Fill and Sign the Waiver of Parents Right to Counsel Form

STATE OF NORTH CAROLINA File No. WAIVER OF PARENT'S RIGHT TO COUNSEL 1. 2. Signature Of Parent I am the parent of the juvenile named above. I have been told t hat I have the right to have a lawyer represent me. I have been told of my right to have a lawyer appointed by the Court if I cannot afford to hire one. With full knowledge of these rights, I knowingly, willingly, and understandingly choose as follows: I do not want a court-appointed lawyer. I will hire my own lawyer at m y own cost. I do not want the a ssistance of any lawyer. I under stand that I have the right to represent myself, and that is what I intend to do. (che ck only one) Name Of Parent (Type Or Print) Date Date Of Birth In The General Court Of Justice District Court Division County IN THE MATTER OF: G.S. 7B-602, -1101.1 AOC-J-143, Rev. 10/13 (Replaces J-203) © 2013 Administrative Office o f the Courts Age Name And Address Of Parent Name Of Juvenile ABUSE/NEGLECT/DEPENDENCY TERMINATION OF PARENTAL RIGHTS to show tha t the paren t’s waiver is knowing and volun tary . NOTE TO JUDGE: G.S. 7B-602(a1) and G.S. 7B-1101.1(a1) require the court to examine the parent and make findings of fact sufficient FI ND INGS OF F ACT The paren t’s waiver is knowing and volun tary . T here fore , the paren t ORD ER Signature Of District Court Judge Date Name O f Di strict Cour t Judge (Ty pe Or P rin t) CO NCLUSIO NS OF L AW The paren t’s waiver is no t knowing and volun tary . may proceed wi thou t appoin ted counsel . may pro ceed wi thou t the as sis tan ce o f counsel .