Form 13.10 Uniform Plea of Guilty - Summary of Facts IN THE DISTRICT COURT OF THE STATE OF OKLAHOMA STATE OF OKLAHOMA, Plaintiff, vs. , Defendant. Last four digits of SS# _ Last four digits of DL# _ State Year of Birth Place of Birth Oklahoma DOC # _ ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) COUNTY Case No. _ [NOTE: The trial judge shall ensure the defendant is sworn either prior to completing the Summary of Facts or prior to inquiry by the Court on the Plea. If the defendant is entering a nolo contendere, or other type guilty plea, correct by pen change where term "guilty" used.] _ _ _ _ (Home Address) PLEA OF GUILTY SUMMARY OF FACTS Part A: Findings of Fact, Acceptance of Plea CIRCLE 1. Is the name just read to you your true name? If no, what is your correct name? I have also been known by the name(s): Yes No _ _ _ 2. 3. My lawyer's name is: (a) Do you wish to have a record made of these proceedings by a Court Reporter? (b) Do you wish to waive this right? _ Yes No Yes No 4. 5. Age: Grade completed in school: _ Yes No Can you read and understand this form? (If the answer above is no, Addendum A is to be completed and attached.) American LegalNet, Inc. www.FormsWorkFlow.com 6. Are you currently taking any medications or substances which affect your ability to understand these proceedings? Have you been prescribed any medication that you should be taking, but you are not taking? If so, what kind and for what purpose? _ Yes No 7. Yes No _ 8. Have you ever been treated by a doctor or health professional for mental illness or confined in a hospital for mental illness? If yes, list the doctor or health professional, place, and when occurred: Yes No _ _ 9. 10. 11. Do you understand the nature and consequences of this proceeding? Have you received a copy of the Information and read its allegations? Does the State move to dismiss or amend any case(s) or count(s) in the information or on page 2 of the information? If so, set forth the cases/counts dismissed or amended. A. Do you understand you are charged with: Crime Statutory Reference (1) (2) (3) (4) O.S. O.S. O.S. O.S. Yes Yes Yes No No No 12. _ _ _ _ Yes Yes Yes Yes No No No No For additional charges: List any additional charges on a separate sheet and label as PLEA OF GUILTY ADDENDUM B. B. Are you charged after former conviction of a felony? If yes, list the felony(ies) charged: Yes No _ _ _ 2 American LegalNet, Inc. www.FormsWorkFlow.com 13. Have you previously been convicted of a felony? If so, when, where and for what felony/felonies? _ _ _ 14. ____ (Check if applicable) Do you understand you are subject to the Delayed Sentencing Program for Young Adults and what that sentencing program involves? (Check if applicable) Do you understand that upon a conviction on a plea of guilty to the offense(s) of you will be required to serve a minimum sentence of: 85% of the sentence of imprisonment imposed before being eligible for parole consideration and are not eligible for earned or other type of credits which will have the effect of reducing the length of sentence to less than 85% of the sentence imposed? % of the sentence of imprisonment imposed or received prior to becoming eligible for state correctional earned credits toward completion of your sentence or eligibility for parole? (Check if applicable) Do you understand that a conviction on a plea of guilty to the offense(s) of will subject you to mandatory compliance with the Oklahoma Sex Offender Registration Act? (Check if applicable) Do you understand that any person sentenced to imprisonment for two (2) years or more for the offense(s) of _______________________________________ , involving sexual abuse, sexual exploitation, or illegal sexual conduct, shall be required to serve a term of post-imprisonment supervision for at least three (3) years under conditions determined by the Department of Corrections in addition to the actual term of imprisonment. There will be no post-imprisonment supervision for a sentence of life or life without the possibility of parole for offenses involving sexual abuse, sexual exploitation, or illegal sexual conduct. (Check if applicable) Do you understand that a conviction on a plea of guilty to the offense(s) of will subject you to mandatory compliance with the Oklahoma Methamphetamine Offender Registry Act? (Check if applicable) Do you understand that the Court is required to include in the sentence of any person convicted of a felony and sentenced to a term of imprisonment after November 1, 2012, a term of post-imprisonment supervision. The post-imprisonment supervision shall be for a period of not less than nine (9) months nor more than one (1) year following confinement of the person and shall be served under conditions prescribed by the Department of Corrections. There will be no post-imprisonment supervision for a sentence of life without the possibility of parole. 3 Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No American LegalNet, Inc. www.FormsWorkFlow.com 15. What is/are the charge(s) to which the defendant is/are entering a plea today? _ _ _ 16. (1) (2) (3) (4) 17. Do you understand the range of punishment for the crime(s) is/are: (List in same order as in No. 15 above)? Minimum of Minimum of Minimum of Minimum of to a maximum of to a maximum of to a maximum of to a maximum of and/or a fine of $ and/or a fine of $ and/or a fine of $ and/or a fine of $ _ _ _ _ Yes Yes Yes Yes No No No No Read the following statements: You have the right to a speedy trial before a jury for the determination of whether you are guilty or not guilty and if you request, to determine sentence. (If pleading to capital murder, advise of procedure in 21 O.S. ' 701.10(B)). At the trial: (1) You have the right to have a lawyer represent you, either one you hire yourself or if you are indigent a court appointed attorney. (2) You are presumed to be innocent of the charges. (3) You may remain silent or, if you choose, you may testify on your own behalf. (4) You have the right to see and hear all witnesses called to testify against you and the right to cross-examine them. (5) You may have your witnesses ordered to appear in court to testify and present evidence of any defense you have to these charges. (6) The state is required to prove your guilt beyond a reasonable doubt. (7) The verdict of guilty or not guilty decided by a jury must be unanimous. However, you can waive a jury trial and, if all parties agree, the case could be tried by a Judge alone who would decide i