Fill and Sign the Have Been Sentenced Form

THE ST A TE O F NEW H A M PSHIRE JUDI CI AL BR AN C H Cour t Na m e: Ca se Nam e: Ca se Num ber: (if k now n) JUVEN ILE ACKNOWLEDGM ENT AN D W AIVER OF R IGHT TO JUR Y TR IAL I , hav e been sente nced after a contested adj ud icatory hear ing and a f indi ng of tr ue on the ch ar ges of the j uveni le peti tion. Par t of my sentence includes suspended, deferred, or im posed incarcer ation at an a dult facilit y. I UNDE RST AND that I cannot be comm itted to an adul t facilit y without f irst being aff orded the right to a jury tr ial, o r waiving m y rig ht to a jury tr ial. I am repr esented by , a l awyer admi tted to pr acti ce l aw in the State o f N ew H ampshi re. I am sati sfied w ith my lawyer and al l ex planati ons hav e been cl ear . I UNDE RS TAND th at I d o not have to w aive (give up) m y righ t to a ju ry trial. I UNDE RS TAND th at b y wa iving m y righ t to a jury trial I a m gi vin g u p the follo wing co nstitu tio nal rights: MY R IGH T under the C onsti tuti on of the U nited States and the N ew H ampshi re C onsti tuti on to be tr ied by an i mpar tial jury. MY RIGH T to hav e a tw elve-per son j ury decide w hether the char ges ag ainst me ar e tr ue o r not tr ue by a unani mo us v erdict. MY R IGHT to t esti fy or not to testi fy be fore a j ury. I f urther under sta nd that if I elect not to t esti fy befor e a j ury, my silence coul d not be use d ag ainst m e by the j ury. No force has been us ed upon m e, nor hav e any thr eats been made to me by any member o f the Pr osecutor 's Off ice or any one el se to hav e me w aive my right to a j ury tr ial. I UNDE RS TA ND th e en tire con ten t of this A ckn owledgm ent a nd W aiver o f Righ t to Jury T rial, and I freel y and v oluntar ily sig n thi s form bel ow . I al so under stan d that I m ay hav e a cop y of thi s form upo n r equest. Date J uvenile Par ent / Guardia n / Custod ian NHJB-2252-DF (12/06/2006) Page 1 of 2 (formerly AOC 333-045) I Case Name: Case Nu mb er: JUV ENIL E ACKNOW LEDGMENT AND W AIVER OF RIGHT TO JURY TRIAL As couns el for the j uveni le, I hav e thor oughly ex plained to th e j uveni le al l o f th e a bove. bel ieve the j uveni le fully under sta nds t he m eani ng o f this Acknow ledg men t an d W aiver o f R ight t o Jur y T rial, and th at h e/she i s not und er th e i nflue nce o f dr ug s or alcohol , and th at h e/sh e know ingly and i ntellig ently w aives his/her rig ht to a jury trial. Date Attor ney for the Juven ile I her eby cer tify that I h ave ex ami ned t he j uvenile concer ning thi s Ac know ledg ment a nd W aiver . Based upo n tha t ex am inati on, I f ind th at th e j uveni le under stands his/her right to a j ury tri al. I f ind t hat the juv enile is not un der the in fluence o f drug s or alcohol and h e/she int ellig ently , know ingly and voluntar ily waives hi s/her right to a j ury tr ial. Dat e Sign ature of Judg e P rinted Name of Judge NHJB-2252-DF (12/06/2006) Page 2 of 2 (formerly AOC 333-045)