IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEBRASKA UNITED STATES OF AMERICA, Plaintiff, vs. Defendant ) ) ) ) ) ) ) ) ) CASE NO._______________ PETITION TO ENTER A PLEA OF GUILTY I, , the defendant inform the judge that I want to plead GUILTY to Count(s) of the (indictment or superseding indictment or information) and that the following answers are true: A. BACKGROUND QUESTIONS: 1. 2. 3. How old are you? ____________________ How much education have you had? _________________________________ Have you ever been under the care of a doctor or in a hospital or institution for drug or alcohol treatment or addiction? Yes No _____ If so, when and where? _____________________________________________ Have you ever been under the care of a doctor or in a hospital for a mental or emotional condition? Yes No _____ If so, when and where? ____________________________________________ If an attorney is now representing you in this case: a) b) c) d) Revised November 2016 4. 5. What is your attorney's name? _________________________________ Have you had enough time to talk with your attorney ? Yes No _____ Have you told your attorney everything about your case? Yes No _____ Are you satisfied with the job he or she has done for you? Yes No _____ 1 American LegalNet, Inc. www.FormsWorkFlow.com e) If you have any objections to the way the attorney has represented you, what are those objections? _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ 6. Do you understand the charge(s) against you? Yes No _____ B. CONSTITUTIONAL RIGHTS - WAIVERS The questions in this section are designed to inform you of valuable constitutional rights you will give up by pleading guilty. 7. Do you understand that you have a right to plead NOT GUILTY to every charge filed against you? Yes No _____ Do you understand that, if you plead NOT GUILTY, you have the following constitutional rights: a) b) the right to a speedy and public trial by jury Yes No _____ 8. the right to an attorney at all stages of the proceedings, and, if you cannot afford to pay an attorney, one will be appointed to represent you Yes No _____ the right to see and hear all witnesses called to testify against you and the right to cross-examine them Yes No _____ the right to use the court's subpoena power to compel the attendance of witnesses and the production of other evidence at trial Yes No _____ the right to take the witness stand or not, as you choose, and that you cannot be required to take the witness stand Yes No _____ the right not to testify and the jury cannot take this as evidence against you Yes No _____ 2 American LegalNet, Inc. www.FormsWorkFlow.com c) d) e) f) Revised November 2016 g) the right to be presumed innocent until and unless the United States has proven you guilty of the offense beyond a reasonable doubt by the unanimous agreement of all 12 jurors. Yes No _____ 9. Do you understand that, if you plead GUILTY, you will be found guilty of the offense without a trial and you will have given up all of the above rights, except the right to an attorney? Yes No _____ Do you understand that, if you plead GUILTY to a felony offense, you will be convicted of a felony? A felony conviction may deprive you of valuable civil rights, such as the right to vote, to hold public office, to serve on a jury and to possess any kind of firearm. Yes No _____ Do you understand that if you are not a United States citizen, that under immigration law, your guilty plea will be considered by immigration officials in determining whether you are deported, that is, removed from the United States? Yes No _____ Do you understand that in nearly all cases involving drug trafficking and in most federal felony cases, if you are not a U.S. citizen your guilty plea will result in your permanent removal from the United States? Yes No _____ 10. 11. 12. C. SENTENCING - GENERAL The questions in this section are designed to assure the judge that you understand aspects of the sentencing process. Answer question 13 only if you are pleading guilty pursuant to an 11(c)(1)(C) agreement. Otherwise, move on to question 14: 13. Do you understand that the judge may accept or reject your plea agreement? If the judge rejects your plea agreement, you may withdraw your guilty plea. If the judge accepts your plea agreement, the judge must follow its terms. That is, the judge must impose any specific sentence or apply the sentencing range, specific Sentencing Guidelines provisions, policy statements, or sentencing factors agreed upon by you and the government in the plea agreement. Your sentence will follow the terms of the agreement, which may be the same, greater or lesser than the sentence you would have received had you pleaded not guilty and had been convicted by a jury. Yes No _____ If you answered question 13, skip question 14 and proceed to question 15. 3 American LegalNet, Inc. www.FormsWorkFlow.com Revised November 2016 14. Do you realize that: a) if you plead GUILTY, the judge may impose the same punishment as if you had pleaded NOT GUILTY and had been convicted by a jury? Yes No _____ b) c) the sentence you will receive is solely a matter for the judge to decide? Yes No _____ there is no guarantee your sentence will be within any particular sentencing guideline range? Yes No _____ 15. What are the mandatory minimum and maximum punishments required by law for the offense or offenses to which you are pleading guilty? Count Imprisonment min max min Fine max Supervised Release min max Special Assessment 16. Do you understand that probation is generally not available if there is a mandatory minimum penalty? Yes No _____ Will you be forfeiting any property to the United States as a result of your guilty plea? Yes No _____ Do you realize that, if you plead GUILTY, the judge may require you to make restitution to any victim of the offense? Yes No _____ Do you understand that, if you are convicted of any offense consisting of possession or distribution of controlled substances, you may be ineligible for any and all federal benefits? Yes No _____ 17. 18. 19. Revised November 2016 4 American LegalNet, Inc. www.FormsWorkFlow.com 20. Do you realize that the judge must require you to pay on each count to which you are convicted a special assessment as follows: each felony count $100; each misdemean