FORM 17. (RULES 5, 11 & 43, N.D.R.Crim.P.)
STATE OF NORTH DAKOTA IN DISTRICT COURT
COUNTY OF ________________ CRIMINAL NO. ___________________
THE STATE OF NORTH DAKOTA,
PLEA OF GUILTY
TO: THE ABOVE-NAMED COURT:
I wish to plead guilty in this case and I state to the Court the following:
1. I am the Defendant in this case, my full name is _________________ and my date of birth is ______________.
2. I am charged with _____(name of offense)_____ in violation of _________(statute or ordinance)____.
3. I plead guilty to the offense of ____ (name of offense)____ in violation of ____ (statute or ordinance)____.
4. I am pleading guilty because on ____(date)____ in the City of ___________, County of _______, and State of North Dakota I committed the following acts: ____(state sufficient facts to establish a factual basis for all elements of the offense to which the defendant is pleading guilty)______.
5. I understand
that the maximum possible sentence for the
misdemeanor offense to which
I am pleading guilty is _____ days imprisonment of______________
or and a fine of
___ (amount)___ . or both, and that the Court may impose a
sentence of imprisonment of not
less than _____ days imprisonment or a fine of ________ or both (if a minimum sentence
is required by statute). I understand the mandatory minimum sentence for the
which I am charged is imprisonment of ______ and a fine of ______ and the following
6. I understand that a person convicted of a crime who is not a United States citizen may be removed from the United States, denied citizenship, and denied admission to the United States in the future.
7. I understand that I may be ordered to pay restitution.
6 8. I understand that I have the right to be admitted to reasonable
7 9. RIGHT TO AN ATTORNEY. I understand that I have the
right to be represented by
an attorney and that an attorney will be appointed to represent me to the extent that I am
unable to pay for my own defense without undue hardship.
8 10. I have fully discussed the charge(s), my constitutional rights,
and this petition with my
attorney, ____(name of attorney)____.
8a 10a. WAIVER OF ATTORNEY. I give up my right to be
represented by an attorney and
any right I might have to request that an attorney be appointed to represent me.
9 11. I understand that I also have the following constitutional
rights which I knowingly and
voluntarily give up:
a. The right to a trial by jury in which I am presumed innocent until proven guilty beyond a reasonable doubt, and all jurors must agree.
b. The right to confront and cross-examine all witnesses against me.
c. The right to remain silent, or to testify for myself.
d. The right to subpoena and present witnesses to testify for me in my defense.
e. The right to a pretrial hearing to contest the admissibility at trial of any confessions or admissions, or of any evidence obtained from a search and seizure.
10 12. I am pleading guilty freely and voluntarily and without any
promises except as
indicated in number 11 13 below.
11 13. I am pleading guilty based on the following plea agreement
with the prosecutor:
_____(if none, so state)________________________________________________.
12 14. I understand that if the Court does not approve this
agreement I have the right to
withdraw my plea of guilty and have a trial.
13 15. I understand that if this plea of guilty is accepted I have the
right to be present at the
time of sentencing and to speak and to present evidence on my behalf.
14 16. I request to be present at the time of sentencing.
14a 16a. I knowingly and voluntarily give up my right to be
present upon (entry of my plea
and) sentencing and request that the court sentence me in my absence, but according to any
plea agreement that might be contained in this petition.
Dated this ____ day of _______,
Signature of Defendant
Printed Name of Defendant
Subscribed and sworn to before me this
____ day of ______,
I, ___(name of attorney)___ state that I am the attorney for the defendant in this criminal
action; that I personally explained the contents of the above petition to the defendant
that I personally observed the defendant date and sign the above petition.
Dated this _____ day of ________,
Attorney for Defendant
PETITION AND PLEA OF GUILTY ACCEPTED BY
(District Court )Date