___________________COURT

____________County, Arizona

STATE OF ARIZONA Plaintiff

[CASE/COMPLAINT NO.]

-vs-

Defendant (FIRST, MI, LAST)

Defendant appears personally and expresses a desire to plead guilty or no contest to the charges indicated and I find the following facts:

1.

2.

Defendant appears: [ ] with counsel [ ] without counsel, (waiver of counsel with file) and understands the following:

3.

Defendant has entered into a: [ ] plea agreement, and consents to its terms; [ ] plea to the court.

4.

Defendant understands the range of penalties to be: (state minimum and maximum possible sanctions).

5.

If arrested on a subsequent offense, defendant may be charged with a more serious offense and associated penalties.

6.

The Court has advised the defendant that this guilty plea may result in a violation of probation or parole.

7.

Defendant was advised of the following: If you are not a citizen of the United States, pleading guilty or no contest to a crime may affect your immigration status. Admitting guilt may result in deportation even if the charge is later dismissed. Your plea or admission of guilt could result in your deportation or removal, could prevent you from ever being able to get legal status in the United States, or could prevent you from becoming a United States citizen.

8.

Defendant understands that the following constitutional rights are given up by changing the plea:

a.

Right to plead not guilty and require the State to prove guilt beyond a reasonable doubt.

b.

Right to a trial [ ] by jury [ ] by a judge [ ] by jury on facts used to aggravate a sentence.

c.

Right to assistance of an attorney at all stages of the proceeding, including appeal. In some cases, the defendant may be eligible for a court- appointed attorney at a reduced cost or at no cost, if the defendant cannot afford one.

d.

Right to confront the witnesses against the defendant and to cross- examine them as to the truthfulness of their testimony.

e.

Right to present evidence in the defendant's own behalf and to have the court compel the defendant's chosen witnesses to appear and testify free of charge.

f.

Right to remain silent, not to incriminate oneself, and to be presumed innocent unless/or until proven guilty beyond a reasonable doubt.

g.

Right to a direct appeal.

9.

Defendant wishes to give up these constitutional rights after having been advised of them.

10.

A basis in fact exists for believing the defendant guilty of the offenses charged.

11.

The plea is voluntary and not the result of force or threat, or promises other than those contained in the plea agreement.

12.

Defendant may file a Rule 33 petition for post-conviction relief and if denied may file a petition for review.

On the basis of these findings, I conclude that the defendant knowingly, voluntarily, and intelligently pleads: [ ] guilty [ ] no contest* to the above charges, and I accept this plea.

* Rule 17.1c, Rules of Criminal Procedure states that a plea of no contest may be accepted only after due consideration of the views of the parties and the interest of the public in the effective administration of justice.

_______________

Date

Signature of Judicial Officer

I certify that the judge personally advised me of the nature of the charges, the range of penalties, and my constitutional rights as indicated above. I understand the constitutional rights which I give up by entering this plea, and I desire to plead guilty or no contest as indicated above. I desire to proceed without an attorney, or if represented, my attorney's signature appears below.