... SALT.,LAKE.CITY JUSTICE COURT SALT LAKE CITY, UTAH. ~.f: STATEMENT OF DEFENDANT ENTERING A 'GUlL TY PLEA NOTIFICATION OF CHARGES

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1 ,,, ~.f:... SALT.,LAKE.CITY JUSTICE COURT SALT LAKE CITY, UTAH., 0 ~ Name of Defendant Case Number. L STATEMENT OF DEFENDANT ENTERING A 'GUlL TY PLEA z NOTIFICATION OF CHARGES.. '!i... /; I have received and read or had read t~ me, a copy of the Information/Citation wli.iqh--states the crim~(-s) with which I. ~ '~am charged. I understand the charges against me. 'I have no questions about wnat J am accused o~having done WAIVER OF CONSTITUTIONAL RIGHTS -.. I understand that by entering a plea ofgud...ty to a criminal charge, I am waiving several constitutionally protected rights,. ~. including the following:..' COUNSEL:,, I have the right to consult ~ith and be represented by an attorney. If the ju?ge determine. that I am too poor to. be a~le to hire a lawyer, the~ the ju~ge could a~point.one to r~resent'me. I might later, if the judge det] rmined I was able/~e. requrred to pay for tpe appomted lawyer's semce to me.,.. /. ' PRIVELEGE AGAINST SELF-INCRIMINATION: Although I can choose to testify if I wish, I cannot be forced by an.yone to take the witnes~ stand and testify or give evidence against myself. That I choose not to testify c~~ be held against me in court. ~ ~. ~ '. CONFRONTATION & CROSS EXAMINATION OF ACCUSERS: I have a right to see and h~~ in o~en ~~<the witnesses to give evidence against me. If I represent myself, I have the right to ask questions of these witnesses otlfl have an attorney, the attorney has the right to ask questions of these witnesses. I also have the right to have witnesses who will testify on my behalf subpoenaed or called to court at government expense. '. JURY TRIAL: I have a right to a speedy public trial before an impartial jury. Therefore, I can choose to have a jury hear the case against me. Any verdict rendered by a jury, whether it is guilty or not guilty, must be by complete agreement of all Jurors. 4 PRESUMPTION & PROOF: At trial I am presu:med innocent until proven guilty. The burden of proving me guilty of the crime(s) charged against me is upon the prosecution. The prosecution must prove each and every element of a crime beyond a reasonable doubt ~---- APPEAL: If-I plead guilty or no eontest or am tried and. convicted of the crime( s) with which I am charged, I have the right to appeal. I am entitled ~o a trialq(!:izovo (a new trial) in the district court only if I file a notice of appeal.within 30 days of sentencing if convicted or within 30 days of entering' a.plea that is held in abeyance I understand each of these constitutional rights. They have been explained to.me by the judge or by a lawyer, I have no questions about them. I know that I could plead not guilty and exercise all of the rights listed above. I understand that by entering a ple<\., of guilty, I AM GIVING UP ALL OF THESE CONSTITIJTIONAL RIGHTS r... Updated 7/15/10

2 CONSEQUENCES OF F;NTERING A GUILTY PLEA I am admitting that I did commit«e crimes(s) to which I plead guilty. I convict myself the same as if! were found guilty by judge or jury. Where more than one crime is involved, sentences may be imposed one after another (consecutively), or they may run at the same time (concurrently). In sentencing me, the judge is not required to follow what any other person, including the prosecutor, recommends, The judge must impose sentence within the following limits: OFFENSE JAIL FINE Class B Misdemeanor O'to 180 days $0 to $ _(lllus ma:ximum 90% surcharge plus $40 legislative fee) $ 1, Class C Misdemeanor 0 to 90 days $0 to $ (plus ma:ximum 35% surchar2e plus $40 lfll:islative fee) $ 1, Infraction None $0 to $ (plus maximum 35% surchar2e plus $40 lfll:islative fee) S 1, ENTRY OF GUILTY PLEA Of my own choice, I enter this plea. No force, promises, or threats have been made to get me to enter this plea. I am not under the lnfluence of alcohol or drugs or anything that would impair my judgment right now. I have read tbis document or had it read to me. I understand its contents and adopt each statement in it as my own: By signing this document, I am saying that I ENTER A PLEA OF GUILTY TO (offense and class):_ ":. -. ;. I understand.that if! want to withdraw my guilty or no contest plea(s ), I inust tile, a written motion to withdraw my plea(s) before sentence is announc.e<:l. "I understand that for a plea held in abeyance, I waive the 45 days to be sentenced and a motion to withdraw from the plea agreement must be 1!\ade within 30 days of pleading guilty or no contest. I will only be allowed to withdraw my plea if! show that it was not knowingly and voluntarily made. I understand that any challenge to my plea(s) made after sentenced must be pursued under the Post-Conviction Remedies Act in Title 78, Chapter 35a, and Rule 65C of the Utah Rules of Civil Procedure... STIPULATION TO NOTICE BY MAIL I agree that notices from the court while tbis case is pending may-be sent by US mail to the address below. I agree to notify the court in writing of any address change within 10 days of the change. The prosecution will be required to send notice by US mail to the address that I am required to provide the court. My failure to comply with this stipulation may result in the issuance of a warrant for my arrest, by the court. SIGNATURE ACKNOWLEDGING AND INCORPORATING ALL OF THE ABOVE Date Defendant's Signature Street Address City I State I Zip Defense Attorney Salt Lake City Justice Court Judge By my signature, I hereby find that the defendant has knowingly and voluntarily entered a GUlL TY or NO CONTEST plea or pleas. Updated

3 I Salt Lake City Justice Court SALT LAKE CITY, UTAH (Defendant's nam~please print) (Case number) DEFENDANT'S WAIVER OF COUNSEL (Defendant: please read and initial each paragraph and sign at the end of the form) 1. I understand that I have a constitutional right to be represented by a lawyer in this case. 2. I understand that I can ask the Court to appoint a lawyer to represent me. If I am indigent, I have the right to a court-appointed lawyer paid for by the government. 3. I understand that I have a right to represent myselfby acting as my own attorney in this case. 4. I have studies law. Yes No 5. Ifl have studied lak, here is a summary of the courses I have taken. 6. I have represented myself before in a criminal case. Yes No 7. I understand that I have been charged with the following crime(s): I. II. m. IV. v. 8. I understand that ifl am found guilty for any crime listed in paragraph 7, the court could sentence me to as much as the amounts circled below: Jail Time Fine I days $1,000 $750 plus 90% surcharge II days $1,000 $750 plus 90% surcharge III days $1,000 $750 plus 90% surcharge IV days $1,000 $750 plus 90% surcharge v days $1,000. $750 plus 90% surcharge 9. I understand that ifl am found guilty of more than one crime, the court can order that the sentences be served consecutively, one after another. Updated 7/15/10

4 10. I understand that ifl represent myself, I am on my own. The court cannot tell me how to try my case or even advise me how to try my case. 11. I am familiar with the Utah Rules of Evidence. Yes No 12. Ifl have a trial, I understand that the Rules of Evidence control what evidence may or may not be introduced at trail. 13. I understand that if I represent myself, I must follow the Rules of Evidence. 14. I am familiar with the Utah Rules of Criminal Procedure. Yes No 15. If I have a trial, I understand that the Rules of Criminal Procedure control the way that a criminal case is tried in court. 16. I understand that if I represent myself, I must follow the Rules of Criminal Procedure. 17. I understand I have a constitutional right not to testify against myself. 18. Ifl have a trail and choose to testify, I understand that I must testify by asking questions of myself and then answering the questions. I understand that I cannot just take the stand and tell my story. I must proceed question by question through my testimony. 19. I understand the penalties that I might suffer ifl am found guilty. I also understand that there are great difficulties in representing myself. However, it is still my desire to represent myself and to give up the right to be represented by a lawyer. Yes No 20. The decision to represent myself is entirely voluntary on my part. Yes No 21. I have read this two-page Waiver of Counsel form or have had someone read it to me. I have initialed each paragraph of this form and sign below to indicate that I have reviewed each item on this form and understand its contents. DATEDthis.dayof, 20 Defendant's Signature Updated 711 5/ 10

5 SALT LAKE CITY JUSTICE COURT PERSONAL INFORMATION AFFIDAVIT To ensure ~hat the Court's records are current, you are required to complete the following affidavit. You are signing at the bottom under the penalties of perjury. Any false statements will place you in contempt of court and subject you to criminal liability. COMPLETE NAME (Printe~> Date of Birth (mm/dd/yy): Driver's License Number: Contact Address: City, State, Zip Code Telephone Number (Home):..:... (Work) (Other). Soc. Sec. Number: Family, Friend or Work Contact (Name): If you are pleading NOT GUlL TY and asking for a court-appointed attorney to represent you, you must answer these questions under oath; 1. Do you work full time? YES NO 2. What kind of work do you do? If part-time work, how many hours do you work, on average? How much are you paid by the hour? How many family members do you support? Do you help support anyone outside the United States? YES NO 7. If you unemployed, bow do you support yourself? How long have you been unemployed? What job/earning skills do you have?----: Do you live with your parents? Do you pay rent or expenses to them? How much per month? What other sources of income do you have that you have not disclosed above? Describe any extraordinary expenses: I swear or affirm under penalties of contempt and perjury that the information given above is complete, accurate and truthful. DATE: Approved: Denied: SIGNATURE: Judge: INFORMATION IN TIDS DOCUMENT IS PROTECTED AND CANNOT BE DISSEMINATED Updated 7/15/10

6 PLEA IN ABEYANCE WARNING AND WAIVER My Name: Case #: I agree with the following terms about my Plea in Abeyance: If the time period for my plea in abeyance has expired and I have not followed the judge's orders, the judge can change my plea in abeyance to a conviction without giving me notice. Ir my plea in abeyance is changed to a conviction, the judge will not issue a warrant for my arrest. A conviction will be entered and the case will be closed. Not more than five days after my plea in abeyance is changed to a conviction, the judge will send me notice of the change to the last address I gave to the court. If I don't agree with the judge changing my plea in abeyance to a conviction, I need to file a written appeal at the Justice Court within 30 days of the day it changed to a conviction and then my case will be. sent to the District Court. OR If I do not file a written appeal within 30 days, I will have one year from the day my plea in abeyance changed to a conviction to ask for a hearing. At the hearing I will have a chance to show that I did follow the judge's orders or that I had a good reason that I did not follow the judge's orders. If the judge changes the conviction back to a plea in abeyance, the judge will tell BCI of the change. This waiver does not apply if the judge wants to add fines or jail on my case. To add fines or jail, the judge has to give me written notice and give me the chance to have a hearing in court. Defendant Prosecutor Defense Attorney Judge, Salt Lake Justice Court Updated 7/1 5110