District Court Form 362 State of Vermont District Court of Vermont WAIVER OF FURTHER APPEARANCES AND REQUEST TO ENTER PLEA www.vermontjudiciary.org State of Vermont v. Defendant Unit No. Circuit Docket No. Address Offense(s) I, the Defendant named above am charged with the crime(s) of which is a misdemeanor under the laws of the State of Vermont. I understand that the maximum punishment for this offense is . I understand that I have the right to be represented by an attorney at my own expense, and if I cannot afford to hire one, to have one appointed at State expense. I am not represented by an attorney and do not wish to be represented by one. . I am represented by an attorney, whose name is has done all that anyone could do to counsel and assist me. I believe that my attorney I understand that as a defendant in a criminal case I have certain constitutional and statutory rights. I understand that I may continue to plead NOT GUILTY to the above offense, and that the State has the burden of proving 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 Court may impose the same punishment as if I had continued to plead NOT GUILTY, stood trial, and been convicted by a jury: a. the right to a trial by jury; b. the right to question any witnesses testifying against me; c. the right to present evidence and have witnesses brought to the Court for me at State expense; d. the right to remain silent regarding the offense with which I am charged; e. the right to appeal. No threats or force have been used against me by anyone to try to make me plead guilty or nolo contendere. I plead guilty or nolo contendere of my own choice, freely and voluntarily. No promises have been made to me by anyone for the 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 the offense(s) with which I have been charged. I understand that by pleading NOLO CONTENDERE I do not deny that I committed the essential parts of the charge(s). I further understand that a plea of GUILTY or NOLO CONTENDERE to a violation of Title 23 of the Vermont Statutes Annotated may result in a suspension of my license or privilege to operate a motor vehicle in the State of Vermont. I understand that, if I am not a citizen of the United States, a plea of GUILTY or NOLO CONTENDERE may have consequences of deportation or denial of United States citizenship. I hereby ask the Court to accept my plea of GUILTY NOLO CONTENDERE in a check or money order payable to the District Court of Vermont for to the charge(s) listed above. I enclose $ payment of the fine imposed by the court, plus the $36.00 surcharge, and 15% of the fine imposed for the offense, rounded upward to the nearest whole dollar as recommended in the attached Notice of Plea Agreement. (Pursuant to 13 VSA Section 7282 6A & B). Date Signature of Defendant 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 voluntary and made with knowledge and 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 charge(s) listed above. Signature of Judge Date 7/08 SML Copy 1 ~ Court Copy 2 ~ Defendant Copy 3 ~ State's Attorney American LegalNet, Inc. www.FormsWorkflow.com