8United States District Court

8UNITED STATES DISTRICT COURT

9FOR THENORTHERN DISTRICT OF CALIFORNIA

10UNITED STATES OFAMERICA,

12v.

Plaintiff,

Defendant.

No.

APPLICATION FOR PERMISSION TO ENTER PLEA OFGUILTY AND ORDER ACCEPTING PLEA

(Fed. R. Crim. P., Rules 10 and 11)

16The defendant represents to the Court:

171.Myfull true nameis. Iam

years of age.

18Ihave gone to school up to and including . Mymost recent

19occupation has been. Irequest that all proceedings

20against me be in mytrue name.

212.Iam represented bya lawyer. His/her name is

22.

233.Ireceived and read a copyof the indictment/information.Ifapplicable:An interpretator

24who speaks read it to me in , and Ihave discussed it with

25mylawyer.

26//

27//

28//

1Ifullyunderstand everycharge madeagainst me. Iunderstand these charges to be as follows:

54.Ihave told mylawyer all the facts and circumstances known to me about the charges

6made against me in the indictment/information.Ibelieve that mylawyer is fullyinformed on all such

7matters.

85.Iknow that the Court must be satisfied that there is a factual basis fora pleaof

9“GUILTY” beforemyplea can be accepted. Irepresent to the Court that Itook the followingactions in

10connection with the charges madeagainst me in Count[s] and that these facts are true

11and correct:

156.Mylawyer has counseled and advised me on thenatureof each charge, all lesserincluded

16charges, all penalties and consequences ofeach charge, all possible defenses that Imayhave in this case

17and constitutional rights Iam waiving.

187.Iunderstand that myconstitutional rights are as follows:

19(a)the right to plead not guiltyor, havingalreadyso pleaded, to persist in that plea;

20(b)the right to a jurytrial;

21(c)the right to represented bycounsel – and if necessaryhave theCourt appoint counsel – at trial and at everyother stage of theproceeding; and

(d)the right at trial to confront and cross-examine adverse witnesses, to testifyand

23present evidence, to compel the attendance ofwitnesses, to be protected from

compelled self-incrimination, and to remain silent, such that if Ido not take the

24witness stand, no inferenceof guilt maybe drawn from such failureand the jury

must be so advised.

268.Iknow that Imayplead “NOT GUILTY” to anyoffense charged against me and exercise

27all of myrights as listed above.

19.Iknow that if Iplead “GUILTY,” Iam giving up all of the trial rights enumerated in

2paragraph 7and that therewill be no trial either beforea court or jury.

310.Iknow that if Iplead “GUILTY,” theresult of myplea is more than just an admission or

4confession of guilt. Iunderstand that it willresult in myconviction, and the Court mayimpose the same

5punishment as if Ihad pleaded “NOT GUILTY,” stood trial and been convicted bya jury.

611.Mylawyer has informed me that the maximum and minimum, if any, punishments which

7the law provides for theoffense charged in Count(s) are as follows:

8(For multiple counts, include the followinginformation for each count)

9(a)Maximum prison sentence:

years

10(b)Mandatoryminimumprison sentence (if applicable):years

11(c)Maximum supervised releaseterm:

years

12(d)Minimumsupervised release term (if applicable):years

13(e)Mandatoryspecial assessment:$

14(f)Restitution:$ (or

(determined bythe Court)

(g)Maximum fine equal to the greater of the following:

(1)$

19(2)$

(3)$

(generally$250,000 for afelony, $100,000

for aClass A misdemeanor, or$5,000 for a

Class B misdemeanor or lower; see 18

U.S.C. § 3571)); or

(twicethe gross pecuniarygain Iderived from the offense); or

(twicethe gross pecuniaryloss caused bythe offense to anotherperson orpersons).

22Ifapplicable:Iunderstand that, because Iam pleadingguiltyto more than onecount, the Court

23mayorderthe sentences on those counts to run consecutively.

24Iunderstand that if Iviolate anycondition of supervised release, the releasemaybe revoked, and

25Imaybe sentenced to all or part of theterm of supervised releaseimposed in addition to anyother term

26of imprisonment which Ihave received. Iunderstand that if Iviolate anyterm of probation, the

1probation maybe revoked, and Imaybe sentenced up to the maximum statutoryterm of imprisonment

2for the offense.

3Iunderstand that Imaybe assessed the costs of confinement and/or supervision. Iunderstand I

4maybe ordered to payrestitution in an amount determined bythe Court.

512.Iknow that the sentence Iwill receive will be decided solelybythe Judge. Iunderstand

6that the Judge will make no decision regardingmysentence until the Judge has read and considered the

7pre-sentence investigation report prepared and submitted to the Court bythe Probation Department. I

8also understand that the Court and counsel cannot promise me nowwhat sentence will be imposed. I

9understand that in decidingwhat sentence it will impose, the Court will calculatemysentencing range

10under theSentencingGuidelines. Iunderstand that while the Court is not bound to applythe Guidelines,

11it musttake them into consideration when sentencingme, togetherwith the factors set forth in 18 U.S.C.

12§ 3553(a).

1313.Iunderstand that under provisions of certain criminal statutes, certain propertyof mine

14maybe forfeited to the United States. Ihave been advised bymylawyer whether, and to what extent,

15mypropertymaybe subject to forfeiture.

1614.If Iam on probation, supervised releaseor parole in this or anyother Court, Iknow that

17bypleadingguiltyhere, myprobation, releaseor parole maybe revoked, and Imaybe required to serve

18time in that case, which maybe consecutive (that is, in addition to) anysentence imposed upon me in

19this case.

2015.Ideclare that no officer or agent of anybranch of government (federal, state orlocal) has

21promised or suggested that Iwill receive a lighter sentence, orprobation, or anyother form of leniency,

22nor haveanyother promises been madeif Iplead “GUILTY” except as follows:

26(Inthespaceabove,insertanypromisesorconcessionsmadetothedefendantortohis/her attorney).

1If anyone elsemade such a promise orsuggestion, except as noted in the previous sentence, Iknow that

2it was entirelywithout authorityor effect.

316.Ibelieve that mylawyer has done all that a lawyer could do to counsel and assist me, and

4Iam satisfied with the advice and help he/she has given me.

517.Iknow that the Court will not permit anyone to plead “GUILTY” who maintains he/she

6is innocent and, with that in mind and because Iam “GUILTY,” Irespectfullyrequest the Court to

7accept myplea of“GUILTY” and to have the clerk enter myplea of“GUILTY” as follows:

1118.Mymind is clear. Iam not under theinfluenceof alcohol or drugs, and Iam not under a

12doctor’s care. The onlydrugs, medicines, or pills that Ihave taken within the past seven days are:

17(Ifnone, so state.)

1819.Iconfirm that mydecision to plead guiltyis made voluntarily, and no one coerced or

19threatened me to enter into this Agreement. Ioffer myplea of“GUILTY” freelyand voluntarilyand of

20myown accord, and with full understandingof all the matters set forth in the indictment/information, in

21this application, and in the certificateof mylawyer which is attached to this application. In offeringmy

22plea of“GUILTY,” Ifreelyand voluntarilywaive (that is, giveup) the constitutional rights guaranteed to

23me as stated in paragraph 7 above.

2420.Iwaive thereading ofthe indictment/information in open court, and Irequest the Court

25to enter myplea of“GUILTY” as set forth in Paragraph 17 ofthis application.

2621.Iunderstand that the Court will address me personallyin open court to determine the

27voluntariness of myguiltyplea and to establish a factual basis forit. Iunderstand that the Court may

28placeme underoath, and that the government mayuse anyfalse statements that Imake under oath

1against me in a prosecution for perjuryor false statement (which is a felony).

222. Iam proficient enough in English to read theabove and have read and fully

3understand it.

4 Iam not proficient enough in English. Ispeak and understand ,

5which is mynative language. Theabove was read to me in and Ifullyunderstand it.

6Signed byme in open court in the presence of myattorneythis dayof, 20 .

Defendant

10CERTIFICATEOFCOUNSEL

11Ihave fullyexplained to myclient the charges in the indictment/information in the case, the

12defenses he/she mayhave to the charges, all of the information set forth in this application, and all the

13rights that a criminal defendant has. In myopinion, myclient understands the charges, the defenses, the

14information in this application, and the rights he or she is giving up bypleadingguilty, and, based on the

15information now known to me, his/her decision to plead guiltyis knowing and voluntary

16Signed byme in open court in the presence of theabove-named defendant aftera full discussion

17of the contents of this certificate with the defendant this dayof, 20 .

19Attorneyfor the Defendant

21INTERPRETER CERTIFICATION

22I, , herebycertifythat Iam a certified [language]

23interpreterand that Iaccuratelytranslated this pleaagreement to the defendant, he/she told me that

24he/she understood it, and Iam satisfied that his/her answer is trueand correct.

25Date

Interpreter’s Signature

4Ifind that:

ORDER

51.The defendant enters this plea of guiltyfreelyand voluntarilyand not out of ignorance,

6inadvertence, fear or coercion.

72.The defendant understands and knowingly, freelyand voluntarilywaives his/her

8constitutional rights.

93.The defendant freelyand voluntarilyexecuted the attached Application and fully

10understands its contents.

114.The defendant has admitted the essential elements of the crime charged.

12IT IS THEREFORE ORDERED that the defendant’s plea of“GUILTY” entered in open court be

13accepted and entered as requested in this Application and as recommended in the certificatesigned by

14the defendant’s lawyer.

15Done in open court this dayof , 20 .

United States District Judge

18Northern District of California