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Pre-Sentence Investigation Report

  1. Van Buren County Probation Office

  2. Statement from the State of Michigan Department of Corrections

    Your case has been referred to the Probation Department for purposes of conducting a Pre-Sentence Investigation for the Court. Your cooperation is necessary as all the information provided to our department must be verified for accuracy.

    Please call (269) 657-8214 Monday - Friday between 8 AM and 5 PM to make an appointment with a pre-sentence investigator. You MUST call to set up your appointment within 24 hours of taking your plea.

    Please immediately fill out your pre-sentence questionnaire. You will be given instructions on how to return the questionnaire by the pre-sentence investigator.

    Failure to provide necessary information or failure to keep an appointment may result in the cancellation of your bond and may affect the outcome of your sentencing. You are expected to comply with the scheduling of your interview either electronically or in person. If a problem should arise, you must notify the Probation Department immediately.

    Please be prepared for your interview by collecting and providing any/all available documents listed below to the agent at the time of your interview.

    1. Driver's license, state identification or other valid picture identification
    2. Birth certificate
    3. Social Security card
    4. Pay stub or letter from your employer on letterhead
    5. Proof of monthly state assistance information (ADC, SSI, Etc.)
    6. Diploma or GED and/or current report card if enrolled in school
    7. Certificates or degrees earned from vocational school, trade school, or college
    8. Letters verifying dates of substance abuse/mental health counseling
    9. AA/NA attendance sheets
    10. Proof of military service
  3. Please fill out this form completely. Your submitted form will be sent to the Van Buren County Probation Office.

    The following information will be used in the Pre-Sentence Report. It is confidential. You must answer it accurately and completely, do not skip any sections or it may lengthen your interview time. If you do not know part of the information requested, fill in what you do know and you can bring the additional information with you at the time of the interview.

  4. US Citizen:
  5. Is your license valid?
  6. Do You Receive Mail Here?
  7. If not, provide your mailing address.
  8. PERSONAL INFORMATION
  9. Which are you:
  10. Do you wear:
  11. ID MARKS
  12. List any identifying scars, marks, tattoos, or amputations.
  13. CURRENT OR PREVIOUS PROBATION OR PAROLE
  14. Have you been on probation or parole in the past?
  15. Other criminal charges pending?
  16. YOUR FAMILY
  17. Father:
  18. Mother:
  19. Was either parent married before?
  20. If your parents are divorced, list the name of your step-father or step-mother.
  21. Step-father:
  22. Step-mother:
  23. List brothers and sisters or other significant family members:
  24. MARITAL HISTORY
  25. Are you:
  26. Your spouse:
  27. Marriage:
  28. Was she or were you ever pregnant? (As the case may be)
  29. Have you ever separated?
  30. Previous marriage(s):
  31. Was she or were you ever pregnant? (As the case may be)
  32. Have you ever separated?
  33. Was she or were you ever pregnant? (As the case may be)
  34. Have you ever separated?
  35. YOUR CHILDREN AND STEP-CHILDREN
  36. If you are male, is anyone currently pregnant by you?
  37. If you are female, are you pregnant?
  38. List sons and daughters (oldest first, also list step-children):
  39. Child is:
  40. Do you pay child support?
  41. Are you up to date?
  42. Child is:
  43. Do you pay child support?
  44. Are you up to date?
  45. Child is:
  46. Do you pay child support?
  47. Are you up to date?
  48. Child is:
  49. Do you pay child support?
  50. Are you up to date?
  51. Child is:
  52. Do you pay child support?
  53. Are you up to date?
  54. Child is:
  55. Do you pay child support?
  56. Are you up to date?
  57. EMPLOYMENT
  58. List your last five (5) jobs, beginning from present job:
  59. Type of employment:
  60. Type of employment:
  61. Type of employment:
  62. Type of employment:
  63. Type of employment:
  64. MILITARY
  65. Status:
  66. EDUCATION
  67. Did you ever skip school?
  68. Were you ever suspended?
  69. Were you ever expelled?
  70. SUBSTANCE ABUSE HISTORY
  71. Alcohol
  72. Marijuana
  73. Cocaine or Crack
  74. Amphetamines, Meth or Speed
  75. Barbiturates, Downers
  76. Hallucinogens, LSD, PCP, Mushrooms
  77. Heroin
  78. Prescription Drugs
  79. Other
  80. Do you feel you need treatment now?
  81. Have you ever injected drugs?
  82. Have you ever received drug or alcohol treatment in the past?
  83. SUBSTANCE ABUSE TREATMENT
  84. AA/NA/Self Help
  85. Completed?
  86. Assessment
  87. Completed?
  88. Detoxification
  89. Completed?
  90. Didactic
  91. Completed?
  92. Dual Diagnosis
  93. Completed?
  94. Educational
  95. Completed?
  96. Intensive Outpatient
  97. Completed?
  98. Methadone Detoxification
  99. Completed?
  100. Outpatient
  101. Completed?
  102. Residential
  103. Completed?
  104. HEALTH
  105. Do you have any serious mental health problems?
  106. Are you receiving disability benefits or workers' compensation?
  107. Are you currently taking prescription medications?
  108. Do you have health insurance or Medicaid?
  109. Have you ever been seen by a psychologist or psychiatrist?
  110. FINANCES
  111. Are you receiving public assistance? (ADC, etc.)
  112. Do you receive unemployment benefits?
  113. Do you have any savings?
  114. Do you own your own home?
  115. Are you:
  116. Do you live with your parents?
  117. Do you pay room & board?
  118. Per:
  119. Do you have a car/truck?
  120. Do you won any other motor vehicles, boats, motorcycles, RVs, etc.?
  121. CRIMINAL JUSTICE HISTORY
  122. Did you have an Attorney?
  123. Did you have an Attorney?
  124. Did you have an Attorney?
  125. Did you have an Attorney?
  126. Did you have an Attorney?
  127. Did you have an Attorney?
  128. Did you have an Attorney?
  129. Did you have an Attorney?
  130. GANG INVOVLEMENT
  131. Did you ever or do you currently belong to a gang?
  132. CURRENT OFFENSE
  133. Appointed or Retained?
  134. Leave This Blank:

  135. This field is not part of the form submission.