CONDITIONAL PLEA FORM[For use with Rule 24.3(b), Arkansas Rules of Criminal Procedure]IN THE CIRCUIT COURT OF , ARKANSASDivisionNo. STATE OF ARKANSASv., DefendantCONDITIONAL PLEAI, (name of defendant), with the approval of thecourt, and the consent of the Prosecuting Attorney am entering a plea of [guilty] [no contest]to Count 1. Count 2. Count 3. I understand my plea is conditioned upon the filing of an appeal on the issueof (describe [motion to suppress seized evidence] [motion to suppresscustodial statement] [motion to dismiss a charge because not brought to trial within the time providedin Rule 28.1 (b) or (c)] or [challenge to the constitutionality of Ark. Code Ann. 247] uponwhich appeal will be based.)I understand that, if the judge approves my plea of [guilty] [no contest], a judgmentand sentence will be entered, and that I may appeal on the issue specified above in themanner provided by the rules of court.I understand that if I win my appeal on the issue specified above, that I maywithdraw my plea of [guilty] [no contest].I have read and understand the above. I have discussed the case and myconstitutional rights with my lawyer. I understand that by pleading [guilty] [no contest], ifmy plea is not later withdrawn, I will be giving up my right to a trial by jury, to confront,cross-examine, and compel the attendance of witnesses, and my privilege againstself-incrimination. I agree to enter my plea as indicated above on the terms and conditionsset forth herein. Date Defendant American LegalNet, Inc. www.FormsWorkFlow.com DEFENSE COUNSEL REVIEWI have reviewed this conditional plea with my client, and I have discussed with myclient its consequences. Defense Counsel DatePROSECUTOR APPROVALI have reviewed this conditional plea and consent to it. Prosecutor Attorney DateCOURT APPROVALThis Conditional Plea Agreement is approved, and I direct that it be entered ofrecord in this case.Circuit JudgeDateThis Conditional Plea Form shall accompany the Sentencing Order and bemade a part of the record in the case.I certify this is a true and correct record of this Court.Date: Circuit Clerk/Deputy: American LegalNet, Inc. www.FormsWorkFlow.com