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Statement of Defendant on Plea of Guilty Page 1 of 4 Revised June 2020 IN THE MUNICIPAL COURT OF EVERETT SNOHOMISH COUNTY, WASHINGTON CITY OF EVERETT, NO. Plaintiff, STATEMENT OF DEFENDANT ON PLEA OF GUILTY vs. Defendant. 1. My true name is: 2. My age is: 3. The last level of education I completed was: . 4. I HAVE BEEN INFORMED AND FULLY UNDERSTAND THAT: I have the right to representation by a lawyer and that if I cannot afford to pay for a lawyer, one will be provided at no expense to me. ¨ I wish to waive my right to an attorney at this time ¨ My attorney is: . I am charged with: Violation of a Protection Order o Domestic Violence (DV) or o Non-DV The elements are: Did, in the City of Everett, with knowledge that Court had previously issued a protection order pursuant to Chapter 26.50 RCW in vs. No. violate the order while the order was in effect by knowingly violating a restraint provision OR a provision excluding from residence, workplace, school or daycare OR coming or remaining within a specified distance of a location. ¨ was (were) committed against an intimate partner. o Count(s) was (were) committed against a family or household member. 5. I UNDERSTAND I HAVE THE FOLLOWING IMPORTANT RIGHTS, AND I GIVE THEM ALL UP BY PLEADING GUILTY: The right to a speedy and public trial by an impartial jury in the county where the crime is alleged to have been committed; The right to remain silent before and during trial, and the right to refuse to testify against myself; The right at trial to hear and question the witnesses who testify against me; The right at trial to testify and to have witnesses testify for me. These witnesses can be made to appear at no expense to me. The right to be presumed innocent unless the charge is proven beyond a reasonable doubt or I enter a plea of guilty; The right to appeal a finding of guilt after a trial. ---PAGE BREAK--- Statement of Defendant on Plea of Guilty Page 2 of 4 Revised June 2020 6. IN CONSIDERING THE CONSEQUENCES OF MY GUILTY PLEA, I UNDERSTAND THAT: My right to appeal is limited. The crime for which I am charged carries a maximum sentence of 364 days in jail and a $5000 fine. □ Checked box indicated Defendant agrees with the following prosecutor’s recommendation. The prosecuting attorney will make the following recommendation to the judge: Violation of a Protection Order: 364 days jail with days suspended for two years (five years if DV), fine. Alc/Drug Eval & comply Mental Health Evaluation DV Treatment DV Victim Panel No Vic Contact Possess no Firearms Forfeit Weapon Anger Mgmt Theft Awareness Class DVS Victim as Df Course SOAP/SODA Order Do Not Return Exclusion Order DUI Victim Panel Ignition Interlock No BAC refusal No driving w/ .02 or > No driving w/o lic & ins No major moving violations Reserve Restitution Served Consecutive to: Served Concurrent with: Credit/Time Served No animal control violations No further similar violations No further criminal law violations Other: The judge does not have to follow anyone’s recommendation as to sentence. The judge can give me any sentence up to the maximum authorized by law no matter what the prosecuting authority or anyone else recommends The judge may place me on probation for up to five years if I am sentenced for a domestic violence offense or under RCW 46.61.5055, or up to two years for all other offenses and impose conditions of probation. If the court orders me to appear at a hearing regarding my compliance with probation and I fail to attend the hearing, the term of probation will be tolled until I appear before the court on the record. The judge may require me to pay costs, fees and assessments authorized by law. The judge may also order me to make restitution to any victims who lost money or property as a result of crimes I committed. The maximum amount of restitution is double the amount of the loss of all victims or double the amount of my gain. If I am not a citizen of the United States, a plea of guilty to an offense punishable as a crime under state law is grounds for deportation, exclusion from admission to the United States, or denial of naturalization pursuant to the laws of the United States. NOTIFICATION RELATING TO SPECIFIC CRIMES: If I am convicted of a crime of violence, any crime of domestic violence or any crime of harassment I may not possess, own, or have under my control any firearm unless my right to do so is restored by a superior court in Washington State, and by a federal court if required. I must immediately surrender any concealed pistol license. RCW 9.41.040. If this is a crime of domestic violence, I may be ordered to pay a domestic violence assessment of up to $100.00 I understand that if this is a crime of domestic violence, the conviction may count as a “prior” in determining whether a future charge of Fourth Degree Assault, Domestic Violence, is charged as a gross misdemeanor or a felony. I understand that pursuant to RCW 43.43.754, a biological sample must be collected for purposes of DNA identification analysis from every defendant convicted of any of the following crimes: Assault in the Fourth Degree where domestic violence was pleaded and proved (EMC 10.16.010); Communicating with a Minor for Immoral Purposes (EMC 10.32.040), Failure to Register (EMC 10.24.150), Harassment (EMC 10.23.010), Patronizing a Prostitute (EMC 10.24.130), Stalking (EMC 10.16.050), Violation of a Sexual Assault Protection Order granted under chapter 7.90 RCW (EMC 10.22.060); Every person who is required to register under RCW 9A..44.130. Travel Restrictions: I will be required to contact my probation officer to request permission to ---PAGE BREAK--- Statement of Defendant on Plea of Guilty Page 3 of 4 Revised June 2020 travel or transfer to another state if I am placed on probation for one year or more and this crime involves: an offense in which a person has incurred direct or threatened physical or harm; (ii) an offense that involves the use or possession of a firearm; (iii) a second or subsequent misdemeanor offense of driving while impaired by drugs or alcohol; (iv) or a sexual offense that requires the offender to register as a sex offender in the sending state. I understand that I will be required to pay an application fee with my travel or transfer request. If this crime resulted in injury to any person or damage to or loss of property, the judge will order me to make restitution, unless extraordinary circumstances exist which make restitution inappropriate. 7. I plead guilty to the crime(s) of Violation of a Protection Order o Domestic Violence (DV) or o Non-DV, as charged in the complaint(s) or citations(s) and notice, or as amended. I have received a copy of that complaint or citation and notice. 8. I make this plea freely and voluntarily. 9. No one has threatened harm of any kind to me or to any other person to cause me to make this plea. 10. No person has made promises of any kind to cause me to enter this plea except as set forth in this statement. 11. Statement of Facts: The judge has asked me to state in my own words what I did that makes me guilty of the crime(s). This is my statement (state the specific facts that support each element of the crime(s)): o The crime(s) was (were) committed this crime against an intimate partner: (name(s)). o The crime(s) was (were) committed against family or household member(s): (name(s)). o [No statement made.] Instead of making a statement, I agree that the court may review the police reports and/or a statement of probable cause supplied by the prosecution to establish a factual basis for the plea, including a determination of my relationship to each victim as: [ ] intimate partner(s) (name(s)). [ ] family or household member(s) (name(s)). 12. My lawyer has explained to me, and we have fully discussed, all of the above paragraphs. I understand them all. I have been given a copy of this “Statement of Defendant on Plea of Guilty.” I have no further questions to ask the judge. Defendant ---PAGE BREAK--- Statement of Defendant on Plea of Guilty Page 4 of 4 Revised June 2020 I have read and discussed this statement with the defendant and believe that the defendant is competent and fully understands the statement. Prosecuting Attorney WSBA No. Defendant's Lawyer WSBA No. Print Name Print Name The foregoing statement was signed by the defendant in open court in the presence of the defendant's lawyer, if represented, and the undersigned judge. The defendant asserted that [check appropriate box]: The defendant had previously read the entire statement above and that the defendant understood it in full; The defendant's lawyer had previously read to him or her the entire statement above and that the defendant understood it in full; or An interpreter had previously read to the defendant the entire statement above and that the defendant understood it in full. The Interpreter’s Declaration is attached. I find the defendant's plea of guilty to be knowingly, intelligently and voluntarily made. Defendant understands the charges and the consequences of the plea. There is a factual basis for the plea. The defendant is guilty as charged. Dated: Judge o Interpreter’s Declaration Attached