CONSENT TO FILING CRIMINAL CHARGE(S) COURT DIVISION Trial Court of Massachusetts District Court Department AFTER GUILTY FINDING OR VERDICT Mass. R. Crim. P. 28(e) DOCKET NO(s). CHARGE(s) TO BE FILED ...................................................................... ................................................................................................................ ..................................................................... ................................................................................................................ ..................................................................... ................................................................................................................ ..................................................................... ................................................................................................................ ..................................................................... DEFENDANT’S NAME ................................................................................................................ DEFENDANT’S CONSENT TO FILING I, the above-named defendant, freely and voluntarily consent to the filing of the charge(s) listed above on the conditions listed below. I have been informed in open court that: 1. I have a right to request and have the Court remove from the file and impose a sentence on any of these charges at any time (or if an end date is specified below, at any time until that date). 2. The prosecutor may request that the Court remove from the file and impose a sentence on any of these charges at any time (or if an end date is specified below, at any time until that date). The prosecutor may request this: • if a related conviction or sentence is reversed or vacated, or • if the prosecutor establishes by a preponderance of evidence that I committed a new criminal offense after these charges were filed, or • (Optional) if the prosecutor establishes by a preponderance of evidence that any of the following event(s) occurred: ____________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 3. I understand that if any of these charges is removed from the file, I may be sentenced on that charge and this may result in additional punishment in this case. 4. (Optional) These charges may not be removed from the file after (date) _______________________________. 5. Additional orders or information: ____________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ SIGNATURE OF INTERPRETER I have translated this document for the defendant. X DATE SIGNATURE OF DEFENDANT X COMMONWEALTH’S CONSENT TO FILING SIGNATURE OF JUDGE X (4/09) SIGNATURE OF PROSECUTOR X American LegalNet, Inc. www.FormsWorkFlow.com