Dd Form 2716-1 - Dod Certificate Of Supervised Release Page 2
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4DEPARTMENT OF DEFENSE
CERTIFICATE OF SUPERVISED RELEASE
1.a. PROBATION/PAROLE OFFICER NAME
b. TELEPHONE NUMBER
(Last, First, Middle)
(Include area code)
c. AGENCY ADDRESS
d. CITY
e. STATE
f. ZIP CODE
2. SUPERVISED RELEASE DESTINATION (Limitation of travel is designated by Parole Officer)
3. CONDITIONS
This Certificate of Supervised Release shall become operative when the prisoner has been notified in writing of the following
conditions:
a. When released, the supervisee will go without delay to the supervision destination as specified above.
b. Within three working days of release, supervisees will report in person to their probation officer, unless directed otherwise by their
probation officer. They will follow their probation officer's reporting instructions and report as directed. After reporting, the supervisee
will complete the Notification of Arrival letter and forward it to
Supervisee's Facility Address (Facility Name/State/ZIP Code)
c. Supervisees will remain within the limits prescribed by their probation officer, and, if they have justifiable cause to leave these
limits temporarily, they will first obtain permission from their probation officer.
d. Supervisees will not change the residence and employment approved in their supervised release plan without first receiving
permission from their probation officer. In the event their residence or employment is involuntarily terminated, they will report these
events to their probation officer within one working day of being notified of such termination.
e. Failure to maintain contact with their probation officer constitutes absconding.
f. Supervisees will promptly and truthfully answer all inquiries directed to them by their respective branch of service, their
commander, their probation officer, or other persons acting in an official capacity.
g. Supervisees will not associate with persons of bad or questionable reputation, nor enter or frequent places where controlled
substances are sold, used, distributed or administered.
h. Supervisees will in all respects conduct themselves in an honorable manner, work diligently at a lawful occupation, support those
dependent on them, meet other family and financial responsibilities to the best of their ability, and avoid unnecessary or excessive
debt.
i. Supervisees will live and remain at liberty without violating the law. Supervisees shall consider themselves convicted felons and
understand that all laws regulating convicted felons may apply; should they have questions they will seek guidance from their
probation officer or Service Clemency and Parole Board.
j. Supervisees will refrain from the excessive use of alcohol and will not purchase, possess, use, distribute or administer any
narcotic or other controlled substance or any paraphernalia related to such substances, except as prescribed by a physician.
k. Supervisees will notify their probation officer within 24 hours of being arrested, detained, or questioned by a law enforcement
officer.
l. Supervisees will not enter into any agreement to act as an informer or special agent of a law enforcement agency without the
permission of their Service Clemency and Parole Board.
m. Supervisees also understand and agree that if they violate any of the conditions of their supervised release, they may be
apprehended or returned to military control, and be held liable to serve the remainder of their sentence to confinement and forfeit
their time served on supervised release, as well as previously earned good conduct time and other abatements.
n. If accepting parole, supervisees waive all good conduct time and abatement earned up to their release date (not applicable to
Mandatory Supervised Release).
o. Supervisees will not possess a firearm, ammunition, or other dangerous weapon.
p. Supervisees will comply with additional conditions of their Supervised Release.
(Listed on subsequent pages)
DD FORM 2716-1, MAR 2013
Page 2 of 4 Pages
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