Plea Form - New Jersey Courts

New Jersey Judiciary
County
Plea Form
Prosecutor File Number
Defendant’s Name:
before Judge:
List the charges to which you are pleading guilty:
Ind./Acc./Comp.#
Count
Nature of Offense
Your total exposure as the result of this plea is:
Degree
Statutory Maximum
Time
Fine
VCCO Assmt*
Max
Max
Max
Max
Max
Total
Please Circle
Appropriate
Answer
2. a. Did you commit the offense(s) to which you are pleading guilty?
[Yes] [No]
b. Do you understand that before the judge can find you guilty, you will have to tell the
judge what you did that makes you guilty of the particular offense(s)?
3. Do you understand what the charges mean?
[Yes] [No]
4. Do you understand that by pleading guilty you are giving up certain rights? Among them
are:
a. The right to a jury trial in which the State must prove you guilty beyond a reasonable
doubt?
b. The right to remain silent?
[Yes] [No]
[Yes] [No]
c. The right to confront the witnesses against you?
*
[Yes] [No]
[Yes] [No]
d. Do you understand that by pleading you are not waiving your right to appeal (1) the
denial of a motion to suppress physical evidence (R. 3:5-7(d)) or (2) the denial of
acceptance into a pretrial intervention program (PTI) (R. 3:28(g))?
[Yes] [No]
e. Do you further understand that by pleading guilty you are waiving your right to appeal
the denial of all other pretrial motions except the following:
[Yes] [No]
Victims of Crime Compensation Office Assessment
Main Plea Form / Revised Form Promulgated by Directive #05-11 (08/01/2011), CN 10079-English
Defendant’s Initials
page 1 of 5
5. Do you understand that if you plead guilty:
a. You will have a criminal record?
[Yes] [No]
b. Unless the plea agreement provides otherwise, you could be sentenced to serve the
maximum time in confinement, to pay the maximum fine and to pay the maximum
Victims of Crime Compensation Agency Assessment?
[Yes] [No]
[Yes] [No]
c. You must pay a minimum Victims of Crime Compensation Agency assessment of $50
($100 minimum if you are convicted of a crime of violence) for each count to which you
plead guilty? (Penalty is $30 if offense occurred between January 9, 1986 and December
22, 1991 inclusive. $25 if offense occurred before January 1, 1986.)
d. If the offense occurred on or after February 1, 1993 but was before March 13, 1995, and [Yes] [No]
you are being sentenced to probation or a State correctional facility, you must pay a
transaction fee of up to $1.00 for each occasion when a payment or installment payment
is made? If the offense occurred on or after March 13, 1995 and the sentence is to
probation, or the sentence otherwise requires payments of financial obligations to the
probation division, you must pay a transaction fee of up to $2.00 for each occasion when
a payment or installment payment is made?
e. If the offense occurred on or after August 2, 1993 you must pay a $75 Safe
Neighborhood Services Fund assessment for each conviction?
[Yes] [No]
f. If the offense occurred on or after January 5, 1994 and you are being sentenced to
probation, you must pay a fee of up to $25 per month for the term of probation?
[Yes] [No]
g. If the crime occurred on or after January 9, 1997 you must pay a Law Enforcement
Officers Training and Equipment Fund penalty of $30?
[Yes] [No]
h. You will be required to provide a DNA sample, which could be used by law enforcement [Yes] [No]
for the investigation of criminal activity, and pay for the cost of testing?
i. Computer Crime Prevention Fund Penalty, N.J.S.A. 2C:43-3.8 (L. 2009, c. 143). If the [Yes] [No]
crime involves a violation of N.J.S.A. 2C:24-4b(5)(b) (knowingly possessing or
knowingly viewing child pornography, N.J.S.A. 2C:34-3 (selling, distributing or
exhibiting obscene material to a person under age 18) or an offense involving computer
criminal activity in violation of any provision of Title 2C, chapter 20, you will be
assessed a mandatory penalty as listed below for each offense for which you pled guilty?
(1)
(2)
(3)
(4)
(5)
$2,000 in the case of a 1st degree crime
$1,000 in the case of a 2nd degree crime
$ 750 in the case of a 3rd degree crime
$ 500 in the case of a 4th degree crime
$ 250 in the case of a disorderly persons or petty disorderly persons offense
Total CCPF Penalty
$
Main Plea Form / Revised Form Promulgated by Directive #05-11 (08/01/2011), CN 10079-English
Defendant’s Initials
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6. Do you understand that the court could, in its discretion, impose a minimum time in
confinement to be served before you become eligible for parole, which period could be as
long as one half of the period of the custodial sentenced imposed?
[Yes] [No]
[Yes] [No]
7. Did you enter a plea of guilty to any charges that require a mandatory period of parole
ineligibility or a mandatory extended term?
a. If you are pleading guilty to such a charge, the minimum mandatory period of parole
ineligibility is
years and
months (fill in the number of years/months) and
years and
months (fill in
the maximum period of parole ineligibility can be
the number of years/months) and this period cannot be reduced by good time, work, or
minimum custody credits.
b. If you are pleading guilty to such a charge, the minimum mandatory extended term is
years and
months (fill in the number of years/months) and the maximum
mandatory extended term can be
years and
months (fill in the number of
years/months).
8. Are you pleading guilty to a crime that contains a presumption of imprisonment which
means that it is almost certain that you will go to state prison?
[Yes] [No]
9. Are you presently on probation or parole?
a. Do you realize that a guilty plea may result in a violation of your probation or
parole?
[Yes]
[Yes]
[No]
[No] [NA]
10. Are you presently serving a custodial sentence on another charge?
a. Do you understand that a guilty plea may affect your parole eligibility?
[Yes]
[Yes]
[No]
[No] [NA]
11. Do you understand that if you have plead guilty to, or have been found guilty on
other charges, or are presently serving a custodial term and the plea agreement is
silent on the issue, the court may require that all sentences be made to run
consecutively?
[Yes]
[No] [NA]
12. List any charges the prosecutor has agreed to recommend for dismissal:
Ind./Acc./Compl.#
Count
Nature of Offense and Degree
13. Specify any sentence the prosecutor has agreed to recommend:
Main Plea Form / Revised Form Promulgated by Directive #05-11 (08/01/2011), CN 10079-English
Defendant’s Initials
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14. Has the prosecutor promised that he or she will NOT:
a. Speak at sentencing?
[Yes] [No]
b. Seek an extended term of confinement?
c. Seek a stipulation of parole ineligibility?
[Yes] [No]
[Yes] [No]
15. Are you aware that you must pay restitution if the court finds there is a victim who
has suffered a loss and if the court finds that you are able or will be able in the
future to pay restitution?
[Yes]
[No]
[NA]
16. Do you understand that if you are a public office holder or employee, you can be
required to forfeit your office or job by virtue of your plea of guilty?
[Yes]
[No]
[NA]
17. a. Are you a citizen of the United States?
[Yes] [No]
If you have answered “No” to this question, you must answer Questions 17b –
17f. If you have answered “Yes” to this question, proceed to Question 18
[Yes] [No]
b. Do you understand that if you are not a citizen of the United States, this guilty
plea may result in your removal from the United States and/or stop you from
being able to legally enter or re-enter the United States?
c. Do you understand that you have the right to seek individualized advice from an attorney [Yes] [No]
about the effect your guilty plea will have on your immigration status?
d. Have you discussed with an attorney the potential immigration consequences of
your plea? If the answer is “No,” proceed to question 17e. If the answer is
“Yes,” proceed to question 17f.
[Yes] [No]
e. Would you like the opportunity to do so?
[Yes] [No]
f. Having been advised of the possible immigration consequences and of your
right to seek individualized legal advice on your immigration consequences, do
you still wish to plead guilty?
[Yes] [No]
18. a. Do you understand that pursuant to the rules of the Interstate Compact for Adult Offender [Yes] [No]
Supervision if you are residing outside the State of New Jersey at the time of sentencing
that return to your residence may be delayed pending acceptance of the transfer of your
supervision by your state of residence?
b. Do you also understand that pursuant to the same Interstate Compact transfer of your
supervision to another state may be denied or restricted by that state at any time after
sentencing if that state determines you are required to register as a sex offender in that
state or if New Jersey has required you to register as a sex offender?
19. Have you discussed with your attorney the legal doctrine of merger?
Main Plea Form / Revised Form Promulgated by Directive #05-11 (08/01/2011), CN 10079-English
[Yes]
[Yes] [No]
[No]
[NA]
Defendant’s Initials
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20. Are you giving up your right at sentence to argue that there are charges you pleaded [Yes]
guilty to for which you cannot be given a separate sentence?
[No]
[NA]
21. List any other promises or representations that have been made by you, the prosecutor, your defense
attorney, or anyone else as a part of this plea of guilty:
22. Have any promises other than those mentioned on this form, or any threats, been made in
order to cause you to plead guilty?
[Yes] [No]
[Yes] [No]
23. a. Do you understand that the judge is not bound by any promises or recommendations of
the prosecutor and that the judge has the right to reject the plea before sentencing you and
the right to impose a more severe sentence?
b. Do you understand that if the judge decides to impose a more severe sentence than
recommended by the prosecutor, that you may take back your plea?
[Yes] [No]
c. Do you understand that if you are permitted to take back your plea of guilty because of
the judge’s sentence, that anything you say in furtherance of the guilty plea cannot be
used against you at trial?
[Yes] [No]
24. Are you satisfied with the advice you have received from your lawyer?
[Yes] [No]
25. Do you have any questions concerning this plea?
[Yes] [No]
Date
Defendant
Defense Attorney
Prosecutor
[ ] This plea is the result of the judge’s conditional indications of the maximum sentence he or she would
impose independent of the prosecutor’s recommendation. Accordingly, the "Supplemental Plea Form for
Non-Negotiated Pleas" has been completed.
Main Plea Form / Revised Form Promulgated by Directive #05-11 (08/01/2011), CN 10079-English
Defendant’s Initials
page 5 of 5