FORM 81A-J
rule 81A.41(4)
File No: [File number] 
RECOGNISANCE RELEASE ORDER
[Offender's name in full]
of [address] 
came before this Honourable Supreme Court of the Northern Territory of Australia at [Darwin / Alice Springs] on [date] and was found guilty of the following offence(s): 
CASE & OFFENCE NOS	
OFFENCE	
File Number	[No]	[offence]	

The Court ordered that the offender be sentenced to [sentence] commencing on [date]. 

The Court ordered that the offender be released forthwith under paragraph 20(1)(b) of the Crimes Act 1914 upon the offender entering into a recognisance of $[amount] to comply with the following condition(s): 

1.	[state conditions] 
I acknowledge that the conditions have been explained to me and I understand them and consent to them.
Signature of offender
Signed by the offender at [Darwin / Alice Springs] on [date].
DEPUTY SHERIFF