Form Crt20259 - Application To Vary A Probation Order - Province Of Manitoba,canada
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2For office use only:
APPLICATION TO VARY A PROBATION ORDER
Court File No.________________________
Canada: Province of Manitoba
_____________________
Date of Probation Order: _________________________
Judge:
Attach Order
1. INITIATED BY: (Check appropriate box)
Offender
Probation Officer / Case Manager
Other _____________________
Offender Name ____________________________________________________________
Date of birth____________________________
first name
middle name(s)
surname
dd/mm/yyyy
Offender Address ___________________________________________________________________________________________________
street address
postal code
city/town/municipality
province
Home telephone number ______________________________ Alternate telephone number_______________________________________
An Application under section 732.2(3) of the Criminal Code to:
change a condition of a Probation Order (specify below)
have the term of a Probation Order decreased or be relieved of a condition (specify below)
Other _________________________________________________________________________________________ (specify below)
The changes requested are: (if more space is required use additional pages)
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
This application is based on the following reasons: (if more space is required use additional pages)
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
I have read and understand the Variation of A Probation Order Information Sheet.
Dated __________________________ at _________________________________ , Manitoba
___________________________________
city/town/municipality
dd/mm/yyyy
Offender Signature
2. TO BE COMPLETE BY PROBATION OFFICER:
Probation Order is:
Supervised
Unsupervised (except for CSW hours)
Probation Officer/ Case Manager is :
Not Opposed
Opposed
Explanation: _______________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Yes
No
N/A
Has the offender reported regularly?
Has the offender been compliant with other conditions?
Yes
No
N/A
Has the offender completed counselling?
Yes
N/A
No
Risk to re-offend generally:
Very Low
Low
Medium
High
Very High
Not Assessed
Name of Probation Officer / Case Manager: ___________________________________
______________________________________
Probation Officer / Case Manager Signature
Address:_______________________________________________________________
______________________________________
Phone Number: _________________________________________________________
Date
3. TO BE COMPLETED BY CROWN ATTORNEY:
Provincial
Federal
Crown is :
Opposed
Not Opposed
Comments: ________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Name of Crown Attorney: ______________________________________________
______________________________________
Crown Attorney Signature
Phone Number: ______________________________________________________
______________________________________
Date
:
THE COURT ORDERS
Application granted
Application denied
Hearing required (return to crown's office)
Other _______________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Dated __________________ at _________________________________ , Manitoba ____________________________________________
Signature of Judge/Justice or Clerk of the Court on Behalf of Judge/
city/town/municipality
dd/mm/yyyy
Justice
Court
Offender
Crown
Probation
Police Agency
CRT20259 (2015/11)
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