IN THE CIRCUIT COURT OF FORREST COUNTY, MISSISSIPPI STATE OF MISSISSIPPI VERSUS CRIMINAL CAUSE NO. __________________ DEFENDANT _______________________________________ WAIVER OF INDICTMENT COMES NOW, _______________________________________, Defendant, in the above styled and numbered matter, who having been by me first duly sworn, on his/her oath, presents and says the following, to-wit: I. That my full name is ___________________________________________, and I am _________ years of age, my Date of Birth is _________________________, and my Social Security Number is ____________________________. II. That I understand I stand charged by Criminal Information dated the _______ day of ___________, 20___, with the crime of_________________________________________ ______________________________________________, an Indictable offense; that said Criminal Information was filed in the Circuit Court of Forrest County, Mississippi; and that said Criminal Information alleges said crime to have been committed on or about the ________ day of ____________________, 20___. III. That I am represented by counsel, Honorable______________________________ ___________________________________, a duly licensed and practicing attorney of the State of Mississippi; that he/she has advised me as to the nature of the charge against me; that he/she American LegalNet, Inc. www.FormsWorkFlow.com has fully advised me of my rights in the premises; and that I am freely and voluntarily executing this Waiver with his/her approval and consent, and upon his/her advice. IV. That I understand I am entitled to have this matter presented to a lawfully constituted Grand Jury of this County for determination of whether an Indictment should be returned against me herein; that I hereby expressly waive that right and agree to proceed by information on oath of the State of Mississippi instead of by Indictment. V. That I understand that I am waiving none of my constitutional rights other than as set forth herein, and specifically, only the right to be proceeded against my information rather than indictment. ________________________________________ SWORN TO AND SUBSCRIBED BEFORE ME, on this the ________ day of _________________________, 20___. ______________________________________________ MY COMMISSION EXPIRES: ____________________________ READ AND APPROVED: ____________________________ ATTORNEY FOR DEFENDANT American LegalNet, Inc. www.FormsWorkFlow.com