State of Alaska

PAROLE VIOLATION REPORT #

Name: ,

Alaska O/L #:

Date of Birth:

Warrant #: - -

Offender #:

Criminal Case #(s):

Offense(s):

Sentence(s):

Date(s) of judgment or revocation:

Supervision Type:	Parole Date:	Current Parole Expiration Date:

I request an arrest warrant be issued.

I request a summons be issued.

arrested the individual without a warrant on due to the following specific facts which demonstrate exigent circumstances:

Submitted by:

, Parole Officer	Date
, Parole Supervisor	Date

Certificate of Service I certify a copy of the charges in this report was given to _______________________________ at _____________________________ on the ______ day of _____________________, 2017.	Parole Officer Printed Name

Technical Violation	Non-Technical Violation	Both

PACE Technical Violation	PACE New Criminal Offense	PACE Both

CHARGES:

On or about , violated Mandatory Parole condition # (condition), by .

SUPPORTING EVIDENCE:

PRIOR INTERVENTIONS:

PRELIMINARY HEARING:

LEGAL/COURT ACTION SINCE RELEASE TO SUPERVISION:

RISK FACTORS IDENTIFIED BY ASSESSMENT TOOL:

[Describe briefly the risk factors of the assessment here, including the date of assessment and risk level.]

OFFENDER MANAGEMENT PLAN:

[Describe briefly the overall plan and recommended programming to include what has already been completed or is pending.]

EVALUATION:

RECOMMENDATION:

Final report submitted by:

, Parole Officer	Date
, Parole Supervisor	Date