STATE OF NEBRASKA FORM NO. CC 2:1 08/2007 Rev. CASE NUMBER WAIVER AND PLEA OF GUILTY Instructions for Completing Waiver and Plea Please be advised that you are accused of violating a statute or city ordinance under the laws of Nebraska. The waiver and plea system has been established for your convenience. You are under no compulsion to use it. Should you desire to appear in Court and contest the matter you may do so. The waiver and plea may be used only by persons who wish to waive all available rights and to enter a plea of guilty. If you sign this form, you will waive the following rights: (1) To have an attorney assist you in preparation of your defense and to represent you in Court; you may be entitled to an attorney at public expense if you cannot afford one. (2) To have the complaint read to you and to be informed of the possible penalties in the event of your conviction. (3) To have a trial before a judge, and in certain cases, a jury. (4) To confront and cross-examine witnesses against you. (5) To require witnesses to attend Court and testify on your behalf. (6) To remain silent and not make any statement concerning the circumstances surrounding this violation. (7) To testify in your own behalf. (8) To require the prosecution to prove you guilty beyond a reasonable doubt and to appeal any final decision or order of the Court. (9) To have sufficient time to prepare your defense. Out of state residents may be required to post bond should a court appearance be desired. Only cash, certified check, or money order will be accepted in payment of any fine and costs. If you would like a receipt, a pre-addressed stamped envelope must be sent to this court requesting such receipt. Waiver and Plea ‰You have until STATE OF NEBRASKA at .M. to return this plea of guilty form or to appear in County Court in person. Failure to do either may result in the issuance of a warrant for your arrest or suspension of your driver’s license by your home state. vs. Defendant Having read and understood the instructions and my rights, I, the undersigned, do hereby enter my appearance on the complaint of violation(s) of As a matter of convenience to me, I request the Court to accept this plea of guilty and waiver of my statutory and constitutional rights and the payment at this time of the scheduled fine. I have been informed that if this plea of guilty and waiver of appearances is accepted, the Court will enter a judgment of conviction finding me guilty as charged, and, where applicable, points may be assessed against my driving record. I also realize that this plea admits the fault of my violation(s) which may be used against me in any later proceeding. DATE: DEFENDANT’S SIGNATURE: THE COUNTY COURT HEREBY ACCEPTS the plea of guilty and enters judgment of conviction finding the defendant guilty as charged. DATE: BY THE COURT: COUNT 1: $ COUNT 2: $ COUNT 3: $ COUNT 4: $ COSTS: $ TOTAL: $ (Seal) RETURN TO THIS COURT: CITATION NO. American LegalNet, Inc. www.FormsWorkflow.com