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8.WAIVER OF RIGHTS REQUIREDIf an individual desires to be considered for entry into the program, upon applying for entry into the programand prior to any further processing of such application, the applicant must voluntarily, knowingly andintelligently execute a document to be provided that he/she has been fully advised of his/her constitutionalrights, including, but not limited to the right to remain silent regarding the facts and circumstances related tothe offense for which the applicant has been arrested/charged and that the applicant has waived the right to aspeedy trial on the said offense for the period of time required for a final decision regarding the application. Inthe event the applicant is accepted into the program, the applicant shall waive his/her right to a speedy trialuntil the applicant is terminated from the program, whether satisfactorily or unsatisfactorily. If at the time ofapplying for entry into the program the applicant has an attorney representing him/her in connection with theoffense for which he/she was arrested/charged, said attorney shall be required to confirm that he/she has alsoadvised the applicant of these same rights.9.SPECIAL CONDITIONS TO ENTRYa.If, in the opinion of the P.T.I. Program Staff Supervisors, theapplicant is in need of special counseling, the applicant must agreeto participate in such counseling programs as a specific conditionof his/her satisfactory completion of the program.b.The P.T.I. Program Staff Supervisors may require the applicant toattend programs designed to provide self-improvement educationor may require the applicant to perform up to forty (40) hours ofcommunity service as a specific condition of his/her satisfactorycompletion of the program. If the applicant is not willing to acceptsuch a condition, the applicant will not be accepted into theprogram.3 of 3PTI GUIDELINES 07-26-2021

PTIDOCUMENT CHECKLIST:When submitting your application to the Pre-Trial Intervention office,please be sure to include the following:Deferred Prosecution Agreement, signed and notarized and mustincluded accurate amount of restitutionWaiver of Rights form, signed and notarizedCopy of Probable Cause AffidavitCopy of InformationP.T.I. Initial Data Sheet,Pre-Trial Interview Worksheet & Financial Affidavit,handwritten and completed by the defendant.****Each required document must be completed in its entirety (whereapplicable). Incomplete packets will be returned causing a delay in theprocessing of your client’s application.****Once completed, these original documents should be e-mailed to theSAO office at the below address:FelonyPTI@sao17.state.fl.usRevised 07-20-21

Revised 07-28-2021BROWARD COUNTY 17TH JUDICIAL CIRCUIT COURTPretrial Intervention ProgramDEFERRED PROSECUTION AGREEMENTIt being alleged in Information # that you committed an offense(Court Case#)(Defendant Name)against the State of Florida on or about the day of 20 , to wit:(Crime(s) Committed)Having been advised of your Constitutional Rights and it further appearing after an investigation of the offense and yourbackground that the interest of the State of Florida, and your interest, will best be served by entering into this Agreement.Therefore, Harold F. Pryor, State Attorney, in and for the Seventeenth Judicial Circuit, Broward County, Florida, agrees thatprosecution in this matter for said offense will be deferred for a period of one (1) year from this date, provided you abide bythe following conditions:1.You will live and remain at liberty without violating any law (Federal, State or Local). A conviction in a Courtof Law, would not be necessary, any criminal arrest could constitute a violation of your Pretrial InterventionAgreement.2.You will pay to the State of Florida, the amount of 50.00 per month toward the cost of your supervision,plus a four percent administrative processing fee in accordance with Florida Statutes 945.31 and 948.09,unless any such payments are specifically waived in compliance with Florida Statutes.3.You shall pay costs of prosecution in the amount of 250.00 within the first month of acceptance to the PTIProgram unless otherwise directed by your officer.4. You will attend school or work regularly at a lawful occupation. You agree that within thirty (30) days of enteringthe program, you will provide a payroll stub to verify employment. Notification to your employer will not formallybe made unless the case involves theft from an employer or employer notification is ordered as a special conditionby the prosecutor. You are not required to work during the period of time you are enrolled as a full-time student.5.You will not change your residence or employment without first procuring the consent of your PretrialIntervention (PTI) Officer.6.You will immediately inform your Pretrial Intervention Supervisor if you get arrested, or have any contactwith law enforcement.7.You will not travel outside of the county you reside in within the first six (6) months of entering the PTI Program,with the exception of travel for work, school or medical appointments within the tri-county areas of MiamiDade, Broward or Palm Beach counties. Any other travel must be approved by your supervising officer.8.You shall associate only with law abiding persons.9.You will make yourself available for the services of the Pretrial Intervention Program by reporting in personto your PTI Officer as directed.10. You will not use any intoxicants to excess, nor will you use any controlled substances. Any positive drug testwill result in your automatic dismissal from the program. You will submit to urinalysis, breathalyzer or bloodtests at any time requested by your officer or the professional staff of any treatment center where you arereceiving treatment, to determine possible use of alcohol, drugs or controlled substances. You shall berequired to pay for such tests.1 of 3

Page 2/Deferred Prosecution Agreement – con’t.RE: State v.(Defendant Name)Docket #:(Court Case #)11. You shall pay restitution in the amount of , plus a four (4) percent surcharge, jointlyand severally if applicable, per Florida Statute 945.31 within the first eight (8) months of PTI in equalmonthly installments as directed by your officer.12. You will truthfully answer all inquiries by your officer, agree that your officer may visit your home, employment,school, or elsewhere, without your prior approval, and will comply with all instructions your officer may give you.13. You will attend any alcohol, drug, psychological or other rehabilitative program directed by your PretrialIntervention Officer and if no such program is deemed necessary, you will enroll in and attend a selfimprovement class or program approved by your Pretrial Intervention Officer, or donate forty (40) hoursof your time to the community. You understand that you will be responsible for any fees or costs associatedwith treatment.14. You will neither possess, carry nor own any weapon or firearm.15. You will testify truthfully in the trial of the co-defendant(s) if so requested by the State Attorney’s Office.16. You will have no contact with the victim or return to the victim’s business or home.17. You will pay the Broward County Public Defender’s Application Fee of fifty (50) dollars, if you arerepresented by the Public Defender’s Office.18. You are not required to enter a plea of guilty to the charges to participate in PTI if you are supervised withinthe state of Florida by the Florida Department of Corrections. However, should you be permitted by PTI toreside out of state during the period of supervision, you must waive your right to trial and plead guilty to thecharges and have your sentencing deferred for a period of one year. Your supervision will be subject to theInterstate Compact for Adult Offender Supervision. Upon successful completion of the Program, asdetermined by the State Attorney’s Office, the State will agree to allow you to withdraw your previously enteredplea of guilty and the case will be dismissed. Should you fail to successfully complete the Program, asdetermined by the State Attorney’s Office, you agree that you will not be allowed to withdraw your plea ofguilty and you will be sentenced by the court.19. Special Conditions:The State Attorney may, during the period of Deferred Prosecution revoke or modify the conditions of your DeferredProsecution by:1. Changing the period of Deferred Prosecution.2. Prosecuting you for this offense if you violate any terms of this agreement.3. Voiding this agreement should it be determined that you have a prior record of adult criminal felony convictions.If you comply with these conditions during the period of Deferred Prosecution, the offense(s) for which you are placed in theprogram will be dismissed. You will have the opportunity to terminate PTI six (6) months early if restitution is paid and allspecial conditions have been completed and in accordance with this agreement.2 of 3

Page 3/Deferred Prosecution Agreement – con’t.RE: State v.(Defendant Name)Docket #:(Court Case #)Signing this Deferred Prosecution Agreement withdraws and/or waives your right to a speedy trial under the Constitutionand Laws of Florida and the United States of America in the cause of which prosecution is being deferred. Attached heretoand incorporated by reference is a Waiver of Rights document executed by and dated this day of ,20 , which is made part of this Agreement.Harold F. PryorState AttorneySigned By:Assistant State AttorneyDatePrint ASA Name:I hereby state that the above has been read and explained to me. I understand the conditions of my Deferred Prosecutionand agree that I will comply with same.Signed By:Print Defendant Name:Signed By:Print Defense Attorney Name:Witnessed by:Print Witness Name:3 of 3DateDateDate

WAIVER OF RIGHTSAs an applicant for entry into the Pretrial Intervention Program (PTI), I, do(Defendant’s Name)hereby affirm that I have consulted with my attorney, concerning this matter,and she/he has advised me of my Constitutional Rights, including, but not limited to my right to a speedy trial by juryand the right to remain silent regarding the facts and circumstances of the offense(s) with which I have been charged.Understanding these rights, I do hereby voluntarily waive the right to a speedy trial of the offense(s) with which I amcharged for the period of time required for a final decision regarding whether or not I will be accepted into the PretrialIntervention Program (PTI).Witness my hand and seal this day of A.D, 20Defendant’s SignatureSworn to and subscribed before me, this day of , 20Notary Public, State of Florida.My Commission Expires:I hereby confirm that, as the attorney of record for , I have advised my client ofhis/her Constitutional RightsDefense Attorney SignatureDateBROWARD COUNTY 17TH JUDICIAL CIRCUIT COURTRevised 07-20-2021

FELONY P.T.I. INITIAL DATA SHEETNOTE: Must apply within forty-five (45) days of arraignmentBe sure to e-mail the original hard copy to: FelonyPTI@sao17.state.fl.us Leave this box blank, for DOC USE DC#: PTIOFFICER:Include P/C, Copy of Information and complete below:DEFENDANT NAME:ADDRESS:TELEPHONE:DATE OF BIRTH:RACE:GENDER:SOCIAL SECURITY NUMBER:ARRESTING AGENCY:ARRESTING OFFICER:DATE OF ARRAIGNMENT:DATE OF ARREST:COURT CASE #:CHARGE(s):ASSISTANT PUBLIC DEFENDER or ATTORNEY:ATTORNEY TELEPHONE#:ASSISTANT STATE ATTORNEY NAME:JUDGE NAME:VICTIM’S INFORMATIONNAME:ADDRESS:TELEPHONE #:CO-DEFENDANT, IF ANY:REFERRAL DATE:Revised 07-20-21

PRETRIAL INTERVIEW WORKSHEET(to be completed by Defendant)Revised 07/20/2021Date:Name: Maiden Name:LastFirstMiddleAddress:Telephone: Work #:Age: Date of Birth: Race: Sex:Social Security Number:Birthplace: County of Residence:Are you a citizen of the United States? If no, what is your Citizenship?Weight: Height: Eye Color: Hair Color:Identification Marks (scars, tattoos, etc):Next of Kin:NameRelationshipAddressTelephone No.Your attorney’s name and telephone #:Driver’s License #: StateExpiration Date:Offense:What offense (s) have you been charged with:What are your feelings about the offense and your part in it? What effect, if any, has it had on you? Isthere anything you would like to do as a result?1 of 8

Juvenile: Have you ever been arrested as a Juvenile (age 17 or under)? If yes, please describe:Adult: Have you ever been arrested as an adult? If yes, please describe:SOCIAL HISTORYFamilyFather’s Name: Age: Occupation:Address:Mother’s Name: Age: Occupation:Address:Stepmother’s name: Age: Occupation:Stepfather’s name: Age: Occupation:Legal Guardian: Age: Occupation:Address: Phone #Quality of relationship (how well do you get along)?2 of 8

Siblings: Please list all brothers and sistersNameAgeAddressArrest record1.2.3.4.5.6.7.8.9.Please list schools attended:GradesDatesSchoolCity/StateMajor.Overall High School grade average: College average:Extracurricular activities in school (s)Have you had any vocational training? If so, what and in what area?What are your activities in your spare time?Do you smoke? (what, how much)Do you drink? (what, how much)Have you ever had any alcohol or drug counseling? If so, where and when?3 of 8

Have you ever used any form of drugs? If so, what kind and when?Are you currently using any drugs? If so, what kind?EMPLOYMENTBeginning with current employer, please list the nSalaryReason for LeavingWhat are your career goals, if any?If you are not currently working, who supports you?What is your gross monthly income from employment?Do you have income from any other sources? If so, what and how much?MONTHLY EXPENSESMortgage/Rent: Per Month Total owed:Car Payment: Per Month Total owed:Medical Bills: Per Month Total owed:Utilities: Per Month Total owed:Credit cards: Per Month Total owed:Other: Per Month Total owed:4 of 8

PERSONAL REFERENCESPlease list personal character referenced who are aware of the charges pending against you:NameAddressPhone Number1.2.3.4.5.Do you have any children? If so, please list as follows:NameDOBAddressMother’s NameFather’s Name.MILITARYHave you ever served in the military? If so, please list branch, date:If you are not currently in the military, have you registered with selective services?RESIDENTIAL HISTORYPlease list the following in reference to where you have lived:AGECITY/STATE.5 of 8

Do you currently live in a house or an apartment?How many bedrooms and bathrooms?Names of persons currently living with you:What is the condition of your residence?If restitution is due in this case, are you willing to make the necessary payments?In addition to supervision, one of the purposes of the pre-trial intervention program is to assist theparticipant in areas of need (emotional, psychological, employment, vocational, educational, etc.). Ifyou are accepted into this program, what do you feel are your needs and in which areas would youneed assistance?If you do not currently have your high school diploma or stable employment, you may be required toattend school or some sort of vocational training. Are you willing to do this voluntarily?Some participants in this program are required to contribute 40 (forty) hours of their time to thecommunity in the form of volunteer work. Are you willing to do this voluntarily?If you are accepted into this program and your pretrial intervention supervisor feels that you are inneed of some sort of counseling, are you willing to submit to this voluntarily?I hereby certify that the above information is true and correct to the best of my knowledge and belief.SignatureDate[ This area intentionally left blank]6 of 8

FINANCIAL AFFIDAVITState of Florida, County of BrowardBefore me, the undersigned authority, personally appeared ,who was sworn and says that the following statement of affiant’s employment, income, expenses,assets and liabilities is true:Occupation:Employed by:Address:Pay period:WeeklyRate of pay: per hourBi-weeklyorMonthly(circle one)salary ----------------------ITEM 1: INCOME (Averaged on a Monthly Basis)Average gross wage per month: Less deductions: Federal Income Tax Social Security Other Total deductions: Average net wage: Itemize other income: TOTAL NET -----------------------------ITEM 2: EXPENSES (Averaged on a Monthly Basis)Rent, house payments:Food:Clothing:Incidentals:Medical and ht, gas, telephone:Average child support paid:Other monthly bills: TOTAL EXPENSES: ----------------------SUMMARYNet income: Less expenses: ----------------------7 of 8

ITEM 3: ASSETSCash on hand or in banks: Stocks, bonds, notes: Real estate: Home Other Automobiles: Make Model Year Other personal property: Itemize other assets: TOTAL ASSESTS: -------ITEM 4: LIABILITIESCredit union: Real estate mortgages: Automobile loans: Other notes or loans: TOTAL LIABILITIES:Affiant’s signature(Print Affiant’s name)Sworn to and subscribed on this day of , 20Notary PublicMy commission expires8 of 8

BROWARD COUNTY 17 TH JUDICIAL CIRCUIT COURT PRE-TRIAL INTERVENTION GUIDELINES . The following sets forth revised policy, procedure and minimum eligibility requirements for obtaining State Attorney Office approval for the entry of an into the Felony Pre-Trial Intervention applicant Program supervised by the Department of Corrections in this circuit.