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LYNCHBURG VA. 24501 114-LYNCHBURG
‘BAILEE: VIOL COND OF RELEASE/PRETRIAL Se
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DISPOSITION 10 THE SHERIFF, JAIL OFFICER OR CORRECTIONAL OFFICER:
Conf the person named in this notice in your fit in sooordance with the orders) below.
HOWEVER, ifthe defendant appeals ANY of the charges below, DO NOT RELEASE him or
her until ALL conditions of bail are met,
[ ] General District Court { } Traffic [ ] Criminal [ ] Civil Division
DISPOSITION NOTICE
Commonwealth of Virgiaia
-ANCURG 14 pR ~» baste iniDonetcRdktom Diticat [Graco
PERRY, MICHAEL LEE: UIE aa 9/20/2001 .
mac se,
EX] Male [ ] Female [XJ Aduit [ ] Juvenile [] DisPostTION ADDENDUM listing additional cases is attuched and incorporated.
1, Case No. YAQOSII=LI-01 au Offense Date 08/29/2023,
[Not guilty [ ] Nolle prosequi [ } Dismissed
(x) Convicted of ,CAPIAS FTACCCA,
[ ] Felony (XJ Misdemeanor
IX] State Code § I92:123.:.cunrn .-[ ] Local Ordinancs 7
VCC BNDI97589, i OTN 6891040511101...
[J Appeal noted [ ] Certified to Grand Juiy 1 $2I6.00 ener {Jn
£X] Jail sentence of 00M 010 D_ ‘imposed with a Bee +» Suspended,
snes HOUES to be served in jail [ J OF WHICH enon days mandatory
[ ] Committed to the Department of Corrections for. ececeeeeeeeienecee
[ ] Commitid to the Department of Fuvenile Justice £07 ennensnue Sees ano
[1 Bxtraiton waived, and Form DC-375 Waivin oF EXTRADITION attached, If not delivered to Demanding State,
RLU 10 COUEE Of son snn eae t) on
Croditis allowed pursuant to § $3.1-187 for time spent in confinement.
Be CBSENO, wen senenrnn nn i o- Original Charge aan-nnn nnn
[ ] Not guilty [ ] Nolte prosequi
EJ Convicted of «oon swsmenniiinnncrmnnnnel [Relony [| Misdemeenor
[] State Code § ... wf ] Local Ordinance . : ~
ver... ae
[J Appeat noted (} Ceritied to Grand Juiy
{Jail etence of
ol 7
iminimurn confinement,
[ 1 Committed to the Departienit of Corrections £0 ewnacnevnrvwnnnenin
[ ] Committed to the Departinent of Fuvenite JUStC® £0F eomomnrnrnnennnesnnnnnn
[ ] Extradition walved, and Form DC-375 WAIVER OF EXTRADITION attached, Ifnot delivered
OUR ON nee 1 Bt ne ieee a
Credit i allowed pursuant to § $3.1-187 for time spent in confinement,
[ ] Civil Contempt} To be serve ] Released upon payment of §
saw hours to be served in jail ] of whi
[ ] Restiution orderod! $ sen
[J Othe ennennnetn
‘SPECIAL CONDITIONS: [ ] Weekend { ] Delayed confinement t0 begin 01 --cwuonsnnennmrsnnne
{ ] Work release [ ] Work releass (if eligible) [] Home-electtonic incarceration [ ] Drug testing ordered
L] Public Workforce Authorized
BAIL AMOUNT: $ a -{ ] I tensed or oxtfed to Croult Court [ ] Happesieg
(] Scoured [ ] Unsecured ["] Recognizance [ ] Held without ball [ ] No change ia existing bail amount
1 No change in existing bal coitions Ciret Court date and tt eens
ADDITIONAL BAIL CONDITIONS: Accased[] may Jmay no part te Commonwealth of Vig
(1 Bature Support Bond § svvowon{ ] Support Arearage Bor 8. ‘ must be posts
ii i conten fndinglrinaeptemp conviction, (Form
withthe Ce within tity G0) days of
I9L1822028. nner ia
FORM DOsseREVISED 7 eeJA040511-11-01
GUMONVEALTH OP VIGGRCA copy ~™
LYNCHBURG J & DR.- ADULT. _ Juvenile and Domestic Relations District Court
909 COURT STREET MAIN LEVEL, LYNCHBURG, VA 24504_ (434) 455-2670
COMMONWEALTHOF VA ange MICHAEL LEE PERRY, It
ea DATE HEARING TE
18/2023 11:50AM CTRM:A
‘TO ANY AUTHORIZED OFFICER: I COMMAND YOU to summon the parties as designated below.
‘TO THE PERSON SUMMONED: | COMMAND YOU to appear before this Court atthe date, place and time specified inthis
‘Summons to respond tothe allegations in the attached documents in accordance withthe provisions of the Juvenile and Domestic
Relation District Court Law. Failure to appear at Court may subject you to contempt of court proceedings.
NOTE: READ THE NOTICE ABOUT RIGHT TO REPRESENTATION BY A LAWYER ON THE BACK OF THIS SUMMONS,
DOCUMENT(S) ATTACHED.
tion of Residual Parental Rights [__] Notice to Respondent in Enforcement Proceeding
‘Under Virginia Code § 20-146.29 ofthe Uniform
‘Child Custody Jurisdiction and Enforcement Act
[ ]PETITION [ ] Notice of re
(District Court Form DC-535)
[_ ] Notice of change in date andor time of hearing
[_ ] Notice to juvenile to show cause why the juvenile's driver's Virginia Code § 46,2-334.001
[Yon :
9/18/2023,
DaveisstED
RETURNS: Each person was served accontng to In, indicated below, unles not
Sane ad Aes
PRETRIAL SERVICES AGENCY
JON KERSEE DISABILITY
grcurais: || PERSONAL OR SUBSTITUTE ACCOMMODATIONS
ee SERVICE REQUIRE! br enantio
SONAL senvice Re aaeaeae
Being nab to make personal service, xcopy wae delivered
Inthe flowing rarer.
C1 Detivered to family member (eo temporary sojrner oF
‘2st age 16 oder at usa place of abode of pty
above ef ving ifermaton ots purport. List
pen and lain of elpon a party
Appropriate Drass Required in Courtroom. No
: see Shorts, Halter Tops, Tank Tops, Bare
Pome on font ar sth te: dct appears be Midrifis/Stomachs, Cut-Offs, T-Shirts, Hats, or
Soe (ocean euptten mean ene Bedroom Slippers. Cell Phones are not allowed
a jn the Courthouse. No Children Allowed in
Courtroom Unless Summoned to Appear.
fon,
FORNDC-SIOx GKONT) a7RIGHT TO REPRESENTATION BY A LAWYER Va Code § 16.1255
‘A lawyer may be appointed only in those cases described below.
NOTE: In determining whether a person is entitled to a court-appointed lawyer or ifa parent is financially abe to pay for
a lawyer, such adult and, if applicable, the parents of a juvenile shall complete a financial ststement form and sign a
statement of indigency,
The Court shall appoint a lawyer as guardian ad litem to represent any child alleged to be abused or neglected, ot
fora child who is the subject of an entrustment agreement or ofa petition seeking termination of residual parental rights
consent to a parental placement adoption, or who is before the Court when the parent desires for good eause to be
relieved of care and custody.
Prior to a detention hearing, the Court shall appoint a lawyer to represent the child unless a lawyer has been
retained and appears on the behalf of the child, and the child's indigence shall be presumed for the purposes of this
appointment only. Prior to any subsequent hearing by the Court of any case involving a child alleged to be in need of
services or supervision or alleged to be delinquent, such child has a right to be represented by a lawyer of the child's own
choice, or, ifthe Court determines that the child is indigent within the contemplation of the law and his or her parents,
‘guardian, legal custodian, or other person standing in loco parentis does not retain a lawyer for the child, the Court shall
appoint a lawyer to represent the child unless an appropriate waiver of counsel has been accepted by the Court. A child
who is alleged to have committed an offense that would be a felony if committed by an adult may not waive the right to
counsel prior to consulting an attomey and the court determining that the waiver of the right to counsel is free and
voluntary,
If the Court appoints a lawyer to represent the child, and finds that the parents are financially able to pay for the
lawyer and refuse to do so, the Court shall assess the costs of legal services against the parents. The child in some cases
may waive his right to be represented by a lawyer, ifthe Court finds that the child and parents, guardian, legal custodian,
(or other person standing in /oco parentis, consent in writing and the interests of such individuals are not adverse,
Prior to a hearing by the Court of any case involving an adult who is charged with abuse or neglect of a child or at
‘hich a parent could be subjected tothe loss of residual parental rights, and prior to the adjudicatory hearing of a petition
in which a child is alleged to be abused or neglected or at risk of abuse or noglect, the child’s parent or guardian or the
adult has a right to representation by lawyer of his own choice, and if such parent, guardian or adult is indigent, the
Court shall appoint a lawyer to represent him, and such parent, guardian or other adult may waive the right to
representation by a lawyer. In addition, the Court shall consider appointing a lawyer to represent the parent or guardian of
4 child who is the subject ofa foster care plan, foster care review or permanency planning hearing.
In all other cases, the Court in its discretion may appoint a lawyer or guardian ad litem to represent the interest of
the child or the parent or guardian, However, if a child’s custody is in dispute and the parents ot other partes seeking
custody are represented by lawyers, no lawyer will be appointed to represent the child unless the judge finds that the
child’s interests are not otherwise adequately represented.
NOTICE REGARDING GUARDIANS AD LITEM: If you are a parent of a child for whom a guardian ad litem is
appointed in a proceeding or a party with a legitimate interest in such child, you will be required to reimburse the
Commonwealth for the cost of the guardian ad litem, The amount you are required to pay may not exceed the amount
awarded to the guardian ad litem by the court and it may be reduced or eliminated if the court determines that you are
indigent or otherwise unable to pay.
NOTICE REGARDING REMOVAL HEARINGS ONLY: If you are a parent, guardian, legal custodian or other
person standing in loco patentis to a child and if the child isthe subject of a removal proceeding at which the cour will
consider whether to remove the child from his/her home and the court determines that the child should be removed from
hishher home, the court will consider whether you should be required to pay child support for this child,
NOTICE REGARDING JUVENILE COMMITMENT: If you are « parent or other person legally obtigated to care for
and support a juvenile who is the subject of a delinquency proceeding, you may be required to pay a reasonable sum for
{reatment ofthe juvenite if the jvenile is committed to the Department of Juvenile Justice ot toa secure local facility,
| certify that I mailed a copy of this document tothe parties named on the front atthe address shown on the front on:
oma DOstex REVERSE) Er2ORDER FOR CONTINUED CUSTODY
Commonwealth of Virginia
‘ [x] Juvenile & Domestic Relations District Court
AOR SEH ss Pa arm De Rs i
Sg ee
920/201
SATB oF it
CHARGED UNDER: [x] State [ ] Local Ordinance
‘Hearing Date and Tim
CHARGE(S):
CERMEA
Otfense Tracking | Offense | Virginia Crime Code 0 Section
Number Date _(For Aciministrative Use Only) oeeem hens
BND-9975.59 192-123 SAQAOS-TLOT
SearAodnstitte | 08/29/2023 | oS ASFA
Desription:
Deseriptiont
Daseripton
Deseripton:
T
Deseion:
{[ ] Addendum listing additional charges is attached and incorporated.
Public Workforce [ ] Authorized [ ] Not Authorized
[1] Secured Bond [ ] UnseouredBond _[ ] Recognizance
[ ] Custody and Supervision of Pretrial Services Agency
[] Third-Party Custody and Supervision
x] No Change in Existing Amount ofBond [ ] Amend Bond to $ :
(] Held Without Bail [x] No change in Existing Bail Conditions
Accused [ ] may [ ] may not leave the Commonwealth of Virginia { ] may { } miay not leave
BAIL: $ ..
‘Additional Conditions of Bai
‘The Accused must
[1 Submit to Drug/Alcohol Screening [ } Submit fo Drug/Alcohol Testing [ } Comply with a CuriOw Of cccnnennenen
[} Avoid All Contact with
[ ] Refrain ftom Possess
Firearm, Destructive Device, Dangerous Weapon.
[ } Refrain from Excessive Use of Aleoho! (J Refrain from Use of Illegal Drugs/Controlied Substances
‘not Preseribed by a Health Care Provider
[1] Maintain or Seek Employment [J Maintain or Commence Education
[] The Accused is assigned to home-electronio incarceration by Budge
] The Accused is to be monitored by a GPS/other tracking device
{J The Accused i to be released only tothe custody of [ J authorized feility representative OR [ ] the following person
TO THE SHERIFR, FAIL OFFICER OR CORRECHONAL OREICHC
Hold the accused in custody pending the hearing date and convey the 0 thatthe accused will
be present in court atthe bearing date and time, unless otherwise ordred by tl i
voruncsss 072s PAGE _1 of,CHECKLIST FOR BAIL DETERMINATIONS
Comore of Vig
by bh CartenbsT
Namo of th Accused PERRY, MICHAEL LE; I.
Nature and Circumstances of the Offense Ban .
‘Weight ofthe Bvidence
‘Was a firearm allegedly used in the offense: [No [x] Yes
Carrenily on probation or pele? [X]No [1 Yes
Prior criminal record CHG disposition not ectransporting a firearm
{1 Te seoued bond provision in Vega Cade § 19.123 appli [ani waived wilh he concuene of he storey of he
‘Commonweatth a the attomey forthe county, city or town,
Prior charges of filing to appear HONE
‘sth perion ely o obstruct or attempt to obstuct justice or thee, injore or inimidte or atempt to thresten nor o inti
‘prospective witness, juror, vet, or family arhousshold member as defined in Viginia Code § 16.1-2282
EJNo [1] ¥es
tgpbersumt 0 Virginia Code § 19.2-130.1, terns of bal set in accordance with the order of a ‘court thet issued a capias,
Other infomation
RECEIVED/FILED
SEP 15 2023
LYNCHBURG J&DR COURT
Bail se ..Va Aland,
‘Special instructions or conditionsLynchburg Community Corrections € Pretrial Services Agency
925 Church Street + Lynchburg « Virginia * 24504
P 434.455.3750 » F 434-847-1037, August 30, 2023
To: Lynchburg Juvenile and Domestic Relations Court RECEIVED FILE
RE: IOLATION OF PRETRIAL RELEASE CONDITIONS AUS 3.0 ano
Defendant: Perry, Michael Lee; il CYNCHBURG JéDR COURT
Bond: {R-Secured [)- unsecured Amount: $4,000
Charges: 10 Theft: Obtain Goods/Services with Intent to Defraud <$4,000, Protective Order: Violation
Case Number: JA040541-4.1-00, 1A040511-12.00
Date Placed: Or/to/23 _ Placed By: Lynchburg Magistrate
Next Court Date: 44/43/23 at 9:00 AM.
‘Type of Violation:
| Failure to Report {3 Now Arrest ( -Falsification of information
1 - Positive Aloohol/Drug Test C-Failure to Appear ‘[X- Other- Violate Release Conditions: Contact with Victim
ppoofies: Michael Lee Porry Il was placed into Pretrial Supervision on 07/40/23 for the above-stated charges. On 08/29/23
Mr. Perry was arrested on charges of; Murder: 2x Degree (offense date 08/22/23) and Dead Body. Disposo on Private
Property (offense date 08/22/23). He is currently being held in the Lynchburg Adutt Detantion Contor without bond and Is
next scheduled to appear in the Amherst JDR Court on 08/30/23, The vietim of the new charges is the samo vietim for which
he is on supervision. Obtaining new charges and having contact with Avtiel Hooks are violations of his current Pretrial
conditions. Itis therefore requested that the Court issue a caplas, revoking Mr. Perry's bond, and that he be removed from
further Pretriat supervision.
a\?
Recommendation: : Last Known Phi & Address by
(1 Continue under Pretrial Supervision 2423 Carroll Avenue lao,
(- Request a Show Cause Lynchburg, VA 24501
~ Request Capias Phone #: (434)333-9756 Coy”
EXl- Remove from Pretrial Services & 2g,
‘Submitted by: (CONFIDENTIAL —turther disclogure prohibited by i lant 7
ul
Sow Reese” $5 229706,0.1-177.1 & 192-1524:201 theCodeo! Vighat
Jon Keesee .
Pretrial Officer
CC: Lynchburg Commonwealth Attorney's Office
‘COURT'S ORDER: ()- Show Cause ()~ Caplas ()- Remove from Pratal Supervision ()- Continue Sipentsion
Revised 05/00/18COMMITMENT ORDER
Commonwealth of Virginia
AccusED: PERRY..MICHABL [BEI Jurisdiction: Lynchburg.
AME CAST aS,
[_ ] Genecat District Court (Traffic)
[J Generat District Court (Criminal)
[ ] Genera District Cou (Cut)
EX] Juvenile & Domestic Relations Distict Court
[ J cirait court
SEX: STATUS: (CHARGED UNDER:
Kx] Mato [ Jremse [ ] Adutt [ ] Juvenite [x] stete [ ] Loca! Ordinance
‘CHARGE(S):
[_ OtenseTrcking T onanse paw igi ie Cota Code Section CaeNanber |
Jesasaodosii1io: 6.2923 [iaND-9975-89 192-123(6) {807A0405111101
|CAPIAS FTA/CCCA,
RECEIVED/FILE!
SEP 15 2023
LYNCHBURG J&DR COUR}
[J Addendum sing sditional charges is attached and incorporated,
BAIL: $1,000.00. news [X] Seoured [ ] Uneoued [ ] Reagnizance
C ) Beta without baat [ |] No additional bail required
C] Release by Judicial Officer to custody of responsibie person or when accused is
20 longer intoxicated
Aceased [] may [X] may not depart the Commonwealth, of Virginia, [X] Other conditions of bail on page two.
TENOT celeased on bail,
‘Court appearance location, dete and time: Ieteased on bail,
[ JGENERAL pistricr x] Jer [ JoIRCUIT Hearing date and time:
Snte%s va0am.
Ct] See acces umabe or unwilling to participa in «til bering J order accused to be rete to Judicial Oct for bail
determination,
[ ] Currently serving sentence
EX] Charges pending in AMHERST J
‘lave held in custody (if other than facility serving
‘TO THE SHERIFF, JAIL OFFICER OR CORRECT,
the Cows, unless otherwise released,
9214/2003 12:23 PM.
aE OFFALY
to take custody of and convey the accused 10
Received: ...
FORNMDC.s2 (MASTER, 7AGE ONE OF TWO) 0500RECOGNIZANCE
Ve. Code $§ 91-185, 9.-1858, 192-123, 192-443, 192.253
Mailing address; [X] Same as above OR [unm
oecfy that this document contains my current mailing adress.
‘CHARGES():
fens Tracking | Virginia Crime Cod Section
Number GucRditratve Us O89) one UBi
[ésonma3c0009055 [ERD-2507-MI 163.1863 7
Danio TD-THER TORN GOODSSERICE WINTNT DEAD Ag]
esoma7300000091 PRI-SOV7Mi 161-2532
‘ssindens PROTECTIVE ORDER: VIOLATION aE
Desens
Dospan ;
Ae
ANCHOR ERE STE
[ 1 Atco ies tence inaarho en core :
2 TEND a yet sEmyjrelease from custody, by signing this form, promise to apgefivin court onthe date and time
noted above. fh dato, tine or place ls changed for any reason by any cout or judge elo promise a spat asso diected. T
tunderatand thet 1[ ] may [ ] may not leave the Commonwealth of Virginia until my case, and any:
further agree to keep the peace and be of good behavior and agree to the conditions listed below.
Be of good behavior in all respects; Appear at all scheduled court hearings; Obey all terms.of any court.
onder, 48; RECEIVEDIFILED
Be under custody and supervision ofPrtria! Services and abo by all conditions they set. Report to
Lynchburg Petal Services on 7/102023 et 10:00AM. Address is 925 Church St, 2nd Flor, The
sumber is 434-435-3750,
and fingerprints taken prior to yout release if the arresting officer requires you to do so.
aay
1, THE DEFENDANT, UNDERSTAND THAT; (1) 3f fll to oboy the conditions, I may be. and, bail may bo revoked;
(2 if Lal to appear, the court may ty and convict me in my absence; (3) if fall to appear in the Ciroult Court on a misdemeanor charge,
1 give up my right to ajar trial; (4) fllure to eppoar isa soparato crime; (5) Imust promptly notty.iHé,churt of any change in my
‘mailing address or where Llive while this case is pending, ; ae
ome Dose oxasTn,PAcE.__1Lor_2y07n9
cube @sosn300000312.*(9) Commonwealth of Virginia oa
ul.
BOND AS CONDITION OF RECOGNIZANCE: ‘By signing this bond, the defendant and each person signing as surety agree that
thy and thei and essgn owe te sum of§ $1000.00. aun tothe omy or ty in which thats oer,
‘This debt is; [ ] UNSECURED pq SECURED BY [ ] Cash [ } Surety Bail Bondsman [x] Property Bail Bondsman [ ] Other Solvent
Sarety(ies) whose ability to pay this debt is measured by the value of reel or personal property which they,own and who further swear or
. ae lions aginst the property euch as meigeges, paid jugaers ed
ma Gefendant and each person wo signs the bond esa surety give up any homestead excmptiongs tothe debt ofthis bond and
Understand that the court may force the sale of ANY property owned by tho defendant or any surety to pay the debt ifthe dofeedant fate
16 dba al ofthe teas and conditions of the recognizance. Each person who signs this bond promss fe the tle and posssson of
al property used to mensuro the ably to pay the debt of thls bord in hs or her name and not use sich piney as collateral for any lose
or debt to alow liens agsint euch property which would prevent the prymont ofthe debt ofthe bond, ‘héverms and conditions of fos
eoognizance are incorperated by reference, and exch person who sign the form agrees to obey al of thé isms and conditions ow bot
sites of thls orm. Ifthe defendant obeys all ofthe conditions listed in the recognizance, the debt ofthis Woh fe void, Ifthe cofencent
Bs Obey the condition of epearance ofthe recognizance te people who signed the bond may be sedired to pay the amount of the
bond,
Vora woara OA (sary
BAIL BONDSMAN INFORMATION
ii ie
~AEEORDARLE. BAIL, BONDING,
PYA'HUNTER GDAWSON
REREAD
4 ‘ABA ARQAAG csi
® oom SURETY (IES) INFORMATION
{{ J check if applicable) Thé defendant is released into the custody of the porson/organization named bgfoy upon completion | of this part:
By signing this par, the enstodinn named below agrees to take custody of the defendant and see that ‘the defendant obeys the conditions
sled shove. Ifthe defendant disappears or doesnot obey evry condition, tho easton promot tonothy he eourt a onoe
‘aR
1 his ecogaeanes was ken by amine porto the Sat appari ofthe defeat before jl
RIGHT TO APPEAL: as
‘You have he rgh to appeal be mount ofthis ond. You sho Baw the ight to appeal any condition of eae, Jf you want to appeal,
contact a lawyer or the court listed on the other sido of this form. :
ADMITTANCE TO RAIL: After I explained the conditions and wernigs
‘comtined inthis document, the defendant and esch person slanting as serety
‘swore orefirmed to Tl the recognizance and, if any, the bond, Toner the
sbsteD
cava 7
ce: Wallles Box
aniseCase No(s).
Offense Tracking Number(s):
Additional Conditions of Bail:
‘The Accused must
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01
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0
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Submit to Drug/Alcohol Screening
‘Submit to Drug/Alcohol Testing
Comply with a Curfew of.
Avoid All Contact with...
Roftain from Possessing Firearm, Destructive Device, Dangerous Weapon
Refrain from Exccssive Use of Alcotol
‘Refrain from Use of Iilegal Drugs/Controlled Substances not Prescribed by a Health Care Provider
‘Maintain or Seek Employment
‘Maintain or Commence Education
‘The Accused is assigned to home-cloctronio incarceration
‘The Accused is to be monitored by a GPS/other ‘tracking device
‘The Acousedis to accompany the arresting officer to te jurisdiction's fingecprnting facility and submit to having his photograph
‘snd fingerprints tzken prior to release.
Other: Be of good behavior in all respects; Appear at all scheduled court hearings; Obey all terms of any
court order,
CBR 6802300012618
FORM DO-52 (MASTER, PAGE TWO OP TWO) 0719 PAGE_2_of 2FINANCIAL STATEMENT ~ ELIGIBILITY DETERMINATION Case No.
FOR INDIGENT DEFENSE SERVICES ‘Commonwealth of Virginis va. cope 192139
PRESUMPTIVE ELIGIBILITY c
Tourrently receive the following type(s) of public assistance in... erate
° can
‘ens soon [J Medicaid ] Supplemental Security Income $ ..
‘SNAP (food stamps) $..
(.) Other (6pecify type and amount)...
[1 Teurrently do not receive public assistance,
‘Names and address of employer(s) for defendant and spouse:
Self. a “
Spouse (not applicable if alleged victim)
NET INCOME:
Pay period (weekly, every second week, twice monthly, monthly).
Naot take home pay (salary/wages, minus deductions required by law)
(Other income sources (please specify)
Were you employed atthe time of your arrest? [ ] yes [ } 0
tyes, my net take home pay was [ J pec week [ ]month
1fno, eagth of time since last employed?
Total wages carned last celendar year? i Senta
TOTAL INCOME, +.
ASSETS:
Cash on hand... aaseaaaa
Bank Accounts at...
Any other assets: (please specify)
witha
Male Of an
Real estate —$ =
with net
sisteigp 7 unenetaai
i ERRANDS
Motor witht
Vehicles valuzof x
Other Personal Property: (describe) .. couerusnoney
i B
“wine Number in household defendent has financial responsibility for, including defendant
EXCEPTIONAL EXPENSES (Total Exooptional Expenses of Family)
‘Medical Expenses (ist only unusual and continuing expenses) 3
Court-ordered support payments/alimony So
] deducted from paycheck [ J not deducted from paycheck
Child-care payments (€g.dBy €818) erase sae ase
Other (esCtB6): een ey }
: mic phe a
cour umsonty
‘Vhs statement is made under oath. Any false statement may TOTAL EXPENSES 5 - c
constitute a violation of law under Virginia Code § 192-161 COLUMN “A” plus COLUMN “B” mines
and be subject to criminal penalty, including incarceration, COLUMN “C” equals availabie funds =
Thereby state that the above information is t to the best of owledge.
Nae of defen peo pi) “Beccy, chaed Lee Tl]
9ts-f23.
FoR enBRavSED Ist eases)