JD-1735, 03/12 Plea Questionnaire/Waiver of Rights (CHIPS and JIPS) 24724748.243, 48.30, 938.243 and 938.30, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 I am the child/juvenile. parent. guardian. legal custodian. Indian custodian. I intend to enter an admission or no contest plea to the child in need of protection or services (CHIPS) or juvenile in need of protection or services (JIPS) grounds as follows: Ground/Statute Plea Ground/Statute Plea Admit No Contest Admit No Contest Admit No Contest Admit No Contest See attached sheet for additional grounds. I am years old. I am in/have completed the grade in school. I do do not understand the English language. I do do not understand the ground(s) to which I am pleading. I am not am currently receiving treatment for a mental illness or disorder. have not have had any alcohol, medications, or drugs within the last 24 hours. If any, please list: Waiver of Rights I understand that by entering this plea, I give up the following rights: I give up my right to a court trial in a JIPS case or a jury trial in a CHIPS case. I give up my right to remain silent and I understand that silence of any party may be relevant. I give up my right to present evidence at trial. I give up my right to use subpoenas to require witnesses to come to court and testify for me at trial. I give up my right to confront in court the people who testify against me and cross - examine them. I give up my right to have the allegations in the petition proved by clear and convincing evidence. I understand the rights that have been checked and give them up of my own free will. Understandings I understand the nature of the acts alleged in the petition and the potential dispositions. I understand that this waiver gives the judge authority to enter orders that may affect me. I understand that the judge does not need to follow any plea agreement or recommendation. I understand that if the judge accepts my plea, the child/juvenile will be found in need of protection or services based upon the facts in the petition or as stated in court. I understand that if I am not represented by an attorney, that an attorney may discover defenses or mitigating circumstances which would not be apparent to me. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Plea Questionnaire/ Waiver of Rights (CHIPS and JIPS) Case No. American LegalNet, Inc. www.FormsWorkFlow.com JD-1735, 03/12 Plea Questionnaire/Waiver of Rights (CHIPS and JIPS) 24724748.243, 48.30, 938.243 and 938.30, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 Voluntary Plea I have decided to enter this plea of my own free will. I have not been threatened or forced to enter this plea. No promise s have been made to me other than as follows: See attached Statement I have reviewed and understand this entire document and any attachments. I have reviewed it with my attorney , if any . I have answered all questions truthfully and either I or my attorney checked the boxes. I am asking the judge to accept my plea and find that the child/juvenile is in need of protection or services. Signature Date (If applicable) I am the attorney for the person completing this document. I have discussed this document and any attachments with my client. I believe my client understands it and any plea agreement. My client is making this plea knowingly, v oluntarily, and intelligently. Attorney Date American LegalNet, Inc. www.FormsWorkFlow.com