STATE OF NORTH CAROLINA County Name Of Defendant File No. STATE VERSUS In The General Court Of Justice District Court Division DEFENDANT'S PLEA OF GUILTY OR NO CONTEST IN DISTRICT COURT G.S. No. Class Maximum Punishment (GU=Guilty NC=No Contest GA=Alford plea) Plea Offense(s) TOTAL MAXIMUM PUNISHMENT MANDATORY MINIMUM FINES & SENTENCES (if any) Terms Of Plea Agreement (if any) DEFENDANT'S STATEMENT WITH PLEA OF (GUILTY) (NO CONTEST) I plead pursuant to Alford ) guilty ( no contest to the charge(s) listed above. I understand that by entering this plea I am giving up the following constitutional rights, among others: (1) the right to plead not guilty and to be tried in district court by a judge, and to confront and to cross-examine the witnesses against me; and (2) the right to remain silent and not to be compelled to incriminate myself. I understand that I have the right to appeal to superior court and to be tried by a jury. I am not now under the influence of any impairing substance. I understand the nature and elements of the charge(s) against me. I understand the maximum sentence(s) for the charge(s) against me and the minimum sentence(s), if applicable. I understand if I am not a citizen of the United States of America, my plea(s) of guilty or no contest may result in my deportation from this country, my exclusion from admission to this country, or the denial of my naturalization under federal law. Other than any plea agreement between the State and me, no one has made any promises or threats against me in any way to cause me to enter this plea. I enter this plea of my own free will, fully understanding what I am doing. Date Signature Of Defendant Witnessed By (if not represented) CERTIFICATION BY LAWYER (If Any) FOR DEFENDANT I certify that I have explained to the defendant and the defendant has acknowledged to me that the defendant understands the constitutional rights that the defendant waives by entering the plea shown above, the nature and elements of the charge(s) shown above, and the maximum sentence(s) and any mandatory minimum sentence(s) that may be imposed for the charge(s) shown above. I certify that the defendant signed this document in my presence and has acknowledged to me that: (1) the defendant is not now under the influence of any impairing substance; (2) other than any plea agreement between the State and the defendant, the defendant has not been made any promise or threatened to enter this plea against the defendant's wishes; and (3) the defendant enters this plea of the defendant's own free will, fully understanding what the defendant is doing. Date Signature Of Lawyer For Defendant PLEA ADJUDICATION Upon consideration of the statement of the defendant set out in this form, the certification set out in this form by the attorney (if any) for the defendant, evidence presented in court, and statements by the District Attorney, defendant, and the defendant's attorney (if any) in open court, the undersigned finds that there is a factual basis for the entry of the plea and that the plea is the informed choice of the defendant and is made freely, voluntarily, and understandingly. The defendant's plea is accepted by the Court and is ordered recorded. Date Name Of Presiding Judge (Type Or Print) Signature Of Presiding Judge AOC-CR-322, Rev. 6/12 © 2012 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkFlow.com