Republic of the Philippines

Regional Trial Court

9999th Judicial Region
Branch XX
Municipality/City, Province

PEOPLE OF THE PHILIPPINES, Criminal Case No. ABCD-1234

Plaintiff,

-versus- For: ILLEGAL POSSESSION OF

DANGEROUS DRUGS
(VIOL. OF SEC. 11, RA 9165)

Mickey Mouse, Donald Duck, Goofy

Accused.

APPLICATION FOR PROBATION

The undersigned, Mickey Mouse, by and through counsel,

hereby applies for probation under the provisions of Presidential
Decree No. 968, as amended by R.A. 10707 and declares:

1. THAT he is XX years old, single, and a resident of Barangay,

Municipality, Province;
2. THAT he has been convicted for the crime of Violation of Sec
Violation of Sec. 12, of Republic Act 9165 sentenced to
serve a term of imprisonment of not more SIX (6) years of
prision correccional;
3. THAT he has not begun to serve the term of imprisonment
imposed on him;
4. THAT the crime for which he has been convicted is not an
offense against the security of the State;
5. THAT he has not previously been convicted by final judgment
of any offense punished by imprisonment of not less than six
(6) months and one (1) day and/or a fine of more than one
thousand pesos (P1,000.00) pesos; and
6. THAT he has not been once on probation under the provision of
Presidential Decree No. 968, as amended by R.A. 10707.
AAA Law Office
Counsel for the Accused
Municipality, Province by: Atty. Walter Elias Disney
Roll of Attorneys No. 65013
IBP No. 123456789
PTR No. ABCD
MCLE Compliance No. VI - 0099999

At my instance:

MICKY MOUSE
Municipality, Province

COPY FURNISHED:

Pros. Bugs Bunny

Office of the Provincial Prosecutor
Municipality, Province

PAROLE AND PROBATION OFFICE

Municipality, Province