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FORM 17. (RULES 11 & 43, N.D.R.Crim.P.)

Effective Date: 1/1/2001

STATE OF NORTH DAKOTA IN ______________________
(Name of court)
COUNTY OF ____________  _______ JUDICIAL DISTRICT
The State of North Dakota,
vs. Criminal No. __________



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 year 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 the maximum possible sentence for the offense to which I am pleading guilty is imprisonment of______and a fine of ______ . I understand the mandatory minimum sentence for the offense with which I am charged is imprisonment of ______ and a fine of ______ and the following requirements:_____________.

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.

8. I understand that I have the right to be admitted to reasonable bail.

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.

10. I have fully discussed the charge(s), my constitutional rights, and this petition with my attorney, ____(name of attorney)____.


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.

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.

12. I am pleading guilty freely and voluntarily and without any promises except as indicated in number 13 below.

13. I am pleading guilty based on the following plea agreement with the prosecutor: _____(if none, so state)________________________________________________________.

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.

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.

16. I request to be present at the time of sentencing.


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 _______, 19___.


Signature of Defendant


Printed Name of Defendant

Subscribed and sworn to before me this

____ day of ______, 19__.



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.

Dated this _____ day of ________, ____.


Attorney for Defendant



Judge of District Court

Effective Date Obsolete Date
01/01/2001 View