Fill and Sign the Vermont Judicial Bureau Po Box 607 White River Junction Vermont Form

Vermont Judicial Bureau PO Box 607 White River Junction, VT 05001 Phone: 802-295-8869 www.vermontjudiciary.org JUD.VJB@vermont.gov NOTICE OF PLEA AGREEMENT PLAINTIFF Docket No.: DEFENDANT □ State of Vermont □ City/Town of: DOB NAME ORIGINAL COMPLAINT REQUESTED JUDGMENT FOR PLAINTIFF Code: _______ Points: _____ Penalties $ _______________ Mandatory Suspension Period: ________________________ Statutory Citation: ________V.S.A. § ___________________ Violation Description: _______________________________ __________________________________________________ Code: _______ Points: _____ Penalties $ ________________ Mandatory Suspension Period: _________________________ □ Seat Belt Violation □ Accident Resulted from Violation (extra 2 points) □ Fatality Resulted from Violation □ Meets criteria for points waiver pursuant to 23 V.S.A. § 2501(b) □ Seat Belt Violation □ Accident Resulted from Violation (extra 2 points) □ Fatality Resulted from Violation DEFENDANT’S PLEA: □ Admitted □ No Contest Statutory Citation: ________V.S.A. § ____________________ Violation Description: ________________________________ ___________________________________________________ REQUESTED DISMISSALS □ Dismiss this case as identified by the docket number at the top of this NOTICE OF PLEA AGREEMENT. □ Dismiss the following cases: Docket No.: ____________________________ Charge code: ______________________ Docket No.: ____________________________ Charge code: ______________________ Docket No.: ____________________________ Charge code: ______________________ Settlement Conditions or Other Information: _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ Notice of Rights: Plaintiff and Defendant both have the right to a hearing on the alleged violation. Plaintiff carries the burden of proof by clear and convincing evidence. If the burden is satisfied, then Plaintiff is entitled to judgment in its favor. If the burden is not satisfied, then Defendant is entitled to judgment without any penalties. All judgments based on evidence presented at a hearing are appealable. Both Plaintiff and Defendant have the right to appeal. Notice of Waivers: By entering this agreement, both parties waive: (1) the right to hearing; and (2) the right to appeal. Notice to Defendant to Pay Penalty: If a monetary penalty is assessed against you, you must pay the penalty within 30 days to avoid having an additional $30.00 fee added to the judgment amount. 4 V.S.A. § 1109. I knowingly and voluntarily enter this plea agreement and request the court to impose the terms shown above. Prosecutor/Issuing Officer: Date: Defendant: ______________ DECISION BY JUDICIAL OFFICER The plea agreement is approved and its terms are imposed as the decision and judgment of the court. So ordered. Date: ______________ ☐ Points are waived pursuant to 23 V.S.A. § 2501(b). 500-00428 – Notice of Plea Agreement (07/2019) Date: ______________ Parent/Guardian: Date: ______________ Approved as to form by Defense Attorney: Date: ______________ Page 1 of 1