SUPERIOR COURT OF WASHINGTON COUNTY OF _______________________ JUVENILE COURT STATE OF WASHINGTON NO: vs. STATEMENT ON PLEA OF GUILTY (STJOPG) Respondent 1. My true name is: _______________________________________________________________. I am also known as: ___________________________________________________________. 2. My age is ____________. Date of Birth: _______________________________. 3. I have been informed and fully understand that I have the right to a lawyer, and that if I cannot afford to pay for a lawyer, the judge will provide me with one at no cost. I understand that a lawyer can look at the social and legal files in my case, talk to the police, probation counselor and prosecuting attorney, tell me about the law, help me understand my rights, and help me at trial. 4. I understand that I am charged with Count 1 , the elements of which are ; Count 2 , the elements of which are . And I have been given a copy of the charge(s). STATEMENT ON PLEA OF GUILTY (STJOPG) - Page 1 of 6 WPF JU 07.0600 (7/2007) - JuCR 7.7; RCW 13.04.033, 13.40.130, .140 American LegalNet, Inc. www.FormsWorkflow.com 5. I UNDERSTAND I HAVE THE FOLLOWING IMPORTANT RIGHTS, AND I GIVE THEM ALL UP BY PLEADING GUILTY: a. b. c. d. e. f. I have the right to a speedy and public trial in the county where the offense(s) allegedly occurred. I have the right to remain silent before and during trial, and I need not testify against myself. I have the right to hear and question witnesses who might testify against me. I have the right to testify and to have witnesses testify for me. These witnesses may be required to appear at no cost to me. I am presumed innocent unless the charge is proven beyond a reasonable doubt or I enter a plea of guilty. I have the right to appeal a finding of guilt after trial. 6. I have been informed that in order to determine an appropriate sentence regarding the charges to which I plead guilty in this matter, the judge will take into consideration my criminal history, which is as follows: a. b. c. d. e. f. 7. The Standard Sentencing Range, which was calculated using my criminal history as referenced in Paragraph 6, above, is as follows: [ ] LOCAL SANCTIONS: COUNT SUPERVISION COMMUNITY FINE DETENTION CVC RESTITUTION $0 to $500 0 to 30 Days $75/$100 [ ] As required [ ] ______ RESTITUTION [ ]1 0 to 12 months 0 to 150 hours [ ]2 0 to 12 months 0 to 150 hours $0 to $500 0 to 30 Days $75/$100 [ ] As required [ ] ______ [ ]3 0 to 12 months 0 to 150 hours $0 to $500 0 to 30 Days $75/$100 [ ] As required [ ] ______ I understand that, if community supervision is imposed, I will be required to comply with various rules, which could include school attendance, curfew, law abiding behavior, associational restrictions, counseling, treatment, urinalysis, and/or other conditions deemed appropriate by the judge. Failure to comply with the conditions of supervision could result in a violation being found and further confinement imposed for the violation up to 30 days. [ ] JUVENILE REHABILITATION ADMINISTRATION (JRA) COMMITMENT: COUNT WEEKS AT JUVENILE REHABILITATION ADMINISTRATION (JRA) FACILITY CVC RESTITUTION [ ]1 [ ] 15 - 36 [ ] 30 - 40 [ ] 52 - 65 [ ] 80 - 100 [ ] 103 - 129 [ ] 180 - Age 21 $75/$100 [ ] As required [ ] ____ [ ]2 [ ] 15 - 36 [ ] 30 - 40 [ ] 52 - 65 [ ] 80 - 100 [ ] 103 - 129 [ ] 180 - Age 21 $75/$100 [ ] As required [ ] ____ [ ]3 [ ] 15 - 36 [ ] 30 - 40 [ ] 52 - 65 [ ] 80 - 100 [ ] 103 - 129 [ ] 180 - Age 21 $75/$100 [ ] As required [ ] ____ I understand that, if I am committed to a Juvenile Rehabilitation Administration (JRA) facility, following my release I may be required to comply with a program of parole for a number of months. I understand that if placed on parole, I will be under the supervision of a parole officer. The conditions of parole will restrict my actions and may require me to participate in activities and STATEMENT ON PLEA OF GUILTY (STJOPG) - Page 2 of 6 WPF JU 07.0600 (7/2007) - JuCR 7.7; RCW 13.04.033, 13.40.130, .140 American LegalNet, Inc. www.FormsWorkflow.com programs including, but not limited to, evaluation, treatment, education, employment, community restitution, electronic monitoring, and urinalysis. Failure to comply with the conditions of parole may result in parole revocation and further confinement. If the offense to which I am pleading guilty is a sex offense, failure to comply with the conditions of parole may result in further confinement of up to 24 weeks. I understand that if I am pleading guilty to two or more offenses, the disposition terms shall run consecutively (one term after the other) subject to the limitations in RCW 13.40.180. I understand that if any additional criminal history is discovered, both the standard sentence range and the prosecuting attorney’s recommendation may increase. Even so, my plea of guilty to this charge is binding. 8. RIGHT TO APPEAL SENTENCE: I understand, that the judge must impose a sentence within the standard range, unless the judge finds by clear and convincing evidence that the standard range sentence would amount to a manifest injustice. If the judge goes outside the standard range, either the state or I can appeal that sentence. If the sentence is within the standard range, no one can appeal the sentence. 9. MAXIMUM PUNISHMENT: I have been informed, and fully understand, that the maximum punishment I can receive is commitment until I am 21 years old, but that I may be incarcerated for no longer than the adult maximum sentence for this offense. 10. COUNTS AS CRIMINAL HISTORY: I understand that my plea of guilty and the judge’s acceptance of my plea will become part of my criminal history. I understand that if I am pleading guilty to two or more offenses that arise out of the same course of conduct, only the most serious offense will count as an offense in my criminal history. I understand that my guilty plea will remain part of my criminal history when I am an adult and may affect my ability to remain in the Juvenile Justice System should I re-offend. I understand that the judge will consider my criminal history when sentencing me for any offense that I commit in the future as an adult or juvenile. 11. GROUNDS FOR DEPORTATION: 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. 12. NOTIFICATION RELATING TO SPECIFIC CRIMES: IF ANY OF THE FOLLOWING PARAGRAPHS DO NOT APPLY, THEY SHOULD BE STRICKEN AND INITIALED BY THE DEFENDANT AND THE JUDGE. [A] SUSPENSION/REVOCATION OF DRIVING PRIVILEGE FOR FIREARMS OR DRUGS: I have been informed that if the offense that I am pleading guilty to involves a finding that I was armed with a firearm when I committed the offense or if the offense was a violation of RCW 9.41.040(1) or chapters 66.44, 69.41, 69.50 or 69.52 and I was 13 years of age or older when I committed the offense, then the plea will result in the suspension or revocation of my privilege to drive. [B] SUSPENSION/REVOCATION OF DRIVING PRIVILEGE FOR DRIVING OFFENSES: I have been informed that if the offense that I am pleading guilty to is any felony in the commission of which a motor vehicle was used, reckless driving, driving or being in physical control of a motor vehicle while under the influence of intoxicants, driving while license suspended or revoked, vehicular assault, vehicular homicide, hit and run, theft of motor vehicle fuel, or attempting to elude a pursuing police vehicle, the plea will result in the suspension or revocation of my privilege to drive. STATEMENT ON PLEA OF GUILTY (STJOPG) - Page 3 of 6 WPF JU 07.0600 (7/2007) - JuCR 7.7; RCW 13.04.033, 13.40.130, .140 American LegalNet, Inc. www.FormsWorkflow.com [C] OFFENDER REGISTRATION FOR SEX OFFENSE OR KIDNAPPING OFFENSE: Because this crime involves a sex offense, or a kidnapping offense involving a minor, or sexual misconduct with a minor in the second degree, communication with a minor for immoral purposes, or attempt, solicitation, or conspiracy to commit a sex offense or a kidnapping offense involving a minor, as defined in RCW 9A.44.130, I will be required to register where I reside, study or work. The specific registration requirements are set forth in the “Offender Registration” Attachment. [D] DNA TESTING: If this crime involves a felony or stalking, harassment, or communication with a minor for immoral purposes, I will be required to have a biological sample collected for purposes of DNA identification analysis. RCW 43.43.754. [E] HIV TESTING: If this crime involves a sexual offense, prostitution, or a drug offense associated with hypodermic needles, I will be required to undergo testing for the human immunodeficiency (HIV/AIDS) virus. RCW 70.24.340. [F] DOMESTIC VIOLENCE ASSESSMENT: If this offense involves domestic violence, I may be required to pay a domestic violence assessment of up to $100. [G] CRIME LAB FEES: If this offense involves a controlled substance, I will be required to pay $100 for the State Patrol Crime Lab fees to test the substance. [H] SCHOOL NOTIFICATION: If I am enrolled in a common school, the court will notify the principal of my plea of guilty if the offense for which I am pleading guilty is a violent offense as defined in RCW 9.94A.030; a sex offense as defined in RCW 9.94A.030; inhaling toxic fumes under chapter 9.47A RCW; a controlled substance violation under chapter 69.50 RCW; a liquor violation under RCW 66.44.270; or any crime under chapters 9.41, 9A.36, 9A.40, 9A.46, and 9A.48 RCW. RCW 13.04.155. [I] SCHOOL ATTENDANCE WITH VICTIM PROHIBITED: I understand that if I am pleading guilty to a sex offense, I will not be allowed to attend the school attended by the victim or victim’s siblings. RCW 13.40.160. [J] FEDERAL BENEFITS: I understand that if I am pleading guilty to a felony drug offense, my eligibility for state and federal food stamps and welfare will be affected. 21 U.S.C. § 862a. [K] MANDATORY MINIMUM SENTENCE: The crime of ____________________________ has a mandatory minimum sentence of at least ___________________ weeks of total confinement. The law does not allow any reduction of this sentence. [L] RIGHT TO POSSESS FIREARMS: [JUDGE MUST READ THE FOLLOWING TO OFFENDER] I have been informed that if I am pleading guilty to any offense that is classified as a felony or any of the following crimes when committed by one family or household member against another: assault in the fourth degree, coercion, stalking, reckless endangerment, criminal trespass in the first degree, or violation of the provisions of a protection order or no-contact order restraining the person or excluding the person from a residence; that I may not possess, own, or have under my control any firearm unless my right to do so has been restored by a court of record. RCW 9.41.040(1). STATEMENT ON PLEA OF GUILTY (STJOPG) - Page 4 of 6 WPF JU 07.0600 (7/2007) - JuCR 7.7; RCW 13.04.033, 13.40.130, .140 American LegalNet, Inc. www.FormsWorkflow.com [M] FIREARMS POSSESSION OR COMMISSION WHILE ARMED: [i] Minimum 10 Days for Possession Under Age 18: I understand that the offense I am pleading guilty to includes possession of a firearm in violation of RCW 9.41.040(1)(b)(iii), and pursuant to RCW 13.40.193, the judge will impose a mandatory minimum disposition of 10 days of confinement, which must be served in total confinement without possibility of release until a minimum of 10 days has been served. [ii] Unlawful Possession with Stolen Firearm: I understand that if the offenses I am pleading guilty to include both a conviction under RCW 9.41.040 for unlawful possession of a firearm in the first or second degree and one or more convictions for the felony crimes of theft of a firearm or possession of a stolen firearm, that the sentences imposed for these crimes shall be served consecutively to each other. A consecutive sentence will also be imposed for each firearm unlawfully possessed. [iii] Armed During Commission of Any Offense: I understand that if the offense I am pleading guilty to includes a finding that either I or my accomplice was armed with a firearm during the commission of the offense, that the standard range disposition shall be determined pursuant to RCW 13.40.160, unless the judge finds a manifest injustice, in which case the disposition shall be determined pursuant to RCW 13.40.193(3). Such confinement will run consecutive to any other sentence that may be imposed. [iv] Armed During Commission of a Felony: I further understand that the offense I am pleading guilty to includes a finding that either myself or my accomplice was armed with a firearm during the commission of a felony (other than possession of a machine gun, possession of a stolen firearm, drive-by shooting, theft of a firearm, unlawful possession of a firearm in the first or second degree, or use of a machine gun in a felony) and, therefore, the following mandatory periods of total confinement will be added to my sentence: For a class A felony, six (6) months; for a class B felony, four (4) months; and for a class C felony, two (2) months. Such confinement will run consecutive to any other sentence that may be imposed. 13. I understand that the prosecuting attorney will make the following recommendation to the judge: _____________________________________________________________________________ _ _____________________________________________________________________________ _ _____________________________________________________________________________ _ 14. I understand that the probation counselor will make the following recommendation to the judge: _____________________________________________________________________________ _ _____________________________________________________________________________ _ _____________________________________________________________________________ _ STATEMENT ON PLEA OF GUILTY (STJOPG) - Page 5 of 6 WPF JU 07.0600 (7/2007) - JuCR 7.7; RCW 13.04.033, 13.40.130, .140 American LegalNet, Inc. www.FormsWorkflow.com 15. Although the judge will consider recommendations of the prosecuting attorney and the probation officer, the judge may impose any sentence he or she feels is appropriate, up to the maximum allowed by law. STATEMENT ON PLEA OF GUILTY (STJOPG) - Page 6 of 6 WPF JU 07.0600 (7/2007) - JuCR 7.7; RCW 13.04.033, 13.40.130, .140 American LegalNet, Inc. www.FormsWorkflow.com 16. The judge has asked me to state in my own words what I did that makes me guilty of this crime. This is my statement: _____________________________________________________________________________ _ _____________________________________________________________________________ _ _____________________________________________________________________________ _ [ ] Instead of making a statement, I agree that the judge may review the police reports and/or a statement of probable cause supplied by the prosecution to establish a factual basis for the plea. 17. I plead guilty to count _________________ in the ____________________________ Information. I have received a copy of that Information. 18. I make this plea freely. No one has threatened to harm me or anyone else to get me to plead guilty. 19. No one has made any promises to make me plead guilty, except as written in this statement. 20. I have read or someone has read to me everything printed above, and in Attachment “A,” if applicable, and I understand it in full. I have been given a copy of this statement. I have no more questions to ask the judge. Dated: _____________________________ ______________________________________ Respondent I have read and discussed this statement with the respondent and believe that the respondent is competent and fully understands the statement. _______________________________________ Deputy Prosecuting Attorney WSBA No. ______________________________________ Attorney for Respondent WSBA NO. _______________________________________ _______________________________________ Type or Print Name Type or Print Name JUDGE’S CERTIFICATE The foregoing statement was signed by the respondent in open court in the presence of his or her lawyer and the undersigned judge. The respondent asserted that [check appropriate box]: (a) (b) (c) The respondent had previously read the entire statement above and that the respondent understood it in full; The respondent’s lawyer had previously read to him or her the entire statement above and that the respondent understood it in full; or An interpreter had previously read to the respondent the entire statement above and that the defendant understood it in full. The Interpreter’s Declaration is attached. I find the respondent’s plea of guilty is knowingly, intelligently, and voluntarily made. Respondent understands the charge and the consequences of the plea. There is a factual basis for the plea. The respondent is guilty as charged. STATEMENT ON PLEA OF GUILTY (STJOPG) - Page 7 of 6 WPF JU 07.0600 (7/2007) - JuCR 7.7; RCW 13.04.033, 13.40.130, .140 American LegalNet, Inc. www.FormsWorkflow.com Dated: _________________________________ ______________________________________ Judge/Commissioner STATEMENT ON PLEA OF GUILTY (STJOPG) - Page 8 of 6 WPF JU 07.0600 (7/2007) - JuCR 7.7; RCW 13.04.033, 13.40.130, .140 American LegalNet, Inc. www.FormsWorkflow.com INTERPRETER’S DECLARATION I am a certified interpreter or have been found otherwise qualified by the court to interpret in the _________________________________ language, which the respondent understands, and I have for the respondent from English into that language. translated the (Identify document being translated) The respondent has acknowledged his or her understanding of both the translation and the subject matter of this document. I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. DATED: Interpreter LOCATION: . American LegalNet, Inc. www.FormsWorkflow.com