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Rule 4.2
Pleas and Pre-Trial Disposition

(d) Voluntariness. The court shall not accept a plea of guilty without first
determining that it is made voluntarily, competently, and with an understanding
of the nature of the charge and the consequences of the plea. The court shall not
enter a judgment upon a plea of guilty unless it is satisfied that there is a
factual basis for the plea.

(e) Agreements. If a plea of guilty is based upon an agreement between the
defendant and the prosecuting authority, such agreement must be made a part of
the record at the time the plea is entered. No agreement shall be made which
specifies what action the court shall take on or pursuant to the plea, or which
attempts to control the exercise of the court's discretion, and the court shall
so advise the defendant.

(g) Written Statement. A written statement of the defendant in substantially
the form set forth below shall be filed on a plea of guilty:

DISTRICT COURT, STATE OF
WASHINGTON, ADAMS COUNTY

No.
______________________________,
Plaintiff Statement of Defendant on
Plea of Guilty
[ ] Count 1:
vs. ____________________
______________________________, [ ] Count 2:
Defendant. ____________________
[ ] Count 3:
____________________
[ ]
__________________________

1. My true name is ________________________________________.
2. My age is ___________________.
3. I went through the ___________________ grade.
4. I Have Been Informed and Fully Understand that:
(a) 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.

(b) I am charged with: ______________________________________________.

The elements are: ______________________________________________.

5. I Understand That I Have the Following Important Rights, and I Give Them
All Up by Pleading Guilty:

(a) The right to a speedy and public trial by an impartial jury in the
county where the crime is alleged to have been committed;
(b) The right to remain silent before and during trial, and the right to
refuse to testify against myself;
(c) The right at trial to hear and question the witnesses who testify against me;
(d) 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;
(e) I am presumed innocent unless the charge is proven beyond a
reasonable doubt or I enter a plea of guilty;
(f) The right to appeal a finding of guilt after a trial.

6. In Considering the Consequences of my Guilty Plea, I Understand That:

(a) The crime with which I am charged carries a maximum sentence of
________ days in jail and a $_____________ fine.

(b) The prosecuting authority will make the following recommendation to
the judge:

(c) 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.

(d) The judge may place me on probation for up to five years if I am
sentenced 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.

(e) 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.

(f) 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 any of the Following Paragraphs
Apply, the Box Should Be Checked and the Paragraph Initialed by the Defendant.

[ ] (g) The crime of
_________________________________ has a mandatory minimum sentence of
_____________________ days in jail and $____________ fine plus costs
and assessments. The law does not allow any reduction of this sentence.

[ ] (h) If this crime involves a sexual offense, prostitution, or a drug
offense associated with hypodermic needles, I will be required to undergo
testing for the human immunodeficiency (AIDS) virus.

[ ] (i) This plea of guilty will result in suspension or revocation
of my driving license or privilege by the Department of Licensing
for a period of ________________. This period may not include
suspension or revocation based on other matters.

[ ] (j) I understand that I may not
possess, own, or have under my control any firearm unless my right to
do so is restored by a court of record and that I must immediately
surrender any concealed pistol license. RCW 9.41.040.

[ ] (k) If this crime involves a drug
offense, my eligibility for state and federal education benefits will
be affected. 20 U.S.C. § 1091(r).

[ ] (l) If this case involves driving
while under the influence of alcohol and/or being in actual physical
control of a vehicle while under the influence of alcohol and/or
drugs, I have been informed and understand that I will be subject to
[ ] the penalties described in the "DUI" Attachment.
OR
[ ] these penalties: The mandatory minimum sentence of
______________ days in jail, _______________ days of electronic home
monitoring and $_____________ monetary penalty. I may also be
required to drive only motor vehicles equipped with an ignition
interlock device as imposed by the Department of Licensing and/or the
court. My driving privilege will be suspended or revoked by the
Department of Licensing for the period of time stated in paragraph
6(i). In lieu of the minimum jail term, the judge may order me to
serve ___________________ days in electronic home monitoring. If I
do not have a dwelling, telephone service, or any other necessity to
operate electronic home monitoring; if I live out of state; or if the
judge determines I would violate the terms of electronic home
monitoring, the judge may waive electronic home monitoring and impose
an alternative sentence which may include additional jail time, work
crew or work camp.

[ ] (m) I understand that if this crime involves sexual misconduct with a minor
in the second degree, communication with a minor for immoral
purposes, or attempt, solicitation or conspiracy to commit a sex
offense, or a kidnapping offense involving a minor, as defined in
RCW 9A.44.130, I will be required to register with the county sheriff
as described in the "Offender Registration" Attachment.

[ ] (n) If this crime involves stalking, harassment or communication
with a minor for immoral purposes, I will be required to have a
biological sample collected for purposes of DNA identification
analysis. RCW 43.43.754.

[ ] (o) Travel Restrictions: I understand that I will be required to
contact my probation officer, the probation director or designee, or
the court if there is no probation department, to request permission
to travel or transfer to another state if I am placed on probation
for one year or more and this crime involves: (i) an offense in
which a person has incurred direct or threatened physical or
psychological 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) 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.

7. I plead guilty to the crime(s) of as charged in the
complaint(s) or citation(s) and notice. 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. The judge has asked me to state in my own words what I did that makes me
guilty of this crime. This is my statement:
______________________________________________________________________.

[ ] 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.

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.

Date:_______________________ _____________________________________________
Defendant

I have read and discussed this statement with
the defendant and believe that the defendant is
competent and fully understands the statement.

_______________________________________ ________________________________
Prosecuting Authority WSBA No. Defendant's Lawyer WSBA No.
Type or Print Name Type or Print Name

The foregoing statement was signed by the defendant in open court in the
presence of the defendant's lawyer and the undersigned Judge. The defendant
asserted that (check the appropriate box):

[ ] (a) The defendant had previously read; or
[ ] (b) The defendant's lawyer had previously read to him or her; or
[ ] (c) An interpreter had previously read to the defendant the entire
statement above and that the defendant understood it in full.

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:____________________ ___________________________________________
DISTRICT COURT JUDGE

(i) Deferred Prosecution Petition. Deferred Prosecution petitions shall be in
substantially the same format as the petition attached to this Rule. Each
petition shall include a case history and an evaluation attached as exhibits.

All Defendants shall read and complete a Statement of Defendant on Deferred
Prosecution in substantially the same format as that attached to this Rule
before approval of a Deferred Prosecution by the Court.

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