CLALLAM COUNTY DISTRICT COURT II STATEMENT OF DEFENDANT ON PLEA OF GUILTY City of Forks Case No. VS 1. My true name is ____________________________ 2. My age is ________ 3. I went through the ___________ grade 4. I HAVE BEEN INFORMED AND FULLY UNDERSTAND THAT: (a.) I have the right to representation by a lawyer and that if I cannot afford to pay for a lawyer, one will be provided at no expense to me. (b.) I am charged with a crime of: ________________________________________________________________________________________ . The elements of this crime are: _______________________________________________________________________________________ _________________________________________________________________________________________________________________ . 5. I HAVE BEEN INFORMED AND FULLY UNDERSTAND THAT I HAVE THE FOLLWONG IMPORTANT RIGHTS, AND I GIVE THEM ALL UP BY PLEADING GUILTY: (a.)The right to a speedy and public trial by an impartial jury in the county where the crime is alleged to have been committed. (b.) The right to remain silent before and during trial, and the right to refuse to testify against myself. (c.) The right at trial to heart and question the witnesses who testify against me. (d.) The right at trial to have witnesses testify for me. These witnesses can be made to appear at no expense to me. (e.) I am presumed innocent until the charge is proven beyond a reasonable doubt or I enter a plea of guilty. (f.) The right to appeal a determination of guilt after a trial. 6. IN CONSIDERING THE CONSEQUENCES OF MY GUILTY PLEA, I UNDERSTAND THAT: (a.) The crime with which I am charged carries a maximum sentence of _________ days in jail and a $ _________ fine. (b.) The crime of _____________________ has a mandatory minimum sentence of _______________________________________________ . The law does not allow any reduction of this sentence. (c.) This plea of guilty will result in suspension or revocation of my driver's license by the Department of Licensing. If I have a driver's license, I must now surrender it to the judge (If not applicable, this paragraph should be stricken and initialed by the defendant and the judge.) (d.) The judge may place me on probation for up to two years and impose conditions of probation. (e.) The judge may require me to pay costs, fees and assessments authorized by law. The judge may also order me to make restitution to any victims who lost money or property as a result of crimes I committed. The maximum amount of restitution is double the amount lf the loss of all victims or double the amount of my gain. (f.) I understand that I may not possess, own, or have under my control any forearm unless my right to do so is restored by a court of record and that I must immediately surrender any concealed weapon license. RCW 9.41.040. (g.) If this crime involves a sexual offense, prostitution, or drug offense associated with hypodermic needles, I will be required to undergo testing for the human immunodeficiency (ADIS) virus. (If not applicable, this paragraph should be stricken and initialed by the defendant and the judge.) (h.) I understand that if this crime involves a sex offense, a kidnapping offense involving a minor, communicating with a minor, or one of the other offenses listed in RCW 9.9A.44, I will be required to register with the county sheriff as described in Attachment "B". (i.) The prosecuting authority will make the following recommendation to the judge: _______________________________________________ _______________________________________________________________________________________________________________ . (j.) The judge does not have to follow anyone's recommendation as to sentence. The judge is completely free to give me any sentence up to the maximum authorized by law no matter what the prosecuting authority or anyone else recommends. (k.) If I am not a citizen of the United States, a plea of guilty to an offense punishable as a crime under state law is grounds for deportation, exclusion from admission to the United States, or denial of naturalization pursuant to the laws of the United States. 7. I plead _____________________ to the crime of ____________________________________ as charged in the complaint or citation and notice. I have received a copy of that complaint or citation and notice. 8. I make this plea freely and voluntarily. 9. No one has threatened harm of any kind to me or to any other person to cause me to make this plea. 10. No person has made promises of any kind to cause me to enter this plea except as set forth in this statement. 11. The judge has asked me to state briefly in my own words what I did that makes me guilty of this crime. This is my statement: ________________ ___________________________________________________________________________________________________________________ . 12. My lawyer has explained to me, and we have fully discussed, all of the above paragraphs. I understand them all. I have been given a copy of this "Statement of Defendant on Plea of Guilty." I have no further questions to ask the judge. State of Washington X_____________________________________________ DEFENDANT I have read and discussed this statement with the defendant and believe that the defendant is competent and fully understands the statement. _____________________________________________________ PROSECTING ATTORNEY _________________________________________________ DEFENDANT'S ATTORNEY The foregoing statement was signed by the defendant in open court in the presence of the defendant's lawyer and the undersigned judge. The defendant asserted that (check appropriate box): (a.) The defendant had previously read; or (b.) The defendant's lawyer had previously read to him or her; or (c.) An interpreter had previously read to the defendant the entire statement above and that the defendant understood it in full. I find the defendant's plea of guilty to be knowingly, intelligently and voluntarily made. Defendant understands the charges and the consequences of the plea. There is a factual basis for the plea. The defendant is guilty as charged. Dated the ________ day of _________________________, _______________. _______________________________________________ JUDGE *I am fluent in the __________________________ language and I have translated this entire document for the defendant from English into that language. The defendant has acknowledged his or her understanding of both the translation and the subject matter of this do