Application for ARD Form. This is a Pennsylvania form and can be use in Erie Local County.
Tags: Application for ARD, Pennsylvania Local County, Erie
COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. COMMONWEALTH OF PENNSYLVANIA : IN THE COURT OF COMMON PLEAS : : OF ERIE COUNTY, PENNSYLVANIA Calendar No. : CRIMINAL DIVISION : v. : JUDICIAL SUBPOENA Plaintiff(s) : NO.: _____________ OF 20_______ -against: ________________________________________ : OTN: _________________________ : APPLICATION FOR DISPOSITION UNDER PROGRAM OF ACCELERATED REHABILITATIVE DISPOSITION/PROBATION WITHOUT VERDICT : Application is hereby made for disposition of this case under the Accelerated Rehabilitative Disposition/Probation Without Verdict Program. To assist the District Attorney=s Defendant(s) Office in evaluating: the suitability of this case for the ARD/PWOV .. .. ....... ......... . ....... Program,. the. following. information. is.provided:. . . . . . . . . . . . . . . . . . . . . INSTRUCTIONS: Answer all questions that apply. If a question does not apply, answer it with the initials AN.A.@ 1. THE PEOPLE OF THE STATE OF NEW YORK Full Name of the defendant: ___ ________________________________________________________________ 2. TO Maiden Name of defendant; or other names previously used: ___________________________________________ 3. Date of Birth: ______________________ Social Security Number: ___________________________ 4. GREETINGS: Number: ___________________________ State Issued:________________________ Driver License 5. Present WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Address: _____________________________________________________________________________ , the Honorable at the Court located at County ofCity: ____________________________ State: ______________ Zip Code: _______________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed Phone (Home) ( ) give _____ (Work) ( )____________________ or adjourned date, to testify and__ evidence as a witness in this action on the part of the 6. Previous Addresses and length of time at each (go back 10 years): _________________________________________ 7. _______________________________________________________________________________________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Present Employment: result of your failure to comply. ___________________________________________________________________________________________ 8. Witness, Honorable , one of the Justices of the Education-Schools and Highest Year attained: Court in County, day of , 20 ___________________________________________________________________________________________ 9A. Have you ever been found guilty or pleaded guilty or no contest to any criminal violation of any kind in any court other than summery offenses, whether in Pennsylvania or anywhere else? If so, explain giving date, place, charge(s), and (Attorney must sign above and type name below) disposition: ___________________________________________________________________________________________________ 9B. Do you have any other pending criminal charge(s) or have you ever been placed on ARD or PWOV? If so, explain Attorney(s) for giving date, place, charges and disposition: ______________________________________________________________ _______________________________________________________________________________________________ Office and P.O. Address 9C. If charged with Driving Under the Influence: Have you ever been adjudicated a delinquent or entered into a coagreement as a juvenile after being charged with Driving Under the Influence of Alcohol? If so, explain giving details:______________________________________________________________________________________________ Telephone No.: __________________________________________________________________________________________________ Facsimile No.: 10. Explanation of your present case, including all details (use reverse E-Mailneeded):_____________________________ side if Address: Mobile Tel. No.: American Page 1 ofLegalNet, Inc. 2 www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. ___________________________________________________________________________________________________ : Calendar No. 11. By applying for ARD/PWOV and by signing this application I acknowledge, certify, and understand each of the : following rights and responsibilities: JUDICIAL SUBPOENA Plaintiff(s) A. I have been advised and I understand that I have a constitutional right to a speedy trial; that -against: pursuant to Pa.R. Crim. P. 1100, the Commonwealth must bring my case to trial within 365 days from the date of the filing of the Criminal Complaint charging me. If my case is not brought to trial within 365 days from the filing of the : Criminal Complaint, I understand I can ask the Court to dismiss all charges against me. Furthermore, I understand that in the event I am incarcerated on these charges, the Commonwealth must bring my case to trial within 180 days from : the date of the filing of the Criminal Complaint, if the Commonwealth fails to do so, I can ask the Court for nominal bail. Defendant(s) : ...................................................... I hereby waive (give up) all of my constitutional rights to a speedy trial as set forth from the date I sign this Application until I either complete the ARD Program or am revoked from it, should I violate the conditions the Court imposes on me. In the event my Application for ARD is denied, I waive (give up) all of my constitutional rights to a THE PEOPLE OF THE the date I sign this Application until the last scheduled day of the term o f Criminal Court speedy trial as set forth fromSTATE OF NEW YORK next following the date of my rejection. I have been advised and I understand that by signing this waiver I am waiving (giving up) any and all rights I may have to be tried within 180th (if in jail) or 365th day following the filing of the TO Criminal Complaint against me. I am signing the waiver because I understand it is to my benefit to do so and to allow the District Attorney as much time as he needs to evaluate my suitability for the ARD Program. I have not been made any promises, nor have I been forced or coerced to sign this waiver. GREETINGS: B. I understand I have the right to be represented by an attorney on my charge(s) and also in connection with my ARD/PWOV Application. If I cannot afford counsel, the Court will provide me free counsel WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before through the Erie County Public Defender=s Office. , the Honorable at the Court located at County of C. It is my responsibility to notify the District Attorney=s Office, in writing, of my arrest in room , any offense day of , 20 , at and/or conviction for on the occurring after this Application is o'clockandthe made in before noon, and at any recessed it is rejected or I am or adjourned date, to testify and give evidence asto witness in this action on the part of the a comply with this requirement is grounds for refusal of the accepted into the Program by the Court. Failure Application and/or may be treated as a false statement subjecting me to prosecution and/or for removal from the Program. D. Your failure towith Driving Under the Influence: I understandcontempt mycourt and will make you liable to If charged comply with this subpoena is punishable as a that it is of responsibility to the partyaon whose behalf thisunderstand was issued for a placed in the ARD of $50 and all damages sustained as a arrange for CRN evaluation. I subpoena that I cannot be maximum penalty Program unless such evaluation is result of I further understand that completed. your failure to comply. I am to contact \DWI Program, 36 North Park Row, Erie, PA 16501 at (814)4543326 between 9:00 a.m. and 3:30 p.m. to arrange an appointment. Witness, Honorable , one of the Justices of the E. I acknowledge that I have completed (or will complete prior to my ARD hearing) all Court in County, day of , 20 processing (e.g. Fingerprinting, etc.) required by me. I understand that failure to do so may delay my acceptance into the program. F. The information I have provided above is true and (Attorney must sign above and type name below) correct. I understand if I have provided false information on this Application, that reason alone is sufficient to refuse this Application. In addition, I understand that by providing false information I can be prosecuted for offenses including, but not limiting to, perjury, false swearing and/or unsworn falsification to authorities. Attorney(s) for DATE: ________________________ DEFENDANT: _________________________________________ DATE: ________________________ ATTY. FOR DEFENDANT:_______________________________ Please Print Office and P.O. Address DATE: _______________________ WITNESS*: _____________________________________________ *When defendant has no attorney Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American Page 2 ofLegalNet, Inc. 3 www.USCourtForms.com