Looking for a Northumberland County, Pa Court Forms And Templates? Download it for free!

(1)

Name: (First, Middle, Last)

____________________________________

(2)

Date of Birth: ___________________

(3)

What was the last year of schooling completed? _____________________

(4)

Can you read, write and understand the English language?______________

If your answer is "No", has this form and the questions on it been read to you so that you fully understand

everything?_______________

(5)

Have you used alcoholic beverages or drugs of any kind, including prescription drugs, within the last twenty-four

(24) hours? ______________________ If your answer is "Yes", is the use of such alcohol or drugs affecting your

ability to make decisions or understand?:__________________________________________________________.

(6)

Are you presently receiving treatment for any mental or emotional disability?:_____________ If "Yes",

explain:____________________________________________________________________________________.

(7)

Are you suffering from any mental or emotional disability? ___________ If "Yes", explain: _________________

___________________________________________________________________________________________

(8)

Do you understand that you have the right to an attorney? If you cannot afford an attorney, you may apply for a

Public Defender. _______________

(9)

What is the name of your attorney?________________________________.

(10)

Have you thoroughly discussed all of the facts & circumstances of the charges filed against you with your

attorney? ___________________

(11)

Has your attorney explained to you all of the elements of the crime (s) to which you are pleading?:_____

(12)

Whose decision is it for you to plead? _____________________________

(13)

Why are you entering a plea?____________________________________________________________.

(14)

If there is a plea agreement between you and the District Attorney, do you understand that the Court is not bound

by the agreement and does not have to accept it?:__________________

(15)

Do you understand that if the Court does not accept the plea agreement, you may withdraw your plea?__

(16)

Do you understand that if the Court allows you to withdraw your plea, the Commonwealth would have 120 days

to bring you to trial, if you are incarcerated on the present charges. If you are not incarcerated or are incarcerated

on other charges, it is 365 days:_____________

(17)

Do you fully understand the permissible range of sentence and/or fines that can be imposed for the crime (s)

charges against you? __________

(18)

Has anybody told, promised or suggested to you in any manner what the actual sentence will be? _____________

(19)

Has anyone made any promises to you or threatened you in any manner or done or said anything to induce you or

pressure you to plead?:________________

(20)

Do you understand that if you were to elect to go to trial:

(a)

You would be presumed innocent?

__________

(b)

The Commonwealth would have to prove each and every element of the charges against you beyond a

reasonable doubt? ___________

(c)

You would not have to testify on your own behalf? __________

(d)

You may testify, but you do not have to? ____________

(e)

You would not have to prove your innocence? ___________

(f)

You would have the right to help select your jury? __________

(g)

For your jury, a group of people, picked at random and representing a cross-section of citizens of

Northumberland County, would be brought into Court, placed under oath & sworn to tell the truth______

(h)

You would have the right through your attorney to ask them certain questions, as would the District

Attorney? __________

(i)

The purpose of the questions would be to decide if the prospective jurors could be fair & impartial? _____

(j)

If the answers to the questions indicate a juror would not be fair and impartial, they would be dismissed

for cause? __________

(k)

There is no limit on dismissals of jurors for cause? _________

(l)

You, through your attorney and the District Attorney, would have the right to eliminate or excuse

additional jurors without giving any reason for their dismissal. These additional dismissals are

peremptory challenges which results in you have a jury of twelve people and two alternates who would

sit, hear, and decide your case? ___________

(m)

Do you understand that in order to be found guilty, the verdict of the jury must be unanimous? In other

words, all twelve jurors must be convinced beyond a reasonable doubt of your guilt____ Initials: _____

Petition For Entry Of A Guilty/nolo Contendere Plea Form - The Court Of Common Pleas Of Northumberland County, Pa Page 3

Related Articles

Related forms

Related Categories