UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA UNITED STATES OF AMERICA v. Plaintiff, CASE NUMBER: WAIVER OF RIGHT TO COUNSEL Defendant. STATEMENT OF DEFENDANT , charged with a G felony G misdemeanor under the laws of the United I, States in the above-entitled case state that I have been duly advised by a United States Magistrate Judge/District Judge. (a) (b) of my right to be assisted and represented by an attorney at all times in these proceedings, and that an attorney would be appointed by the Court to represent me if I am financially unable to obtain an attorney if I so desire. I do not wish to have an attorney to consult with or represent me today, and I elect to proceed without an attorney. Read, agreed to, and signed this WITNESS: day of , . United States Magistrate Judge / District Judge Defendant CERTIFICATION BY MAGISTRATE JUDGE/DISTRICT JUDGE I certify that on the day of , , appearing before me in open court in the orally waived his right to be advised and represented above-entitled case, defendant by an attorney, after being fully advised by me of his/her right to an attorney appointed for him/her at United States Government expense if he/she were financially unable to obtain an attorney; and I further certify that such waiver appeared to me to be made, with full understanding, as to today's proceedings only, but defendant failed or refused to execute a written waiver. Dated: United States Magistrate Judge / District Judge CR-32 (06/07) WAIVER OF RIGHT TO COUNSEL American LegalNet, Inc. www.FormsWorkflow.com