COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : _____________Court ____________ County _____________ Tennessee Index No. : PLEA OF GUILTY AND No. Calendar CaseNumber : WAIVERS OF JURY TJUDICIAL SUBPOENA RIAL Plaintiff(s) -against: AND APPEAL page 1 of 1 : ______________________________________ vs. ______________________________________ : Defendant(s) : . . . . . . . . . . . a . . . . . . . . . . . . . . and . . . . . . . with . . . . . . I have received.and.read . .copy .of .the indictment . . . .discussed. it . . . . my.attorney. My attorney has informed me as to the nature of the charges against me and I understand the nature of the charges. My attorney has further advised me as to the possible punishment for the crime charged against me. I desire to voluntarily enter a plea of guilty to the following: Offense(s) pleading to: OF THE STATE OF NEWPunishment: THE PEOPLE YORK _______________________________________ TO ___________________________________________________________ _______________________________________ ___________________________________________________________ _______________________________________ ___________________________________________________________ GREETINGS: _______________________________________ ___________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ___________________________________________________________ , the Honorable at the Court located at___________________________________________________________ County of _______________________________________ in room , on the day of , 20 , at o'clock in the noon, and at any recessed PLACEor adjourned date, to_____________________________________ this action on the part of the OF CONFINEMENT: testify and give evidence as a witness in _______________________________________ Type Felony Offender (Check one of the following if a felony): Mitigate - 20% Standard - 30% Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Persistent or Aggravated - 40% Aggravated a maximum 50% the party on whose behalf this subpoena was issued for and Persistent -penalty of $50 and all damages sustained as a result of your failure to comply. It has been explained to me and I understand that I may plead not guilty to any offense charged and that Iof thea right to a Witness, Honorable , one of the Justices have speedy and public trial by jury. I further understand that by pleading guilty I will not be receiving a jury trial or any other trial of any Court in County, day of , 20 kind. As to a fine, if any, I waive my right to have the jury fix the fine. I further understand my right to have my case appealed to an appellate court, but I hereby waive my right to have my case appealed due to my guilty plea and acceptance of punishment as set forth above. (Attorney must sign above and type name below) I, therefore, voluntarily and of my own free will and choice and without any threats made upon me or without any promises being made to me, and being fully aware of the action I am taking do hereby request the court to accept my plea of GUILTY to the charges set forth above. Furthermore, I waive my right to trial by jury and submit my case forthe Trial Judge for full and final Attorney(s) to determination. I further waive my right to an appeal. These actions are concurred in by the District Attorney General. Date: ________________________________ ____________________________________________ District Attorney General Office and P.O. Address Approved, Attested and Concurred by: Approved by Court: _________________________________ ____________________________________ Facsimile No.: Attorney for Defendant ______________________________________ Defendant Telephone No.: Circuit Judge E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com