FORM 81A-I
rule 81A.41(3)

IJIS ID: [IJIS ID]							   File No: [File number]
NOTICE OF SUSPENDED SENTENCE OF IMPRISONMENT 
IF SECURITY IS NOT REQUIRED
[Offender's full name], [male / female / other], [date of birth]
of c/– [Darwin Correctional Centre / Alice Springs Correctional Centre] AT [Darwin / Alice Springs] in the Northern Territory

was found guilty by this Honourable Supreme Court of the Northern Territory at [place] which recorded a conviction for the offences shown below and on [date] it imposed the sentences shown opposite each offence:
SENTENCE
CASE & OFFENCE NOS	
OFFENCE	
SENTENCE	
File Number	[No.]	[offence]	[sentence]	

The total effective period of imprisonment is [number] YEAR(S) and [number] MONTHS to commence on [date].
And it was further ordered that:
1.	[state order, for example, the offender is to be released on [date] and that [where applicable: the whole of the sentence be held in suspense from the making of this order / the sentence be held in suspense for [period] from the making of this order].] 

2.	[state order, for example, that pursuant to section 40(6) of the Sentencing Act 1995, the period of [period] from the making of this order is the period during which the defendant must not commit another offence punishable by imprisonment if the defendant is to avoid being dealt with under section 43 of the Sentencing Act 1995.
CONDITIONS:
[state conditions]
I acknowledge that the conditions have been explained to me and I understand them and consent to them.
Offender
Signed by the offender at [Darwin / Alice Springs] on [date].
DEPUTY SHERIFF