C.O.R.E. Online Probation Form

Comprehensive Offender Rehabilitation & Education Program
Serving the 19th Judicial Circuit St Lucie, Martin, Indian River, & Okeechobee Counties

Probation Report
FILL OUT COMPLETELY

Report for the Month of:

Probation Officer:

Name:

DOB:

Email Address:

Address:

City:

State:

Zip:

Who else resides at this address:

Home #:

Cell #:

Work #:

DL No:

State of DL:

Status of DL:

Valid

Suspended

None

Do you currently own a vehicle:

Yes

No

Make:

Model:

Year:

Color:

Tag:

EMPLOYMENT

Employers Name/Company:

Job Title:

Address:

Phone:

Hours worked per week:

Weekly take home pay: $

Other Income:

EXPENSES

Mortgage/Rent per month:

Utilities per month:

Cable/Internet per month:

Cell Phone per month:

Car Payment per month:

Insurance per month:

Misc Expenses:

HEALTH

(1) Medication (currently taking):

Reason for taking:

(2) Medication (currently taking):

Reason for taking:

(3) Medication (currently taking):

Reason for taking:

COURT ORDERED CONDITIONS

List all progress on conditions that pertain to your case (if do not apply type NA)

DUI Program (Classes, Substance Use Evaluation, Counseling if required):

Any other program/class/evaluation (Anti-Theft, Anger Management, Batterers Intervention, Mental Health, etc.):

Community service hours (Non-Profit or Governmental Agency)

Victim Impact Panel:

Vehicle Immobilization:

Court Assessed Fees:

Misc:

Probation Fees $65 (first month) $55 (month thereafter) Diversion Fees $45 (per month)
Fees can be paid with a credit/debit card or via US Mail in the form of a money order or cashiers check

Enter Payment Amount:

Comments:

BY SUBMITTING I SWEAR AND AFFIRM THAT THE ABOVE REPRESENTATIONS ARE TRUE AND CORRECT
TO THE BEST OF MY INFORMATION, KNOWLEDGE, AND BELIEF

Unemployment	Social Security	Food Stamps
Workman’s Comp	Pension	SSI/Disability
Child Support	Alimony	AFDC