IN THE CRIMINAL COURT OF WILLIAMSON COUNTY, TENNESSEE STATE OF TENNESSEE vs. CASE NO. ___________________ _____________________________ DEFENDANT PETITION FOR WAIVER OF TRIAL BY JURY AND REQUEST FOR ACCEPTANCE OF PLEA OF GUILTY My true name is ________________________________________________and my attorney is______________________________________. I have received a copy of the indictment, discussed it with my attorney and understand the nature of the charges against me. I have told my attorney the facts and circumstances concerning the accusation against me and have discussed with my attorney any defenses that could be raised on my behalf. My attorney has further advised me as to the punishment provided by law for the offense charged against me in the indictment and the offense to which I seek to plead guilty by this petition. My sentence on a plea of guilty will be set out in the attached negotiated plea agreement or agreements if I am pleading to more than one count of the indictment. I understand that I have the right to plead not guilty to any offense of which I have been charged and that if I choose to plead not guilty I have a right to a speedy and public trial by jury; that at a trial I have the right to the assistance of counsel, the right to confront and cross-examine witnesses testifying against me, the right to use the subpoena process of the court to compel the production of any evidence, the right not to be compelled to testify or incriminate myself, and the right to have a jury impose any fine in excess of $50.00. I further understand that if I choose to have a trial and am convicted, I have the right to appeal that conviction to the Court of Criminal Appeals of the State of Tennessee and the right to the assistance of counsel in obtaining a review of my conviction by the appellate court. I do hereby waive my right to a trial by jury and understand that by so doing I am giving up all the above rights. I further understand that in accepting this plea of guilty, the court may ask me questions and require that I answer under oath, on the record, with the assistance of my attorney, and that if I am not truthful in my responses, my answers may later be used against me in a prosecution for perjury or the making of a false statement. I am aware that the judgment of conviction which will result from my plea of guilty may be used to enhance the punishment for subsequent offenses. I do hereby request that my plea of guilty to the charges set forth in the attached negotiated plea agreement(s) be accepted by the court and I submit my case to the trial judge for decision both as to my guilt and the punishment to be imposed on me. I certify that I am not under the influence of alcohol, narcotics, drugs or any other mind altering substances, that I fully understand the nature of my actions here today, and that my actions are voluntary and not the result of force, threats or promises of any nature. ___________________ Date _____________________________________ Defendant APPROVED: _________________________________ Attorney for Defendant _________________________________ District Attorney General American LegalNet, Inc. www.USCourtForms.com