Fill and Sign the Delinquency Waiver of Counsel Form

NHJB-2213-DF (07/01/2015) Page 1 of 2 THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http://www.courts.state.nh.us Court Name: Case Name: Case Number: (if known) DELINQUENCY WAIVER OF COUNSEL I , of have been charged with before said Court. I have h ad explained to me at arraignment (my first court hearing) my right to be represented by an attorney. I under stand that representation by an attorney would include counsel and investigative, expert, and other services, includi ng process to compel the at tendance of witnesses. I understand that if I am financially un able to pay for an attorney by myself, the Cour t will appoint one to represent me. I have been advised by the court that I may ask to have an attorney appointed to consult with me about the decision to waive counsel and that appointment of counsel for this purpose is not subject to a repayment requirement and wo uld cost me nothing. I am here with my Parent Guardian Custodian The above person is “non-hostile” and is not the victim or complaining witness in this or any other case against me AND s/he agrees wi th me that I should give up my right to have an attorney. I have had the charges agains t me fully explained. I understand that the char ge against me would be a FELONY if committed by an adult. I understand that the char ge against me would be a CLASS A MISDEMEANOR if committed by an adult. I understand that the char ge against me would be a CLASS B MISDEMEANOR if committed by an adult. I understand that if I waive (giv e up) my right to have an attorney and if the Court finds I have committed the above offense(s), penalties may include: placement on conditional release; attendance at individual or fami ly counseling; release in the care and supervision of a relative, group home, or crisis hom e; the payment of a fine up to $250, restitution or both in cases of delinquency; and/or loss or denia l of driver's license for a minimum of 90 days but not more than a year. I understand what I am doing. I DO NOT want an attorney and hereby waive (give up) my right to have an atto rney represent me. Signature of Juvenile Date Signature of Parent/Guardian/Custodian Case Name: Case Number: DELINQUENCY WAIVER OF COUNSEL NHJB-2213-DF (07/01/2015) Page 2 of 2 ORDER The undersigned Judge, having asked the juvenile if s/he understands the charge(s) against him/her, the possible penalties whic h the Court may order and the possible consequences of the waiver of the right to counse l, is satisfied that s/he fully understands his/her right to have an attorney represent him/her and, if indigent, to have an attorney appointed by the Court. The Court also discussed, with the juvenile and parent(s) the right to consult with an attorney, at no charge, whether to request or waive counsel and is satisfied that the right was waived com petently, voluntarily and with full understanding of the consequences. The Court makes the following case specific findings: The juvenile is repres ented by a non-hostile parent, guardian, or custodian. The juvenile and his/her parent(s), guardi an, or custodian agree to waive counsel. In the Court’s opinion the waiver is made competently, voluntarily and with full understanding of the consequences. The petition against the minor does not allege a violation of First Degree Assault, RSA 631:1; Second Degree Assault, RSA 631:2; Burglary, RS A 635:1 or any violation of Homicide, RSA 630; Sexual Assault, RSA 632-A; Interference with Freedom, RSA 633; or Robbery, RSA 636. The prosecution has informed the court that it does not intend to seek certification of the juvenile pursuant to RSA 169-B: 24, 25 or any other provision of law permitting adult prosecution of the juvenile. The Court has NOT rece ived information indicating that the minor has an intellectual, cognitive, emotional, learning or sensory disability. A verbatim record has been ma de of the waiver of counsel proceeding and all subsequent proceedings in this case shall also be recorded. : Accordingly the Court: Accepts the juvenile’s waiver of counsel OR Declines to accept the juvenile’s waiver of counsel Judge’s additional notes and observati ons supporting the above finding: Date Signature of Judge Printed Name of Judge