Acknowledgment And Waiver Of Rights

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Acknowledgment and Waiver of Rights
UNITED STATES DISTRICT COURT
District of New Hampshire
UNITED STATES OF AMERICA
ACKNOWLEDGMENT AND
v.
WAIVER OF RIGHTS
_____________________________
Case Number: _________________________
Defendant
I,
, hereinafter the defendant, do hereby freely and voluntarily
make the following statements that I understand shall apply to each and every offense to which I intend to plead
GUILTY.
I understand that I am under no obligation to plead GUILTY, and that even after signing this form I am still
under no obligation to plead GUILTY. I understand that I do not have a negotiated plea agreement with the
government and that the Judge can impose any sentence authorized by law for the offense to which I am pleading
GUILTY.
I have discussed the present plea of GUILTY with my attorney,
, Esquire,
who has explained the nature and elements of the offense(s) to me, which I fully understand. The offense(s) to which
I am pleading GUILTY, the statutory reference, the elements of the offense(s), (all of which the government would
have to prove beyond a reasonable doubt), and the possible penalties for the offense(s), are as follows:
1. Statute and the Elements of the Offense.
The defendant is pleading guilty to the following statutes. The defendant acknowledges, understands and
agrees that if this case proceeded to trial, the United States would be required to prove the following elements beyond
a reasonable doubt:
[Title and Text of Offense and Statutory Citation]
I. Title of Offense Charged/Statutory Citation: ______________________________________________________
Elements of the Offense Charged: _______________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
II. Title of Offense Charged/Statutory Citation: ______________________________________________________
Elements of the Offense Charged: _______________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Page 1
USDCNH-88 (1-16)

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