania or anywhere else? If so, explain giving date, place, charge(s), and
disposition:
___________________________________________________________________________________________________
9B.
Do you have any other pending criminal charge(s) or have you ever been placed on ARD or PWOV? If so, explain
giving date, place, charges and disposition: ______________________________________________________________
_______________________________________________________________________________________________
9C.
If charged with Driving Under the Influence: Have you ever been adjudicated a delinquent or entered into a co-
agreement as a juvenile after being charged with Driving Under the Influence of Alcohol? If so, explain giving
details:______________________________________________________________________________________________
__________________________________________________________________________________________________
10. Explanation of your present case, including all details (use reverse side if needed):_____________________________
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