Fill and Sign the Dui Guilty Plea Kentucky Court of Justice Form

1. I, ________________________________________ hereby waive service of process and voluntarily enter my appearance in the action. 2. Citation Number ____________________________, charges me with the follow\ ing offense(s): _________________________________________________________________________\ ________________ ________________________________________________________________________\ _________________. 3. I plead guilty to the above-charged offense(s). 4. As further evidence of my intent to plead guilty, I am posting a performance bond in the amount of $______ ____ to cover the possible court costs, fees, and fines in the action which may be assessed against me by the trial court. I realize that when judgment is entered in the action, the money deposit\ ed for the bond will be applied toward my court costs, fees, and fines, and the balance, if any, will be returned by mail to me at: Address: __________________________________ __________________________________ __________________________________ __________________________________, 2_____ ____________________________________________ Date Defendant's Signature AOC-480 Doc. Code: BP Rev. 6-17 Page 1 of 1 Commonwealth of Kentucky Court of Justice www.courts.ky.gov ENTRY OF APPEARANCE AND PLEA OF GUILTY (PERFORMANCE BOND) lex et justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE Case No. ____________________ Court ____________________ County ____________________ Division ____________________ Distribution: Court File Defendant TO BE COMPLETED BY COURT CLERK AND MAILED TO DEFENDANT: TO THE ABOVE-NAMED DEFENDANT, This is to inform you judgment has been entered against you by the District Court of ______________________ County on the _____ day of __________________, 2_____, in the amount of $__________ (court costs, fees, and fines) for violation of KRS _________________________________________________________________\ ______________. This judgment was satisfied by application of the money you deposited as a performance bond. After application of the bond to the court costs, fees, and fines, $__________________ remained. This amount is being returned to you. _______________________________________ Clerk By: _____________________________________ D.C. ------------------------------------------------------------------------\ -------- [Give statute number(s) or describe offense(s) charged]