STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT STATE v. DISTRICT COURT _______ DIVISION _______________________________________ WAIVER OF RIGHT OF JURY TRIAL IN THE FIRST INSTANCE IN SUPERIOR COURT I, the above-named Defendant in the case in which I am charged as follows, Arraignment Date Warrant Number Offense Charged do hereby WAIVE, that is GIVE UP, my right to a jury trial in the first instance in the Superior Court and I CONSENT to be tried on the charge listed above by an Associate Judge of the District Court sitting without a jury. I also understand that if I give up this right to a jury trial in the Superior Court in the first instance and if I am found guilty and sentenced in the District Court, I still have my right to appeal to the Superior Court for a jury trial. THIS WAIVER GIVES UP MY RIGHT TO AN IMMEDIATE TRANSFER OF MY CASE TO THE SUPERIOR COURT FOR JURY TRIAL. ______________________________ Defendant or Attorney of Record ______________________________ Date Filed NOTE: IF YOU DESIRE TO WAIVE, THIS SIGNED WAIVER MUST BE FILED IN COURT WITHIN TEN (10) DAYS OF THE DATE OF ARRAIGNMENT. DC-17 (revised October 2012) American LegalNet, Inc. www.FormsWorkFlow.com