IN THE CIRCUIT COURT OF FORREST COUNTY, MISSISSIPPI STATE OF MISSISSIPPI VERSUS ___________________________________ Race: Gender: SSN: DOB: __________________ __________________ __________________ __________________ CAUSE NO._______________ DEFENDANT PETITION TO ENTER PLEA OF GUILTY The defendant, after having been first duly sworn, on oath represents and states unto the Court as follows: 1. My full name is __________________________________________________ and I am also known as _____________________________________. I request that all proceedings against me be conducted in my true name. 2. I am represented by attorney _____________________________________. 3. In the above referenced indictment, I have been charged with committing the crime of ________________________________________________________. If convicted of that charge, I can be sentenced to serve a term of from _________ years (minimum) to _________ years (maximum) and/or be fined an amount from $________ (minimum) to $__________(maximum). I DESIRE TO PLEAD GUILTY TO THE CHARGE OR CHARGES OF: ________________________________________________________________________ AND REQUEST THE COURT TO ACCEPT MY PLEA OF GUILTY TO THIS CHARGE OR CHARGES. 4. I have told my attorney all of the facts and circumstances known to me about the charge(s) against me. I believe that my attorney is fully informed on all such matters. My attorney has counseled and advised me (a) on the nature of each charge, (b) on 1 American LegalNet, Inc. www.FormsWorkFlow.com any and all lesser included charges(s), and (c) on all possible defenses I might have to these charge(s). I believe that my attorney has done all that anyone could do to counsel and assist me, and I am satisfied with the advice and help my attorney has given me. After consulting with my attorney, I am entering my please of "GUILTY" freely and voluntarily, of my own accord and with full understanding of all matters set forth in the indictment, in this petition, and in the certificate of my attorney which is included at the end of this petition.____________ (initials of the Defendant) 5. I understand that I may plead "NOT GUILTY" to any charge against me and that if I choose to plead "NOT GUILTY" the Constitution guarantees me the following rights: (a) (b) (c) the right to a speedy and public trial by jury; the right to see, hear, and face in open Court all witnesses called to testify against me, and the right to cross-examine those witnesses; the right to use the power and process of the Court to compel the production of any evidence, including the attendance of any witnesses in my favor; the right to have the assistance of any attorney at all stages of the proceedings; the presumption of innocence, i.e., the State must prove beyond a reasonable doubt that I am guilty; the right to take the witness stand at my sole option and, if I do not take the witness stand, I understand that the jury may be told that this shall not be held against me; and the right to appeal my case to the Mississippi Supreme Court if I am convicted at a trial on the charge(s) in the indictment. (d) (e) (f) (g) Knowing and understanding the Constitution guarantees set forth in this paragraph, I hereby waive all of them and renew my desire to enter a plea of "GUILTY".____________ (initials of the Defendant) 6. I also understand that if I plead "GUILTY," the Court may impose the same punishment as if I had pled "NOT GUILTY," stood trial and was convicted by a jury. I know that if I plead "GUILTY" to the charge(s) of________________________ ___________________________, the possible sentence which may be imposed on me is imprisonment for a term of from _________ years (minimum) to _________ years (maximum) and/or be fined an amount of $_________ (minimum) to $__________ (maximum). 2 7. American LegalNet, Inc. www.FormsWorkFlow.com I also know that the sentence is up to the Court, that the Court is not required to carry out any understanding made by me and my attorney with the District Attorney, and further, that the Court is not required to follow the recommendation, if any, of the District Attorney. 8. There are other unresolved charges pending against me in __________________ County, Mississippi, for which I have either been arrested or indicted. The District Attorney has agreed to take the following action with regard to these charges: _______________________________________________________________ ______________________________________________________________ _______________________________________________________________ If this provision of No. 8 is not applicable, please write "Not Applicable" in the spaces provided above and initial at the end of this sentence. ____________ (initials of the Defendant) 9. I have ( ) have not ( ) been convicted of one or more felonies in the past. If applicable, please the offense, the year, and the location in the following spaces: ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ 10. I am ( ) am not ( ) presently on probation or parole. I understand that pleading guilty to this indictment may cause a revocation of my probation or parole, and that this could result in a sentence of _______ years being imposed on me in my prior case. I further understand that if my parole or probation is revoked, my sentence in this present case may be imposed consecutively to or in addition to any sentence I may get in my prior case if revoked. I am ______ years of age and have gone to school up to and including ___________________. My physical and mental health are presently satisfactory. At this time, I am not under the influence of any drugs, alcohol, or other intoxicants (nor was I at the time the offense was committed) except: ______________________________________________________________ ______________________________________________________________ 3 11. American LegalNet, Inc. www.FormsWorkFlow.com 12. I do not claim to be suffering, nor have I ever suffered, from any type of mental disease or disorder, except: _______________________________________________________________ ______________________________________________________________ 13. Other than the information stated in paragraph No. 7 and 8 herein above, I declare that no officer or agent of any branch of government (federal, state, and local) or any judge has made any promise or suggestion