VIRGINIA: CULPEPER JUVENILE AND DOMESTIC RELATIONS DISTRICT COURT
DEFENDANT:______CASE #: ______
OFFENSE(S): ______
______
GUILTY PLEA/STIPULATION TO THE EVIDENCE FORM
NOTICE TO THE DEFENDANT: Before you can plead guilty or stipulate to the evidence, the Court will ask you some questions that you will have to answer under oath. The questions you will be asked are like those that are on this form. Your attorney will go over these questions with you. If you do not understand a question, you should talk about it with your attorney or ask the Judge to explain the question.
If you stipulate to the evidence of a crime, that means that you are pleading not guilty while agreeing that the State has enough evidence to convict you of the crime.
1. (a) Is the name listed above your correct name? Yes _____
No _____
(b) Is the information listed above about your criminal charges correct? Yes _____ No _____
(c) What was the last grade you completed in school? ______
(d) Do you read and write the English language? Yes ____
No ___
2. The State must prove each part of the charges against you. Do you understand what the State must prove to be able to convict you on each charge and have you discussed the charges with your lawyer? Yes _____ No _____
3. (a) Have you told your lawyer about the facts and other things that might help you in your case, including the names and addresses of all possible witnesses? Yes ___ No ____
(b) Have you had enough time to talk with your lawyer about the facts and other things that might help you in your case?
Yes ___ No ___
4. Have you talked with your lawyer about whether you should plead not guilty, plead guilty or plead not guilty and stipulate to the evidence? Yes _____ No ______
5. After talking with your attorney, did you decide for yourself whether you should plead guilty or stipulate to the evidence?
Yes ___ No _____
6. Have your parents or anyone connected with any part of this case, such as the police or the Attorney for the State, or any other person, including your attorney, in any way threatened you or forced you to plead guilty or stipulate to the evidence? Yes ___ No ___
7. Why are you pleading guilty or stipulating to the evidence?
______
______
______
8. Do you understand that by pleading guilty or stipulating to the evidence you give up your right to refuse to testify or to refuse to provide evidence against yourself, including the right to refuse to give a urine sample for a drug screen? Yes ___ No ___
9. Do you understand that by pleading guilty or stipulating to the evidence you give up your right to require that the witnesses testify in your presence and the right to cross-examine those witnesses? Yes ___No ____
10. Do you understand that by pleading guilty or stipulating to the evidence you give up your right to defend yourself?
Yes ____ No ______
11. Have you previously been charged with any other offenses?
Yes ___ NO ___
IF YOUR ANSWER IS YES, do you realize that what the Court does in this case may allow another Court that has dealt with you before on a criminal matter to give you an additional punishment, including jail time? Yes ___ No ___
12. Do you understand that a conviction in this matter may be used against you if you get charged in the future with another crime? Yes ___ No ___
13. Does the crime for which you are charged involve the possession or distribution of drugs? Yes ___ No ___
IF YOUR ANSWER IS YES, have you talked with your lawyer about the fact that you may be able to raise the defense of accommodation, even if you are guilty? Yes ___ No ___
14. Do you understand that that the maximum punishment for this offense/these offenses is
a fine of $ ______
______days in detention,
___ commitment to the Department of Juvenile Justice until you turn 21,
_____ months in jail if sentenced as an adult?
Yes ___ No ___
15. Do you understand that, when the Judge sentences you, the Judge has the right to transfer your custody to the Department of Social Services or to someone other than your parents or present custodian? Yes ___ No ___
16. (a) Does the crime that you are charged with require that you serve a sentence that the Court can not suspend? Yes ___ No ___
(b) IF YOUR ANSWER IS YES, do you understand what this sentence is? Yes ___ No ___
17. Has anyone made any promises about what will happen if you plead guilty? Yes ___ No ___
18. Have you worked out a plea agreement with the Attorney for the State? Yes ___ No ___
19. Do you understand that the Court is not required to follow any recommendation from the Attorney for the State or your Attorney as to how you should be punished? Yes ___ No ___
20. Have you reviewed with your lawyer “Consequences of Adjudications and Findings of Guilt in Virginia for Juveniles”, a copy of which is posted in the hall and which is available from the clerk? Yes ___ No ___
21. Are you entirely satisfied with the lawyer who was appointed or hired to represent you? Yes ___ No ___
22. Have you used any medication or drugs or consumed any alcohol in the last 24 hours? Yes ___ No ___
23. Do you understand all of these questions? Yes ___ No ___
24. Do you have any questions for the Court? Yes ___ No ___
25. Have you read this form or had someone read it to you?
Yes ___ No ___
26. Are the answers in this form true? Yes ___ No ___
______
Date Defendant
______
Parent/Custodian Parent/Custodian
______
Date Attorney for the Defendant
These questions were asked by the Judge in open Court on ______, 20___.
______
Judge
Del Guilty plea form
10-27-2011