VIRGINIA: IN THE CIRCUIT COURT OF LOUDOUN COUNTY COMMONWEALTH OF VIRGINIA v. ) ) ) CRIMINAL NO. _____________ ) ) _______________________ Defendant WAIVER OF RIGHT TO TRIAL BY JURY AND PLEA TO: The Judge of the Circuit Court of Loudoun County, Virginia: I, _______________________, in the presence of the Honorable ____________ _________________________, Judge of the Circuit Court of Loudoun County, Virginia, and with the consent and approval of _________________________, Attorney for the Commonwealth for said County, and ______________________, my counsel, this ________ day of ________________, 200_, hereby waive trial by jury, and plead guilty not guilty to the Indictment hereto attached, as provided for under § 19.2-257 of the Code of Virginia, 1950, as amended. Given under my hand this _______ day of ___________________, 200_. _____________________________ DEFENDANT SEEN & APPROVED: __________________________ Judge __________________________ Attorney for the Commonwealth __________________________ Counsel for the Defendant American LegalNet, Inc. www.USCourtForms.com