IN THE COURT OF COMMON PLEAS OF WESTMORELAND COUNTY, PENNSYLVANIA CRIMINAL DIVISION COMMONWEALTH OF PENNSYLVANIA vs. CASE NO._______________________ Name Address ________________________________________ City State Zip PLEASE CHECK IF NEW ADDRESS WAIVER OF ARRAIGNMENT, ENTRY OF PLEA, AND ENTRY OF APPEARANCE I ___________________________________________, defendant in the above case: 1. 2. 3. Understand the nature of the charges against me, Understand the right to be represented by counsel, Understand the right to file motions, including a Request for a Bill of Particulars, a Motion for Pretrial Discovery and Inspection, a Motion Requesting Transfer from Criminal Proceedings to Juvenile Proceedings and an Omnibus Pretrial Motion,and the time limits within which the motions must be filed. Understand that failure to appear without cause at any proceeding for which my presence is required, including trial,that my absence may be deemed a waiver of the right to be present, and the proceeding may be conducted in my absence. 4. I hereby waive my Court Arraignment and enter a plea of I request a trial. . Counsel and defendant agree that the Clerk of Courts will be kept informed of any changes in the defendant's current address listed above. The Clerk of Courts shall enter the appearance of the following attorney as Attorney of Record for the above named defendant. _____________________________________ __________________ Defendant's Signature *DEFENDANT CANNOT SIGN Date Signed WAIVER UNLESS ATTORNEY SIGNS BELOW _________________________________________________ ___________________________ Attorney for Defendant - PLEASE PRINT ATTORNEY STATE ID # (MANDATORY) _____________________________________ _____________________ Attorney for Defendant - Signature Date Signed (MANDATORY) WHITE - Clerk of Court YELLOW ­ Court Admin. PINK ­ Dist. Attorney MDJ 12 REV. 5/17/13 GOLD - Attorney American LegalNet, Inc. www.FormsWorkFlow.com