plea_form by chrstphr

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									                                    PLEA FORM


_________________________________
DEFENDANT NAME

_______________________________________
OFFENSE

_______________________________________
CASE NUMBER


_____ I HEREBY ENTER A PLEA OF NOLO CONTENDERE AND WAIVE
      APPEARANCE FOR TRIAL.

_____ I HEREBY ENTER A PLEA OF GUILTY AND WAIVE APPEARNCE FOR A TRIAL.

_____ I HEREBY ENTER A PLEA OF NOT GUILTY AND REQUEST A TRIAL BEFORE
      THE COURT OR A JURY TRIAL. (CIRCLE ONE)

________________________________
DATE

________________________________
SIGNATURE OF DEFENDANT OR
AGENT

________________________________
PHYSICAL ADDRESS

________________________________
CITY, STATE, ZIP

________________________________
MAILING ADDRESS IF DIFFERENT

________________________________
CITY, STATE, ZIP

________________________________
TELEPHONE NUMBER


SWORN TO AND SUBSCRIBED BEFORE ME THIS THE _____ DAY OF ______________,
20_____.


_____________________________________________
NOTARY PUBLIC/COURT CLERK/MAGISTRATE

								
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