STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT RIGHTS/WAIVER FORM Defendant Date of Arraignment Offense(s) Bail Commissioner I, the above-named Defendant, hereby certify that the bail commissioner of the District Court has advised me that I am charged with a crime and of my rights as follows: 1. That I have the right to remain silent. If I make a statement it may be used as evidence against me. 2. That I have reasonable time to consult with an attorney and be admitted to bail. 3. That I have a right to be represented by an attorney of my own choice at my own expense. If I cannot afford an attorney the court will refer me to the public defender or other assigned attorney at no cost to me. 4. That I have a right to a trial by jury in the first instance. I may waive that right and have a trial in the District Court. If I am found guilty I am entitled to appeal that judgment to the Superior Court and have a de novo trial before a jury. IT WAS ALSO EXPLAINED TO ME THAT I MUST APPEAR IN COURT AT THE TIMES ON THE DATES GIVEN TO ME! I acknowledge that the above have been explained to me and that I understand these rights: I give up my right to an immediate transfer for jury trial. ______________________________ Defendant's Signature These rights were explained to me through an interpreter. ______________________________ Interpreter's Name ______________________________ Interpreter's Signature DC-12 (revised October 2012) American LegalNet, Inc. www.FormsWorkFlow.com