County
New Jersey Judiciary
Plea Form Prosecutor File Number
Defendant’s Name:
before Judge:
List the charges to which you are pleading guilty:
Statutory Maximum
Ind./Acc./Comp.# Count Nature of Offense Degree Time Fine VCCA Assmt*
Max
Max
Max
Max
Max
Your total exposure as the result of this plea is:................................Total
Please Circle
Appropriate Answer
a. Did you commit the offense(s) to which you are pleading guilty? [Yes] [No]2.
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)? [Yes] [No]
3. Do you understand what the charges mean? [Yes] [No]
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? [Yes] [No]
b. The right to remain silent? [Yes] [No]
4.
c. The right to confront the witnesses against you? [Yes] [No]
d. Do you understand that by pleading you are not waivingyour 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]
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]
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.)
[Yes] [No]
Defendant’s Initials______________
*
Victims of Crime Compensation Agency Assessment
_
Main Plea Form / Revised Form Promulgated by Directive #14-08 (10/08/2008), CN 10079-English page 1 of 4
Defendant’s Initials_______________
Main Plea Form / Revised Form Promulgated by Directive #14-08 (10/08/2008), CN 10079-English page 2 of 4
d. If the offense occurred on or after February 1, 1993 but was before March 13, 1995,
and 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?
[Yes] [No]
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]
5.
h. You will be required to provide a DNA sample, which could be used by law
enforcement for the investigation of criminal activity, and pay for the cost of
testing?
[Yes] [No]
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]
Did you enter a plea of guilty to any charges that require a mandatory period of parole
ineligibility or a mandatory extended term? [Yes] [No]7.
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 the maximum period of parole ineligibility can be years and
months (fill in 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]
Are you presently on probation or parole? [Yes] [No] 9.
a. Do you realize that a guilty plea may result in a violation of your
probation or parole? [Yes] [No] [NA]
Are you presently serving a custodial sentence on another charge? [Yes] [No] 10.
a. Do you understand that a guilty plea may affect your parole eligibility? [Yes] [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]
Defendant’s Initials_______________
Main Plea Form / Revised Form Promulgated by Directive #14-08 (10/08/2008), CN 10079-English page 3 of 4
List any charges the prosecutor has agreed to recommend for dismissal:
Ind./Acc./Compl.# Count Nature of Offense and Degree
12.
13. Specify any sentence the prosecutor has agreed to recommend:
Has the prosecutor promised that he or she will NOT:
a. Speak at sentencing? [Yes] [No]
b. Seek an extended term of confinement? [Yes] [No]
14.
c. Seek a stipulation of parole ineligibility? [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?
(If no, answer question #17b) [Yes] [No]
b. Do you understand that if you are not a United States citizen or national, you may be
deported by virtue of your plea of guilty? [Yes] [No]
18. a. Do you understand that pursuant to the rules of the Interstate Compact for Adult
Offender 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?
[Yes] [No]
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?
[Yes] [No]
19. Have you discussed with your attorney the legal doctrine of merger? [Yes] [No] [NA]
20. Are you giving up your right at sentence to argue that there are charges you
pleaded guilty to for which you cannot be given a separate sentence? [Yes] [No] [NA]
Defendant’s Initials_______________
Main Plea Form / Revised Form Promulgated by Directive #14-08 (10/08/2008), CN 10079-English page 4 of 4
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]
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?
[Yes] [No]
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]
23.
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.
