intra state transfer application

INDIANA INTRASTATE APPLICATION FOR PROBATION TRANSFER
(Receiving Court)*
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Social Security Number*
Cause Number*
Offense*
Supervision Start Date*

MonthDayYear
Date
Supervision End Date*

MonthDayYear
Date
County you want to transfer to:*
Address where you reside/will reside in the other county:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name*

First NameLast Name
I am applying for transfer of my probation from Noble County, Indiana, to another county in Indiana. I understand that my supervision in another county may be different than the supervision I would be subject to in Noble County. I agree to accept any difference tha tmay exist because I believe that transferring my probation will improve my changes for making a good adjustment in the community.

If I am allowed to transfer my supervision to the listed county, I will reside at the address provided on this form, comply with the terms and conditions of my supervision that have been placed on meby the sentencin gcourt, or that will be placed on me by the receiving county. I understand that if I fail to comply with all the terms and conditions that the sentencing court or receiving court or both, placed on me, that it may be considered a violation of my probation and I may be returned to the sending county. I agree that I may be held in the receiving county's jail concerning any violation of my probation conditions. I agree to be subject to any administrative sanctions in the receiving county for technical violations of my probation conditions if authorized by the sentencing court. I agree that the fact-finding hearing and dispositional proceedings for any violations of my probation conditions may be held in the receiving court if authorized by the sentencing court.
Offender's signature*

Clear
Date*

MonthDayYear
Date
Your Probation Officer's Name
Date

MonthDayYear
Date
Should be Empty: