State of Minnesota County Judicial District: Court File Number: Case Type: District Court Criminal State of Minnesota, Plaintiff vs. , Defendant I understand: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. I am charged with committing the offense(s) described in the complaint, citation, or ticket. The maximum sentence for a gross misdemeanor offense is a fine of $3,000 and applicable surcharges, one year in jail, or both. I have the right to be represented by an attorney at all times, including police line-up or during police questioning. An attorney will be appointed to represent me if I cannot afford to pay for an attorney. I do not have to say anything about the case. I do not have to answer questions from anyone about the case. Anything I say may be used against me in Court. I can speak to an attorney before my next Court appearance, and I will be given enough time before my next Court date to obtain an attorney. I can have a jury trial or a trial by a judge without a jury. I can tell the judge today what I think should be done about bail or my release from custody. I can be charged with a crime if I fail to appear in Court when I am told or notified of a Court date, and the punishment for failure to appear can include jail, a fine, or both. I wish to (check one): represent myself without an attorney. request a court-appointed attorney and have completed a form regarding my income, property, and expenses. request a continuance for more time to consult my own attorney. I have (check one): been booked and fingerprinted on this offense. not been booked and fingerprinted on this offense. Gross Misdemeanor DUI Statement of Rights 12. Dated: Your attorney: Street Address: City/State/Zip: Telephone: ( ) E-Mail address: CRM203 State ENG Rev 7/15-R Signature Your Name: Street Address: City/State/Zip: Telephone: ( ) E-mail address: www.mncourts.gov/forms Date of Birth Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com