________________________________ COURT

______________________ County, Arizona

STATE OF ARIZONA Plaintiff

[CASE/COMPLAINT NO.]

-vs-

Defendant (FIRST, MI, LAST)

The purpose of this form is to advise you of your right to trial by jury and to allow you to give up that right if you so choose.

I understand that I am entitled to a trial by jury on these charges and, if applicable, on facts used to aggravate any sentence. The right to a trial by jury means the right to have my guilt or innocence, or, if applicable, facts used to aggravate any sentence, decided by a group of citizens whose decision must be unanimous.

I understand that once I have made the decision to give up my right to a jury trial, I may change my mind only with the permission of the court, and may not change it at all once the trial has actually begun.

After reading and understanding all the above, I hereby waive my right to:

[ ] trial by jury on guilt or innocence;

[ ] trial by jury on facts used to aggravate any sentence.

_______________

Date

Defendant

I have explained to the defendant the right to trial by jury and consent to the defendant's waiver of it.

_______________

Date

Defense Attorney

I consent to waiver of trial by jury in this case.

_______________

Date

Prosecutor

I approve of the waiver of the trial by jury in this case.

_______________

Date

Signature of Judicial Officer