CR-226, 12/04 Waiver of Right to Attorney 247247970.02(1)(b) & (6), Wis. Stats.; Art I, Sec. 7, Wis. Const. This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY State of Wisconsin, Plaintiff - vs - Name Date of Birth Waiver of Right t o Attorney Case No. I am asking the court to allow me to represent myself and give up my constitutional right to have an attorney represent me. I understand that if I choose to represent myself today, I may change my mind at any time during this case and may be given an opportunity to have an attorney represent me. I am years old. I have completed years of schooling. I do do not have a high school diploma, GED, or HSED. I am am not presently employed. If employed, state your place of employment and occupation: I do do not read, write, and/or understand the English language. I am not am currently receiving treatment for mental or emotional problems. I have not have received treatment in the past for mental or emotional problems. I have not have had any alcohol, medications (whether prescribed or not) , or drugs within the last 24 hours. I do not do have physical or psychological disabilities that may affect my ability to understand what is happening in court or communicate my position or views on this case to the court. I understand that I have been charged with the following crime(s) that carry the following penalties: Crimes Penalties (minimum and maximum) I understand I have the right to : Have an attorney represent me at all stages of this proceeding. Have an attorney appointed for me by the state public defender if I do not have the money to hire an attorney. Hire my own attorney at my own expense. Ask the court to review a determination by the state public defender that I am not indigent and able to hire my own at torney. Ask the court to find me indigent or partially indigent and appoint a court - appointed attorney for me at county expense if I have been found not eligible for a public defender. I understand I may be required to pay the county for fees paid to the court - appointed attorney. Represent myself and act as my own attorney. Check this box if you have read and understood the above. I understand an attorney would : Represent me and speak on my behalf in court. Advise me about my legal rights and options. Explain and assist me with legal and court procedures. Help me negotiate a settlement of my case with the district attorney. American LegalNet, Inc. www.FormsWorkFlow.com CR-226, 12/04 Waiver of Right to Attorney 247247970.02(1)(b) & (6), Wis. Stats.; Art I, Sec. 7, Wis. Const. This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 Investigate and explore possible defenses to the charges against me that may or may not be readily apparent to me. Prepare and conduct my defense at any motion hearing or trial. File motions on issues of evidence, testimony, and procedures of the police. Assist me at sentencing if I am convicted of any crime. File an appeal, if requested. Check this box if you have read and understood the above. I understand that if I represent myself: The judge cannot be my attorney and cannot give me any legal advice. The district attorney cannot be my attorney and cannot give me legal advice. The judge, district attorney, and court personnel are not required to explain court procedures or the law. The judge cannot treat me differently because I do not have an attorney. I will be required to follow all legal rules and procedures that an attorney would have to follow in court, It may be difficult for me to challenge evidence pre sented by the district attorney, even if my case goes to trial. It may be difficult for me to presen t evidence. If I want to testify I must be sworn as a witness and answer questions from the district attorney. It may be difficult for me to do a good job as my own attorney. Check this box if you have read and understood the above. I am making this decision to represent myself knowingly and voluntarily. No one has made any promises or threats to me, and no one has used any influence, pressure, or force of any kind to get me to not ask for an attorney. No one has told me I should no t ask for an attorney to represent me. I have read, or have had read to me, this entire document. I have truthfully answered and understood all portions of this document. I understand the court process involved in my case so that I can adequately re present myself. I want to give up my right to an attorney. I want to represent myself. Defendant Print or Type Name Date American LegalNet, Inc. www.FormsWorkFlow.com