COURT COUNTY . . District Court . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... Form No. 357 : Index No. Waiver of Arraignment State of Vermont District Court of Vermont : Calendar No. WAIVER OF ARRAIGNMENT AND REQUEST TO ENTER PLEA : State of Vermont vs. JUDICIAL SUBPOENA Plaintiff(s) Circuit Unit No. Docket No. Defendant -against- Address : : Offense(s): I, the Defendant named above am charged with the crime(s) of Defendant(s) : and have. been .cited. to. appear. before.the.above District. Court. on . . . . . . . to answer to this . .... ... . ..... ..... .. ........... .... .. charge which is a misdemeanor under the laws of the State of Vermont. I understand that the maximum punishment for this offense is THE PEOPLE the right to be represented YORK I understand that I haveOF THE STATE OF NEW by an attorney at my own expense, and if I cannot afford to hire one, to have one appointed at State expense. TO I am not represented by an attorney and do not wish to be represented by one. . I believe that my I am represented by an attorney, whose name is attorney has done all that anyone could do to counsel and assist me. I understand that as a defendant in a criminal case, I have certain constitutional and statutory rights. I understand that I GREETINGS: may plead NOT GUILTY to this offense, and that the State would then have to prove me guilty beyond a reasonable doubt. I understand that by pleading GUILTY or NOLO CONTENDERE I am giving up the following rights, and that the WE COMMAND YOU, if I had plead NOT excuses being laid aside, you convicted you attend Court may impose the same punishment asthat all business and GUILTY, stood trial, and beenand each ofby a jury: before , the Honorable to appear before a judge to have my at the explained and be given a copy of the Information and Court a. the right rights located atagainst me; County of Affidavit describing the charges the b. the in room right to a on the jury; day of , trial by , 20 , at o'clock in the noon, and at any recessed c. the right to to testify and give evidence as a witness in this or adjourned date,question any witnesses testifying against me; action on the part of the d. the right to present evidence and have witnesses brought to the Court for me at State expense; e. the right to remain silent regarding the offense with which I am charged; f. the right to appeal. No threats orYour failurebeen used against me by anyone punishable as ame plead guilty or nolo will make youplead to force have to comply with this subpoena is to try to make contempt of court and contendere. I liable the party on whose behalf this subpoena was issued for a maximum penalty of $50 and to me by anyone for the as a guilty or nolo contendere of my own choice, freely and voluntarily. No promises have been made all damages sustained result of your failure to comply. State except those which are contained in the attached Notice of Plea Agreement. I agree that there is a factual basis for my plea of guilty or nolo contendere, supported by the affidavit. I understand that by pleading GUILTY I admit that I committed the essential parts ,of theof the Justices of the have been Witness, Honorable one offense with which I charged. I understand that by pleading NOLO CONTENDERE I do not deny that I committed the essential parts of the County, day of , 20 charge. Court in understand that a plea of GUILTY or NOLO CONTENDERE to a violation of Title 23 of the Vermont I further Statutes Annotated may result in a suspension of my license or privilege to operate a motor vehicle in the State of Vermont. I hereby ask the Court to accept my plea of GUILTY NOLO sign above and type (Attorney must CONTENDERE name below) in a check or money order made payable to the District Court of to the charge(s) listed above. I enclose $ Vermont for payment of the fine imposed by the court, as recommended in the attached Notice of Plea Agreement. Signature of Defendant Date Attorney(s) for Signature of Guardian ad Litem (if defendant is under 18 years of age) Signature of Attorney I accept the defendant's plea to the charges listed above, finding it to be voluntaryAddress with knowledge and Office and P.O. and made understanding of its consequences after a knowing waiver of constitutional rights. The plea has a factual basis. I adjudge the defendant guilty and enter a judgment of guilty. I do not accept the defendant's plea by waiver for the charges listed above. Telephone No.: Date Signature of Judge Facsimile No.: 12/03 SML E-Mail Address: Mobile Tel. Copy 2 ~ Defendant No.: Copy 1 ~ Court Copy 3 ~ State's Attorney American LegalNet, Inc. www.USCourtForms.com