Statement of Defendant on Plea of Guilty

Statement of Defendant on Plea of Guilty

1. My true name is

2. My age is

3. The last level of education I completed was:

4. I Have Been Informed and Fully Understand that:

(a) I have the right to representation by a lawyer and that if I cannot afford to pay for a lawyer, one will be provided at no expense to me.

(b) I am charged with:

In count(s) , the defendant committed the offense against another family or household member as defined in RCW 10.99.020.

The elements are:

as set out in the charging document.

as follows:

5. I Understand That I Have the Following Important Rights, and I Give Them All Up by Pleading Guilty:

(a) The right to a speedy and public trial by an impartial jury in the county where the crime is alleged to have been committed;

(b) The right to remain silent before and during trial, and the right to refuse to testify against myself;

(c) The right at trial to hear and question the witnesses who testify against me;

(d) The right at trial to testify and to have witnesses testify for me. These witnesses can be made to appear at no expense to me;

(e) I am presumed innocent unless the charge is proven beyond a reasonable doubt or I enter a plea of guilty;

(f) The right to appeal a finding of guilt after a trial.

6. In Considering the Consequences of My Guilty Plea, I Understand That:

(a) My right to appeal is limited.

(b) The crime with which I am charged carries a maximum sentence of days in jail and a $ fine.

(c) The prosecuting authority will make the following recommendation to the judge:

(d) The judge does not have to follow anyone’s recommendation as to sentence. The judge can give me any sentence up to the maximum authorized by law no matter what the prosecuting authority or anyone else recommends.

(e) The judge may place me on probation for up to five (5) years if I am sentenced for a domestic violence offense or under RCW 46.61.5055, or up to two (2) years for all other offenses and impose conditions of probation.

(f) The judge may require me to pay costs, fees and assessments authorized by law.

(g) If I am not a citizen of the United States, a plea of guilty to an offense punishable as a crime under state law may be grounds for deportation, exclusion from admission to the United States, or denial of naturalization pursuant to the laws of the United States.

Notification Relating to Specific Crimes: If any of the Following Paragraphs Apply, the Box Should Be Checked and the Paragraph Initialed by the Defendant.

(h) The crime of has a mandatory minimum sentence of days in jail and $ fine plus costs and assessments.

(i) The crime of prostitution, indecent exposure, permitting prostitution and patronizing a prostitute has a mandatory assessment of $ .

(j) If this crime involves patronizing a prostitute, a condition of my sentence will be that I not be subsequently arrested for patronizing a prostitute or commercial sexual abuse of a minor.

(k) If this crime involves a sexual offense, prostitution, or a drug offense associated with hypodermic needles, I will be required to undergo testing for the human immunodeficiency (HIV/AIDS) virus.

(l) This plea of guilty will result in suspension or revocation of my driving license or privilege by the Department of Licensing for a minimum period of

(m) I understand that RCW 46.20.265 requires that my driver’s license be revoked if the current offense falls under specified chapters and age conditions.

(n) If I am convicted under RCW 26.50.110, the court shall impose a mandatory fine of $ .

(o) I may not possess, own, or have under my control any firearm, and under federal law any firearm or ammunition, unless my right to do so is restored.

(p) If this crime involves a violation of Title 77 RCW, the Department of Fish and Wildlife may suspend or revoke my privileges.

(q) If this crime involves a drug offense, my eligibility for state and federal education benefits will be affected.

(r) This plea of guilty is considered a conviction under RCW 46.25.010 and I will be disqualified from driving a commercial motor vehicle.

(s) If this case involves DUI, I have been informed and understand that I will be subject to:

the penalties described in the “DUI” Attachment or the “Washington State Misdemeanor DUI Sentencing Attachment.”

OR

these penalties: Mandatory minimum sentence:

• days in jail.

• days of electronic home monitoring.

• $ monetary penalty.

• If 24/7 sobriety program is available, if I have 2 prior offenses, a 6-month period of 24/7 sobriety program monitoring; or 6 months of ignition interlock device requirement; or both.

• Comply with the rules and requirements of the Department of Licensing regarding the installation and use of a functioning ignition interlock device on all motor vehicles that I operate.

• The Department of Licensing will suspend or revoke my driving privilege for the period of time stated in paragraph 6(l).

If I have no prior offenses: instead of the minimum jail term, the judge may order me to serve days in electronic home monitoring or days on 24/7 sobriety program monitoring.

If I have prior offense(s):

• The judge shall order me to submit to an expanded alcohol assessment and comply with treatment deemed appropriate by that assessment.

• If I have one prior offense, instead of mandatory jail and electronic home monitoring, the judge may order me to serve not less than days in jail, and either days of electronic home monitoring or a 120-day period of 24/7 sobriety program monitoring or a 120-day period of ignition interlock device requirement, or both.

• If I have two prior offenses, instead of mandatory electronic home monitoring, the judge may order me to serve additional jail time.

The judge may waive electronic home monitoring or order me to obtain an alcohol monitoring device with wireless reporting technology, if that device is reasonably available, if I do not have a dwelling, telephone service, or any other necessity to operate electronic home monitoring.

The judge may waive electronic home monitoring if I live out of state, or if the judge determines I would violate the terms of electronic home monitoring.

I understand that the 24/7 sobriety program is a program which requires tests of my blood, breath, urine or other bodily substances to find out if I have alcohol, marijuana, or any controlled substance in my body.

(t) If this case involves reckless driving under specified DUI-related conditions, I will be subject to the penalties for Reckless Driving described in the “DUI” Attachment or the “Washington State Misdemeanor DUI Sentencing Attachment.”

(u) If this case involves negligent driving in the first degree with prior offenses, I will be subject to the penalties described in the DUI sentencing attachment.

(v) If this case involves operating a vehicle without an ignition interlock device, then my sentence will run consecutive to certain other sentences.

(w) If this case involves tampering with or circumventing an ignition interlock device, then my sentence will run consecutive to certain other sentences.

(x) If this crime involves specified sex offenses or kidnapping offenses involving a minor, I will be required to register with the county sheriff.

(y) I will be required to have a biological sample collected for DNA identification analysis unless a sample already exists.

(z) Travel Restrictions: I will be required to contact my probation officer or court for permission to travel or transfer to another state if I am placed on probation for one year or more and this crime involves specified offenses.

7. I plead guilty to the crime(s) of as charged in the complaint(s) or citation(s) and notice.

The complaint or citation and notice was orally amended and I waive filing of a written amended complaint or citation and notice.

8. I make this plea freely and voluntarily.

9. No one has threatened harm of any kind to me or to any other person to cause me to make this plea.

10. No person has made promises of any kind to cause me to enter this plea except as set forth in this statement.

11. Statement of Facts: The judge has asked me to state in my own words what I did that makes me guilty of the crime(s). This is my statement (state the specific facts that support each element of the crime(s)):

I committed this crime against a family or household member as defined in RCW 10.99.020.

Instead of making a statement, I agree that the court may review the police reports and/or a statement of probable cause supplied by the prosecution to establish a factual basis for the plea.

12. My lawyer has explained to me, and we have fully discussed, or I have read, all of the above paragraphs. I understand them all. I have been given a copy of this “Statement of Defendant on Plea of Guilty.” I have no further questions to ask the judge.

The foregoing statement was signed by the defendant in open court in the presence of the defendant’s lawyer, if represented, and the undersigned judge. The defendant asserted that (check the appropriate box):

(a) The defendant had previously read; or

(b) The defendant’s lawyer had previously read to him or her; or

(c) An interpreter had previously read to the defendant the entire statement above and that the defendant understood it in full.

Interpreter Declaration: I am a certified or registered interpreter, or have been found otherwise qualified by the court to interpret in the language, which the defendant understands. I have translated this document for the defendant from English into that language.

Signed at (city) , (state) , on (date)

I find the defendant’s plea of guilty to be knowingly, intelligently, and voluntarily made. Defendant understands the charges and the consequences of the plea. There is a factual basis for the plea. The defendant is guilty as charged.