IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR MULTNOMAH COUNTY THE STATE OF OREGON, ) Plaintiff, ) vs. ) ) __________________________________________, ) Defendant ) 1. 2. Case No. DUII Diversion Form 4 PETITION FOR ENTRY OF PLEA, WAIVER OF JURY TRIAL, AND ORDER My true name is ______________________________, but I also am known as ________________________________________. I am _____ years old. I have gone to school through ___________________________. My physical and mental health are satisfactory. I am not under the influence of any drugs or intoxicants, except __________________________________________ ________________________________________________________________________________________________________. 3. I have checked the following that describes me: … … … … I am able to read, write, and understand the English language, and I have read this petition completely; I am able to read, write, and understand the English language, and this petition has been read aloud to me completely; I am unable to read the English language, and this petition has been read aloud to me completely; I am unable to read, write, or understand the English language, and this petition has been read aloud to me in the _____________________ language by ____________________________, a person qualified to interpret the English language into the _______________________ language. 4. I † (am) † (am not) represented by a lawyer. I understand that I have the right to hire a lawyer or have the court appoint a lawyer to represent me, if the court finds that I cannot afford to hire a lawyer. I choose to give up my right to a lawyer. I will represent myself. (_____) [Defendant initial if giving up right to a lawyer.] 5. If represented by a lawyer, I have told my lawyer all the facts I know about the charge against me. My lawyer has advised me of the nature of the charge and the defenses, if any, that I have in this case. I am satisfied with the advice and help my lawyer has given me. 6. I understand that I have the following rights: a) the right to jury trial; b) the right to see, hear, and cross-examine or question all witnesses who testify against me at trial; c) the right to remain silent about all facts of the case; d) the right to subpoena witnesses and evidence in my favor; e) the right to have my lawyer assist me at trial; f) the right to testify at trial; g) the right to have the jury told, if I decided not to testify at trial, that they cannot hold that decision against me; and h) the right to require the prosecutor to prove my guilt beyond a reasonable doubt. 7. I understand that I give up all of the rights listed in paragraph 6 when I plead guilty or no contest. I understand I give up: a) any defenses I may have to the charge; b) objections to evidence; and c) challenges to the accusatory instrument. 8. By this petition, I am pleading † (guilty) † (no contest) to the crime of driving under the influence of intoxicants (DUII) which is a Class A misdemeanor under Oregon law. The maximum penalties are one year in jail and a fine of $6,250 or $10,000 if the offense was committed in a motor vehicle and there was a passenger younger than 18 and at least three years younger than me. The minimum penalties are 48 hours of imprisonment or 80 hours of community service; and a fine of $1,000 if this is my first conviction, $1,500 if this is my second conviction, or $2,000 if this is my third conviction and I am not sentenced to a term of imprisonment. I will be required to pay a filing fee, unitary assessment fee, and additional fee unless the court finds me indigent and waives all or part of these fees. I will also be required to complete and pay for an alcohol or drug abuse assessment and any recommended treatment. There will be a mandatory suspension of my driving privileges for ____ year(s), and the court may order me to attend a victim impact panel and pay a participation fee. 9. I am submitting this plea along with a petition to enter the diversion program under ORS 813.200 to 813.270. I understand that, if the court grants the petition, the court will accept this plea but will not enter a judgment of conviction at this time. 10. I understand that: a. If I fully comply with the conditions of the diversion agreement within the diversion period requested in the attached petition, the court will dismiss the charge with prejudice under ORS 813.250. If the court does not have a policy of automatically dismissing the DUII charge at the end of one year, I will have to file a motion at the end of the diversion period requesting that the charge be dismissed. 08-09 (01/08) Page 1 of 3 Distribution: Original – courtCopies – DA, Evaluator, Petitioner, Defense Attorney (See SLR 4.075) Supplementary Local Rules Fourth Judicial District, Circuit Court of the State of Oregon for Multnomah County Draft Revision to be Effective February 1, 2008 American LegalNet, Inc. www.FormsWorkflow.com DUII Diversion Form 4 – Page 2 Case No. b. 11. If I fail to comply with the diversion agreement within the diversion period, the court will enter a judgment of conviction on the charge and will sentence me. I understand that if the court enters judgment on this plea, it is equivalent to conviction and that on this plea alone, without receiving any evidence, this court can find me guilty of the crime of DUII. 12. I understand that, if the court denies the diversion petition and I go to trial, nothing in this petition will be used against me. 13. I understand that if I am not a citizen and the court enters judgment on this plea, it may result in my removal from this country, exclusion from admission to the United States, or denial of naturalization. 14. This plea is based only on what is written on this petition. No promises have been made to me by my lawyer or any officer or agent of any branch of government (federal, state, or local) that I will receive a particular sentence or form of treatment from this or any other court, on these or any other charges, other than is set forth in this petition. † I plead no contest - OR – 15. † I plead guilty because in ________________ County, Oregon, I did the following: ____________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ 16. I † (am) † (am not) currently on probation, parole, or postprison supervision. I know that if I am and the court enters judgment on the plea in this case, it may cause revocation of my probation, parole, or postprison supervision and I may be required to serve jail or prison time in that case in addition to any sentence imposed on me in this case. 17. I understand the charge against me and the information in this petition. I am signing this petition and entering this plea voluntarily, intelligently, and knowingly. 18. I understand that if I fail to comply with the terms of the diversion and the court enters a judgment of conviction, I have the right to appeal the conviction by complying with the rights to appeal explained or provided to me at the time the court enters the judgment of conviction. _______________ Date ________________________________________ Defendant's Signature _____________________________________ Defendant’s Name (printed or typed) ORDER The court finds the defendant's plea of † (no contest) † (guilty) to be knowingly, intelligently, and voluntarily made. The court accepts this plea for purposes of ORS 813.200 to 813.270. ___________________ Date 08-09 (01/08) _______________________________________ Judge’s Signature Page 2 of 3 Distribution: Original – Court ___________________________________ Judge’s Name (printed or typed) Copies – DA, Evaluator, Petitioner, Defense Attorney (See SLR 4.075) Supplementary Local Rules Fourth Judicial District, Circuit Court of the State of Oregon for Multnomah County Draft Revision to be Effective February 1, 2008 American LegalNet, Inc. www.FormsWorkflow.com DUII Diversion Form 4 – Page 3 Case No. CERTIFICATE OF COUNSEL I am the attorney for the defendant in this proceeding and I certify that: 1. I have fully explained to my client the charge and possible defenses that may apply in this case. 2. I have personally examined this plea petition, explained all its provisions to my client, and discussed fully with my client all matters described and referred to in the petition. 3. I have explained to my client the maximum penalty and other consequences of entering a guilty or no contest plea, including possible immigration consequences. 4. To the best of my knowledge and belief, my client’s decision to enter this plea is made voluntarily, intelligently, and knowingly. 5. I have told my client that if he or she is eligible for court-appointed counsel and wishes to pursue an appeal, I will transmit the information necessary to perfect the appeal to the Office of Public Defense Services. Signed by me in the presence of the above-named defendant and after full discussion of the contents of the certificate with the defendant this __________ day of __________________________________, 20____. _______________________________________ Defendant's Attorney’s Signature _______________________________________ Attorney Name (typed or printed) _________________ Bar Number CERTIFICATE OF INTERPRETER I, the undersigned interpreter, hereby certify that I have read aloud the petition to the above defendant in the _________________ language. Signed by me in the presence of the above-named defendant this ________ day of _______________________________, 20 _____. _________________________________________________ Interpreter’s Signature _____________________________________________ Interpreter Name (typed or printed) 08-09 (01/08) Copies – DA, Evaluator, Petitioner, Defense Attorney (See SLR 4.075) Page 3 of 3 Distribution: Original – Court Supplementary Local Rules Fourth Judicial District, Circuit Court of the State of Oregon for Multnomah County Draft Revision to be Effective February 1, 2008 American LegalNet, Inc. www.FormsWorkflow.com