(CR.040) Page 1 of 1 (E .D. 7 - 1 - 1 9 ) REQUEST FOR MENTAL HEALTH DIVERSION; ADVISAL AND WAIVER OF RIGHTS SUPERIOR COURT OF CALIFORNIA, COUNTY OF BUTTE RULES ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE: FAX NO. (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF BUTTE Butte County Courthouse One Court Street, Oroville, CA 95965 (530)532-7002 North Butte County Courthouse 1775 Concord Avenue, Chico, CA 95928 (530)532-7002 PLAINTIFF: PEOPLE OF THE STATE OF CALIFORNIA DEFENDANT: REQUEST FOR MENTAL HEALTH DIVERSION; ADVISAL AND WAIVER OF RIGHTS PC 247 1001.36 CASE NUMBER: Defendant: Initial each statement below. 1. I am the defendant in the above - captioned case, which charges the following law violation(s) for which I am requesting Mental Health Diversion (Pen. Code 247 1001.36): 2. I have been advised of, understand, and waive my right to a speedy trial in this ca se. 3. I understand that to be granted Mental Health Diversion, I am required to provide an assessment or other evidence confirming that I suffer from a mental disorder as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. I understand I am also required to comply with treatment for said mental disorder(s) as a condition of diversion. 4. I understand that the Mental Health Diversion program, if granted, will be no longer than two years and will include a court -ordered treatment program. 5. I understand that if accepted into the Mental Health Diversion program, fail ure to comply with the terms of the diversion program may result in reinstatement of criminal proceedings. 6. I understand that if I am arrested or charged with a new criminal offense while participating in the Mental Health Diversion program, criminal proceedings in this case may be reinstated and I may be found no longer eligible for Mental Health Diversion. 7. I understand that if I perform satisfactorily during the period of Mental Health Diversion, the Court will dismiss the criminal charges. I understand that upon successful completion of the Mental Health Diversion program, the arrest upon which the diversion was based shall be de emed to have never occurred, except as stated in statement 8, below. 8. I have been advised and understand that the arrest upon which the diversion was based may be disclosed by the Department of Justice to any peace officer application request and that, notwithstanding sub division (f), this section does not relieve the defendant of the obligation to disclose the arrest in response to any direct question contained in any questionnaire or application for a position as a peace officer, as defined in section 830. I declare under penalty of perjury under the laws of the State of California that I have read and understand each of the foregoing eight statements, and by initialing each statement I agree to their contents. Date: (TYPE OR PRINT NAME) (SIGNATURE OF DEFENDANT ) American LegalNet, Inc. www.FormsWorkFlow.com