FORM 15. (RULE 17.1, N.D.R.Crim.P.)

(INSTRUCTIONS: If an item numbered below is not applicable to this case, then counsel will note the same in the margin opposite the item number with the letters "N.A.") CAUTION: In exchange for items of discovery requested under subdivision (A) defendant waives his right to remain silent on those issues and agrees to furnish the prosecution with similar information requested by the prosecution and which the defendant intends to use at the trial on that issue.[See Rule 16(c).]

A. DISCOVERY BY DEFENDANT [Circle appropriate response]

1. The defendant states he [has] [has not] obtained full discovery and [has] [has not] inspected the Prosecution file. (If Prosecution has refused discovery of certain materials, Defendant's counsel shall state nature of such material.)

_____________________________________________________

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2. The Prosecution states it [has] [has not] disclosed all evidence in its possession, favorable to defendant on the issue of guilt.

3. The defendant requests and moves for: [Circled sub-paragraph shows motion requested]

a. Discovery of all oral, written or recorded statements or memorandum of them made by Defendant to investigating officers or to third parties and in the possession of the Prosecution.

(Granted) (Denied) ________________________________

Magistrate (Date)

b. Discovery of the names of the Prosecution's witnesses and their statements.

(Granted) (Denied) ________________________________Magistrate (Date)

c. Inspection of all physical or documentary evidence in Prosecution's possession.

(Granted) (Denied) ________________________________Magistrate (Date)

4. Defendant, having had discovery of items 2 and 3a, 3b and 3c, requests and moves for discovery and inspection of all further or additional information coming in to the Prosecution's possession as to Items 2 and 3a, 3b, and 3c between this conference and trial.

(Granted) (Denied) ____________________________________Magistrate (Date)

5. The defendant moves and requests the following information, and the Prosecution states:(Circle the appropriate responses)

a. The Prosecution [will] [will not] rely on prior acts or convictions of a similar nature for proof of knowledge or intent. Defendant stipulates to the following prior convictions, but reserves the right to object (on grounds other than authenticity) to their introduction in evidence at trial):

Date of Conviction _______ Offense _______

Date of Conviction _______ Offense _______

Date of Conviction _______ Offense _______

Date: _______

____________________________________

Defendant

____________________________________

Attorney for Defendant

b. The Prosecution [will] [may] [will not] call expert witnesses to testify. The name of each witness, his qualifications, the subject of his testimony, and his reports [have been] [will be] supplied to the defendant.

c. Reports of physical or mental examinations in the control of the Prosecution [have been] [will be] supplied to defendant.

d. Reports of scientific tests, experiments or comparisons and other reports of experts in the control of the Prosecution, pertaining to this case [have been] [will be] supplied to defendant.

e. Inspection and or copying of any books, papers, documents, photographs or tangible objects which the prosecution:

(1) obtained from or which belong to defendant, or

(2) which will be used at the hearing or trial,

[have been] [will be] supplied to defendant.

f. Information in the Prosecuting Attorney's possession concerning a prior conviction of any person the Prosecution intends to call as a witness at the hearing or trial [has been] [will be] supplied to defendant.

g. The Prosecution [will] [may] [will not] use any prior felony conviction for impeachment of defendant if he testifies.

Date of Conviction _______ Offense _______

Date of Conviction _______ Offense _______

Date of Conviction _______ Offense _______

Defendant stipulates to such prior convictions, but reserves the right to object (on grounds other than authenticity) to their introduction in evidence at trial.

Date: _______

________________________________

Defendant

_________________________________

Attorney for Defendant

6. The Prosecution states that:

a. Proceedings before the grand jury [were] [were not] recorded.

b. Transcription of the grand jury testimony of the accused, and all persons whom the prosecution intends to call as witnesses at a hearing or trial [have been] [will be] [will not be] supplied. The defendant [moves] [does not move] for the production of transcripts of such testimony.

7. The Prosecution states that:

a. There [was] [was not] an informer (or lookout) involved.

b. The informer [will] [will not] be called as a witness at the trial.

c. It [has] [has not] given defendant the name, address and phone number of the informer.

d. It will claim privilege of nondisclosure. The defendant moves for the disclosure of the name of such informer. The hearing on the motion will be set before a Magistrate upon notice.

8. The Prosecution states that there:

a. [has] [has not] been any electronic surveillance of the defendant or his premises.

b. [has] [has not] been any lead obtained by electronic surveillance of defendant's person or premises.

9. Any information the Prosecution has, indicating entrapment of defendant, [has been] [will be] supplied to defendant.

B. DISCOVERY BY THE PROSECUTION

The Prosecution requests the following discoverable items moved for and granted to the defendant under subdivision (A):

________________________________________________________________

________________________________________________________________

The following statements are made by the defendant in response to the Prosecution's request:

10. Competency, Insanity and Diminished Mental Responsibility.

a. There [is] [is not] any claim of incompetency of defendant to stand trial.

b. Defendant [will] [will not] rely on a defense of insanity at the time of the offense.

c. Defendant [has] [has not] supplied the name of his witness, both lay and professional, on the issue.

d. Defendant [has] [has not] permitted the Prosecution to inspect and copy all medical reports under his control or the control of his attorney.

e. Defendant [will] [will not] submit to a psychiatric examination by a court-appointed doctor on the issue of his sanity at the time of the alleged offense.

11. Alibi.

a. Defendant [will] [will not] rely on an alibi.

b. Defendant [has] [has not] furnished the Prosecution a list of his alibi witnesses (but desires to be present during any interview of such witness).

12. Scientific Testing.

a. Defendant [has] [has not] furnished the Prosecution the results of scientific tests, experiments or comparisons and the names of the persons who conducted the tests.

b. Defendant [has] [has not] provided the Prosecution with all records and memoranda constituting documentary evidence respecting such tests in his possession or under his control or [has] [has not] disclosed the whereabouts of said material. If such documentary evidence is not available but destroyed, the defendant [has] [has not] stated the time, place and date of said destruction and the location of reports, if any, concerning the destruction.

13. Nature of Defense.

a. Defendant states that his defense includes: (circle appropriate response)

(1) lack of knowledge of contraband

(2) alibi

(3) diminished mental responsibility

(4) entrapment

(5) self-defense

(6) general denial.

Defendant [will] [will not] offer evidence after Prosecution rests.

b. Defendant [will] [will not] waive husband and wife privilege.

c. Defendant [will] [may] [will not] testify.

d. Defendant [will] [may] [will not] call additional witnesses.

e. Defendant [will] [will not] call character witnesses.

f. Defendant will supply the Prosecution names, addresses, and phone numbers of additional witnesses for defendant _______ days before trial.

14. Defendant's counsel states that: [circle appropriate response]

a. As of the date indicated below he [does] [does not] know of any problems involving delay in arraignment, the Miranda Rule or illegal search and seizure or arrest, or any other constitutional problem, except as set forth above.

b. He has inspected this form, and [does] [does not] know of any motion or matter that defendant desires to present to the Court, other than those indicated on this form.

c. There [is] [is not] [may be] a probability of a disposition of this case without trial.

d. Defendant [will] [will not] waive a jury and ask for a court trial.

C. MOTIONS REQUIRING SEPARATE HEARING BEFORE MAGISTRATE

15. The defendant moves: [circled subparagraph shows motion requested]

a. To suppress physical evidence in the Prosecution's possession on the grounds of: [circle appropriate response]

(1) illegal search and seizure

(2) illegal arrest

The hearing on such motion to suppress will be set before a Magistrate upon notice.

(Defendant will file a formal motion to suppress such evidence accompanied by a memorandum brief within _______ days. The Prosecution will file a responsive memorandum brief within _______ days after receipt of defendant's brief.)

b. To suppress admissions or confessions made by defendants on grounds of: [circle appropriate subparagraph]

(1) delay in arraignment

(2) coercion or unlawful inducement

(3) violation of the Miranda Rule

(4) unlawful arrest

(5) improper use of lineup (Wade, Gilbert, Stovall decisions)

(6) improper use of photographs

The hearing on such motion to suppress is set for:

(1) date of trial, or

(2) upon notice.

c. All material uncovered during the course of surveillance [will] [will not] be supplied to defendant. The defendant [moves] [does not move] for the production of such material. The hearing on the motion will be set before a Magistrate upon notice.

(MOTIONS MADE IN THE COURSE OF THIS OMNIBUS HEARING PURSUANT TO RULE 12(b)(3), N.D.R.Crim.P., ARE DEEMED TO HAVE BEEN TIMELY MADE)

16. The defendant moves: [circled paragraph indicates the motion]

a. To dismiss for failure of the indictment or information to state an offense.

(Granted) (Denied) ________________________________ Magistrate(Date)

b. To dismiss the indictment or information (or count _______ thereof) on the ground of duplicity.

(Granted) (Denied) _______________________________ Magistrate(Date)

c. To sever case of defendant _______ and for a separate trial.

(Granted) (Denied) ________________________________ Magistrate(Date)

d. To sever count _______ of the indictment or information and for a separate trial thereon.

(Granted) (Denied) ________________________________ Magistrate(Date)

e. For a Bill of Particulars.

(Granted) (Denied) ________________________________ Magistrate(Date)

f. To take a deposition of witness _______ for testimonial purposes and not for discovery.

(Granted) (Denied) ________________________________ Magistrate(Date)

g. To require Prosecution to secure the appearance of witness _______ who is subject to Prosecutorial direction at the trial or hearing.

(Granted) (Denied) ________________________________ Magistrate(Date)

h. To dismiss for delay in prosecution.

(Granted) (Denied) ________________________________ Magistrate(Date)

i. To inquire into the reasonableness of bail.

Amount fixed _______.

(Affirmed)

(Modified to _______) _____________________________

Magistrate(Date)

j. To continue the trial of the case.

(Granted) (Denied) ________________________________

Magistrate(Date)

k. To change the venue of the trial.

(Granted) (Denied) ________________________________

Magistrate(Date)

17. The Prosecution moves that the defendant: [circle appropriate paragraph]

a. Appear in a lineup.

(Granted) (Denied) ________________________________

Magistrate(Date)

b. Speak for voice identification by witness.

(Granted) (Denied) _______________________________ Magistrate(Date)

c. Be fingerprinted.

(Granted) (Denied) ________________________________ Magistrate(Date)

d. Pose for photographs (not involving a reenactment of the crime).

(Granted) (Denied) ________________________________

Magistrate(Date)

e. Try on articles of clothing.

(Granted) (Denied) ________________________________

Magistrate(Date)

f. Surrender clothing or shoes for experimental comparison.

(Granted) (Denied) ________________________________

Magistrate(Date)

g. Permit the taking of specimens of material under fingernails.

(Granted) (Denied) ________________________________

Magistrate(Date)

h. Permit the taking of samples of blood, hair and other materials of his body which involves no unreasonable intrusion.

(Granted) (Denied) ________________________________

Magistrate (Date)

i. Provide samples of his handwriting.

(Granted) (Denied) _______________________________

Magistrate(Date)

j. Submit to a physical external inspection of his body.

(Granted) (Denied) ________________________________

Magistrate(Date)

D. STIPULATIONS

Stipulations shall be executed by defendant, his counsel and the prosecuting attorney and shall be attached hereto and filed at the Omnibus Hearing. Witness lists will be exchanged prior to trial.

E. Trial Date and Time: ________________________________

Trial Place: ________________________________________

F. Trial by [Court] [Jury] Ordered.

G. Estimated Trial Time: _______________________________

H. _____________________________________________________ _________________________________________________________________

_________________________________________________________________

_________________________________________________________________

APPROVED: This _______ day of _______, 19__.

_________________________________

Prosecuting Attorney

_________________________________

Attorney for Defendant

__________________________________

Defendant

SO ORDERED:

_______________________________

Magistrate

Date: ______

*City of _______.

**Before ____________________

(name of Judge)