THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) Charge ID Number(s): NOTICE OF INTENT TO ENTER PLEA OF GUILTY I am hereby informing the Court of my intention to enter a plea of GUILTY to the charge(s) of presently pending against me. I have discussed my intent to plead guilty with my lawyer who has explained to me the nature of the charge, the elements of the offense the State must prove and the maximum and minimum penalties. I have voluntarily and willingly signed this form. I realize that I had earlier entered a plea of NOT GUILTY and that as a result of this change in plea, I will not go to trial as scheduled. I hereby waive my right to a speedy trial caused by this change in plea. This is a: Terms: A presentence investigation report is not requested. A presentence investigation report is requested because: Capped Plea Fully Negotiated Plea Naked Plea Defense counsel would like to be present for interview. Defense counsel will arrange for an interpreter to be present for interview. I understand that if I do not appear for my plea and sentencing hearings, as scheduled by the Court, a criminal arrest warrant will be issued for my immediate arrest. Date Defense Counsel Telephone Number Defendant's signature Address Telephone Number I certify that on this date I provided a copy of this document to (other party) or to (other party's attorney) by: Hand-delivery OR US Mail OR E-mail (E-mail only by prior agreement of the parties based on Circuit Court Administrative Order). Date Signature Counsel for the Defendant NHJB-2715-S (03/25/2013) American LegalNet, Inc. www.FormsWorkFlow.com