[31 Pa.B. 1326]
[Continued from previous Web Page]
Appendix for Exhibits
Exhibit: Description: 1. Prior Record Form 2. Written Guilty Plea Agreement Form 3. ARD Agreement Form 4. Criminal Case Scheduling Form 5. Waiver of Common Pleas Arraignment Form 6. CRN Notice Form
56TH JUDICIAL DISTRICT--CARBON COUNTY
PRIOR CRIMINAL RECORD STATEMENTDEFENDANT'S NAME: __________
OTN #: __________
DEFENSE COUNSEL: _________________ DA: _________________
Representations regarding prior record:
I, _________________ , defendant, represent that my prior criminal record, including prior ARDs, is set forth here in full, to the best of my memory. I understand that if this listing is in error, the parties will not be bound by the agreement. I also understand that an intentional false statement by me on this document could result in a separate criminal prosecution.
Charge
(include all arrests)Disposition Approximate Date _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________
(Defendant/Date)
_________________
(Defense Counsel/Date)
_________________
(DA assigned to case/date)
EXHIBIT ''1''
IN THE COURT OF COMMON PLEAS OF CARBON COUNTY, PENNSYLVANIA
CRIMINAL
COMMONWEALTH OF PENNSYLVANIA : : CASE NO. vs : : 180 DAYS: ______
STIPULATION CHARGES FOR TRIAL, GUILTY PLEA OR ARD
COUNT # 1 __________ COUNT # 2 __________ COUNT # 3 __________ COUNT # 4 __________ COUNT # 5 __________ COUNT # 6 __________ AND NOW, this ______ day of ______ , 20 , the following stipulation is entered into between the Commonwealth and the Defendant in connection with the above charges: (check one)
____ TRIAL BY JURY ____ NON-JURY TRIAL ____ GUILTY PLEA ____ ARD
__________
__________
__________
___________________________ ___________________________ Defendant Attorney for the Defendant
___________________________ ___________________________ D. A. or Assistant D. A. ___________________________ Address
___________________________
Telephone Number
ORDER AND NOW, this _____ day of ______ , 2000, it is hereby ORDERED and DECREED that the Defendant shall appear in Court Room #1/2, Carbon County Courthouse, Jim Thorpe, Pennsylvania, on the ______ day of ______ , 2000 at _____ .M. prevailing time or on further order of the Court, for _________________ .
BY THE COURT
_________________
P.J.
EXHIBIT ''2''
IN THE COURT OF COMMON PLEAS OF CARBON COUNTY, PENNSYLVANIA
CRIMINAL
COMMONWEALTH OF PENNSYLVANIA : : CASE ID NO. __________ vs. : : O.T.N. NO. __________ _________________ , : Defendant
EXPLANATION OF ACCELERATED REHABILITATION PROGRAM (A.R.D.)
and
WAIVER OF RIGHTS FORM
1. I understand that I have been charged with a crime and that I have a right to go to trial on that charge. I am presumed innocent of this charge and the prosecution must prove my guilty beyond a reasonable doubt. 2. Notwithstanding my right to go to trial, I ask to be placed in the Carbon County A.R.D. Program and I CERTIFY THAT I HAVE NOT PREVIOUSLY BEEN IN SUCH A PROGRAM IN THIS OR ANY OTHER JURISDICTION. 3. I understand the District Attorney will consider any prior criminal conviction I may have. (a) I understand the District Attorney will consider a victim's input on my request for A.R.D. 4. I am aware that I will be in the A.R.D. program for up to a period of twelve (12) months, and that the special terms and condition of the program are as follows: (a) I will pay the costs of the prosecution of the charges filed against me. (b) I may have to receive an alcohol and/or drug evaluation or a mental health evaluation and follow through with any recommended treatment and pay the costs thereof. (c) I will complete any community service hours as may be ordered by the Court. (d) If I caused any property damage or personal injury to anyone and do not have insurance to pay for such damage or personal injury, I will make restitution to the victim of the amount of such damage or personal injury. (e) I will abide by the general rules and regulations applicable to all persons on A.R.D. (f) I understand that as a special incentive if all of the above special conditions are met and paid in full within six (6) months, that my participation in the A.R.D. Program can be concluded at that time. 5. I understand that the charges which have been filed against me will not be further prosecuted while I am in the A.R.D. Program, but if I fail to complete the program satisfactorily, I will be removed from the program and the charges filed against me will then be prosecuted according to law as if I had never been in the A.R.D. Program. 6. I understand that if I successfully complete the A.R.D. Program, the charges which have been filed against me will be dismissed. 7. I understand that I can reject this offer of A.R.D. and demand that my case be brought to trial instead and that neither rejection of A.R.D. nor any statement I make in these A.R.D. proceedings can be used against me at trial. 8. I understand that by participating in the A.R.D. Program I waive (give up) the following rights: (a) My right to a preliminary hearing. (b) My right to a formal Court arraignment. (c) The right to have my case tried before a jury within three hundred and sixty-five (365) days from the date the charges were filed against me and dismissed if not tried within 365 days. (d) The applicable statute of limitations within which prosecution must be commenced on the charges against me. 9. Time spent in processing the application for A.R.D. will be excluded in computing the 365 days under Rule 600. 10. I understand that if my case is removed from the A.R.D. program and sent back for trial, the District Attorney will then have one hundred and twenty (120) days within which to bring me to trial. I have read the above and fully understand it.
DATE: _________________ SIGNED: _________________ Defendant As attorney for the above-named Defendant, I certify that I have fully discussed and reviewed the foregoing explanation and waiver of right to the Defendant and I believe he/she understand them.
DATE: _________________ SIGNED: _________________ Attorney for Defendant I agree that this case is suitable for inclusion in the A.R.D. Program, and I move that the Defendant be placed on A.R.D.
DATE: _________________ SIGNED: _________________ (Assistant) District Attorney
EXHIBIT ''3''
IN THE COURT OF COMMON PLEAS OF CARBON COUNTY, PENNSYLVANIA
CRIMINAL
COMMONWEALTH OF PENNSYLVANIA : : O.T.N. NO. _________________ vs. : : S. D.No. ______ , 20 Defendant :
CRIMINAL CASE SCHEDULING INFORMATION
Defense Counsel: __________ Asst. District Atty. __________ Entry of Appearance Signed? __________ Master Charge: __________ Is defendant in jail? __________ Date Complaint Filed: __________ Waiver of Arraignment signed? __________ Date of Preliminary Hearing: __________
IMPORTANT NOTICE You and your attorney are required to appear for the following proceedings. These dates may not be changed without Leave of Court.
1. Arraignment (if not waived): __________ 9:00 A.M. Prevailing time, Courtroom Two, Courthouse, Jim Thorpe, PA 18229 2. Pre-trial Conference: __________ 9:00 A.M. Prevailing time, District Atty. Office, Courthouse, Jim Thorpe, PA 18229 3. Last Day to Plea-Plea Day: __________ 1:00 P.M. Prevailing time, Courtroom One, Courthouse, Jim Thorpe, PA 18229 4. Jury Selection: __________ 9:00 A.M. Prevailing time, Courtroom One, Courthouse, Jim Thorpe, PA 18229 ***FAILURE TO APPEAR MAY RESULT IN A FORFEITURE OF YOUR BAIL BOND AND THE ISSUANCE OF A BENCH WARRANT FOR YOUR ARREST*** The undersigned defendant and defense counsel hereby acknowledge receipt of a copy of this notice.
Date: _________________ _________________ Defendant
_________________
Defendant's Counsel
_________________ District Justice
EXHIBIT ''4''
IN THE COURT OF COMMON PLEAS OF CARBON COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA : : D. J. ID # _________________ VS. : O.T.N. # _________________
: C.P. ID # _________________
_________________ : WAIVER OF ARRAIGNMENT
I, the undersigned attorney for the Defendant, do hereby waive the arraignment provided for in PA. Rule of Criminal Procedure No. 571 which is scheduled to be held in this case on
_________________ .I, the undersigned Defendant, understand that:
1. The information containing the charges against me will be filed in the Office of the Clerk of Courts and a copy will be mailed to my attorney and to me.
_________________ (Defendant's initials)
2. Any discovery must be concluded 14 days after the scheduled arraignment date.
_________________ (Defendant's initials)
3. I must file a Bill of Particulars in writing within 7 days after the scheduled arraignment date. _________________ (Defendant's initials)
4. If I intend to offer the defense of alibi, insanity or mental infirmity, I must notify the attorney for the Commonwealth in writing within 30 days after the scheduled arraignment date. _________________ (Defendant's initials)
5. I must file all pre-trial motions for relief on or before 30 days from the scheduled arraignment date. _________________ (Defendant's initials)
6. If I fail to file any motions for discovery or pre-trial relief within the prescribed time limits, it shall be considered a waiver of the rights to file such motions.
_________________ (Defendant's initials)7. I must give the Court notice prior to stated jury selection date if I desire to have my case tried before a Judge without a jury.
_________________ (Defendant's initials)
Date: _________________ _________________ Defendant's Signature
_________________ Attorney for Defendant
EXHIBIT ''5''
ALCOHOL HIGHWAY SAFETY PROGRAM
CARBON MONROE PIKE
DRUG & ALCOHOL COMMISSION, INC.
PROCEDURES FOR CRN EVALUATIONS
1. The CRN or Court Reporting Network evaluation is a computer-supported information system which provides the Courts with a detailed personality and alcohol intake profile of a person charged with Driving Under the Influence. 2. The Court must have in their possession, prior to your sentencing or acceptance into the ARD program, the completed CRN evaluation. It is important that you keep the scheduled appointment given to you to avoid any delays in your case. 3. Please have the following information with you at the time of your evaluation: -- Time and date of arrest -- Driver's license number -- Blood Alcohol Concentration Level
4. The cost of the CRN evaluation is $35. Payment in full in required at the time of the evaluation. Failure to appear, bringing the $35 fee and/or the above-requested information, will result in the re-scheduling of your appointment. A $15 rescheduling fee will be assessed for missed appointments. PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO:
Carbon-Monroe-Pike Drug & Alcohol Commission, Inc.
_________________ _________________ Date of Appointment Time _________________ AHSP Program Director
CARBON OFFICE ADMN./MONROE OFFICES PIKE OFFICE 128 S. First Street 14 N. Sixth Street SR # 1 Box 493 Lehighton, PA 18235 Stroudsburg, PA 18360 Milford, PA (610) 377-5177 (570) 421-1960 (570) 296-7255 Fax: (610) 377-5099 Fax: (570) 421-3548 Fax: (570) 296-6375
EXHIBIT ''6''
[Pa.B. Doc. No. 01-395. Filed for public inspection March 9, 2001, 9:00 a.m.]
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