Forms provided here are for reference purposes. To download forms to fill out please visit the
Minnesota Courts website.
| 1. | My full name is __________ and I have been charged by Delinquency Petition in juvenile court with the offense(s) of: _________ which would be a felony if committed by an adult. This felony carries a presumptive sentence of __________ [range] months in prison under the Minnesota Sentencing Guidelines and applicable statutes. |
| 2. | The offense(s) is alleged to have occurred on __________ and I was __________ years old at the time, having a date of birth of __________. |
| 3. | I understand the charge(s) against me in this case. |
| 4. | I understand that I have a right to an attorney. |
| 5. | I am represented by an attorney, and: |
| a. | I feel that I have had sufficient time to discuss my case with my attorney. |
| b. | I am satisfied that my attorney is fully informed as to the facts of this case. |
| c. | My attorney has discussed possible defenses that I may have. |
| d. | I am satisfied that my attorney has represented my interests and has fully advised me. |
| 6. | I understand I have the right to a jury trial, and at that trial I have the following rights: |
| a. | The right to be presumed innocent unless and until proven guilty beyond a reasonable doubt. |
| b. | The right to be present and cross-examine all witnesses brought by the prosecutor. |
| c. | The right to subpoena and bring in my own witnesses. |
| d. | The right to remain silent or testify in my own defense. I understand that if I choose to remain silent, my silence could not be used against me. |
| e. | The right to a unanimous verdict by the jury. |
| 7. | I understand that if I enter a plea of guilty to an offense, I give up the rights listed above in #6. |
| 8. | I understand that the judge will not accept a plea from someone who says they are innocent. I am not saying that I am innocent of the charge(s) to which I am pleading guilty. |
| 9. | I am entering my plea of guilty freely and voluntarily. |
| | □ No promise of any agreement has been made to me. |
| | □ The following agreement has been reached in exchange for my plea: |
| 10. | If the court does not accept my guilty plea, I have a right to withdraw my plea and anything said in court cannot be used against me. However, if the court accepts my guilty plea, there will be a disposition in juvenile court and an adult prison sentence will be stayed. |
| 11. | I have discussed with my attorney and understand the potential maximum penalties under the Minnesota Sentencing Guidelines and criminal statutes. We have discussed and I understand that there may be sentencing departures, either upward if the court finds aggravating circumstances, or downward if the court finds mitigating factors in the case. I understand that if the court finds I have violated the terms of the stayed prison sentence, the court can send me to prison. |
| 12. | I understand I have a right to discuss my case with my parent(s), legal guardian(s), or legal custodian(s), and I have either done so or waive my right to do so. |
| 13. | I understand I could be on probation until my 21st birthday. |
| 14. | I understand that my plea may increase the penalties for future offenses, and this plea will be used to compute my adult criminal history score. |
| 15. | If I plead guilty and I am adjudicated for a "crime of violence," it may be illegal for me to possess any firearm. |
| 16. | If I plead guilty to a felony, I may be required to submit a DNA sample. For felony driving while impaired offenses and most sex offenses, a mandatory period of conditional release will follow the adult prison sentence if it is executed. Violating the terms of this conditional release may increase the time I serve in prison. In this case, the period of conditional release is _______ years. |
| 17. | If I plead guilty to a sexual offense or predatory offense, I may be required to have a psychosexual evaluation, register as a predatory offender, and submit a DNA sample. |
| 18. | I understand that if I am not a citizen of the United States, my guilty plea may result in deportation, exclusion from admission to the United States, or denial of naturalization as a United States citizen. |
| 19. | I understand that my probation or parole could be revoked because of the guilty plea to this offense. |
| 20. | I (have) (have not) been a patient in a mental hospital. |
| 21. | I (have) (have not) talked with or been treated by a psychiatrist or other person for a nervous or mental condition. |
| 22. | I (have) (have not) been ill recently. |
| 23. | I (have) (have not) recently taken pills or medicine. |
| 24. | Based upon all of this information, I am choosing to waive or give up my right to have a jury trial. |
| 25. | No threats have been made to coerce me into waiving these rights. No promises have been made to me except as set forth in paragraph 9. |
| 26. | I am waiving or giving up my rights freely and voluntarily. I have had sufficient time to discuss my rights and options with my attorney. |
Minnesota Legislature