Fillable APPLICATION FOR ADMISSION INTO THE INDIANA COUNTY COURTS (County of Indiana)

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APPLICATION FOR ADMISSION INTO THE INDIANA COUNTY COURTS (County of Indiana)

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The APPLICATION FOR ADMISSION INTO THE INDIANA COUNTY COURTS (County of Indiana) form is 4 pages long and contains:

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U.S.A. forms for County of Indiana

BROWSE COUNTY OF INDIANA (PA) FORMS

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APPLICATION FOR ADMISSION INTO THE INDIANA COUNTY COURTS
REGULAR ARD PROGRAM
COMMONWEALTH OF PENNSYLVANIA : IN THE COURT OF COMMON PLEAS
: INDIANA COUNTY, PENNSYLVANIA
:
VS :
:
_________________________________ : No: _________________________
DEFENDANT
The (defendant) undersigned hereby applies for participation in the Indiana County Courts
Regular ARD Program. Rules of Criminal Procedure: 300-320.
The (defendant) undersigned also understands his/her rights under Pa. Rules of Criminal
Procedure 600, prompt trial, and sign the attached (Waiver of Rights to a Speedy Trial, Waiver of
Statute of Limitations and Waiver of Formal Court Arraignment) forms of agreement as prescribed by
the Court.
Defendant:_______________________________ Date filed:______________________
ALL CHARGES MUST BE REPORTED BELOW OR APPLICATION WILL BE DENIED!
1. __________________________________ 4. __________________________________
2. __________________________________ 5. __________________________________
3. __________________________________ 6. __________________________________
THIS APPLICATION FOR ADMISSION INTO THE REGULAR ARD PROGRAM MUST BE COMPLETED AND FILED
WITH THE COURT ADMINISTRATOR’S OFFICE.
FILED BY:____________________________ DATE FILED:__________________________
APPROVED:__________________________ DISAPPROVED:_______________________
DISTRICT ATTORNEY:_________________________ DATE:________________________
PLEASE TYPE OR PRINT LEGIBLY: Page 2
The following questions are to be answered truthfully and completely under oath or
affirmation. This application will be used to determine your eligibility for consideration into the
Indiana County Courts ARD Program.
Defendant’s Full Name:__________________________________________________________
Date of Birth:______________________Age:______Sex:__________Race:_______________
Social Security No.:____________________________________________________________
Education Completed:__________________________________________________________
State and Driver’s Operating No.:_________________________________________________
Legal Residence:______________________________________________________________
Mailing Address_______________________________________________________________
Home Telephone:_________________________Message Phone:_______________________
Have you ever served in the Armed Forces? Yes No
Legal Counsel, if represented:____________________________________________________
Attorney’s Address:____________________________________________________
Telephone:____________________________________________________
CRIMINAL OFFENSE HISTORY:
1. Have you ever been arrested, convicted or placed on a pretrial (ARD) diversion type program,
besides the current offense? If yes, date of arrest (month and year):__________________
2. Charges:_________________________________________________________________
3. Jurisdiction (city and state): __________________________________________________
4. Sentence or juvenile disposition: ______________________________________________
5. Are you currently on probation, parole or any other pretrial diversion programs? Yes _____
No_____. If yes, county and state of jurisdiction: _________________________________
I hearby swear to (or affirm) the truth of each and every answer to the Application for Admission
in the Indiana County Courts ARD Program. I REALIZE THAT AN INTENTIONAL FALSIFICATION AS TO
ANY ANSWER OR PART THEREOF, IS A CRIME THAT IS PUNISHABLE AS A MISDEMEANOR OF THE
SECOND DEGREE, WHICH IS A FINE NOT EXCEEDING $5,000.00 AND IMPRISONMENT NOT EXCEEDING
TWO (2) YEARS OR BOTH
.
A FALSE STATEMENT WILL RESULT IN THE DISAPPROVAL OF APPLICATION.
________________________________
DEFENDANT
Subscribed and Sworn to (or affirmed) before me this ____ day of _________________, 20___.
________________________________
District Justice or Notary Public
COMMONWEALTH OF PENNSYLVANIA CASE NO: _________________________
VS O.T. N. NO:_________________________
___________________________________
DEFENDANT
EXPLANATION OF ACCELERATED REHABILITATION PROGRAM (ARD) 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 guilt beyond a reasonable doubt.
2. Notwithstanding my right to go to trial, I ask to be placed in the Indiana County ARD 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 that I may have.
(a) I understand the District Attorney will consider a victim’s input on my request for ARD.
4. I understand that the maximum period that a defendant can be placed on ARD is two (2) years and that most
cases have a one (1) year period of ARD and the special terms and conditions of the program are as follows:
(a) I will pay the costs of the Accelerated Rehabilitation Program.
(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 the Accelerated Rehabilitation Program.
5. I understand that the charges which have been filed against me will not be further prosecuted while I am in the
ARD 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 ARD Program.
6. I understand that if I successfully complete the ARD Program, the charges which have been filed against me
will be dismissed and the arrest record expunged.
7. I understand that I can reject this offer of ARD and demand that my case be brought to trial instead and that
neither rejection of ARD nor any statement I make in these ARD proceedings can be used against me at trial.
8. I understand that by participating in the ARD 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 complaint was 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 ARD will be excluded in computing the 365 days under Rule 600.
10. I understand that if my case is removed from the ARD 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 under Rule 600.
I HAVE READ THE ABOVE AND FULLY UNDERSTAND IT.
SIGNED: SIGNED: ________________________________
Defendant Defense Attorney
DATE: _____________________ (Revised 12-13-18)
COMMONWEALTH OF PENNSYLVANIA : IN THE COURT OF COMMON PLEAS
: INDIANA COUNTY, PENNSYLVANIA
:
VS :
:
_________________________________ : No: _________________________
DEFENDANT
WAIVER OF ARRAIGNMENT AND APPEARANCE OF COUNSEL
Part I
(ACKNOWLEDGMENT OF DEFENDANT)
I, _____________________________________, hereby acknowledge the following:
(Defendant’s Name)
1. I understand the nature of the charges against me;
2. I understand that I have the right to be represented by an attorney;
3. I understand that I have the right to file motions, which includes the right to file the following:
(i) a Request for a Bill of Particulars, which may be filed within seven (7) days following the date
arraignment is scheduled; (ii) a Motion for Pretrial Discovery and Inspection, which may be filed
within fourteen (14) days following the date arraignment is scheduled; (iii) an Omnibus Pretrial
Motion, which may be filed within thirty (30) days following the date arraignment is scheduled.
4. I waive my right to appear for arraignment.
I hereby enter a plea of NOT GUILTY to any and all charges against me.
_____________________________ ________________________________
Date Defendant’s Signature
Part II
(ACKNOWLEDGMENT OF COUNSEL AND ENTRY OF APPEARANCE)
I ____________________________, Attorney at Law, hereby acknowledge the following:
1. The defendant understands the nature of the charges;
2. The defendant understands the rights and requirements of Rule 571 of the Pennsylvania Rules of
Criminal Procedure;
3. The defendant waives his right to appear for arraignment.
I hereby enter my appearance for the defendant.
___________________ ___________________________________ ___________________
Date Attorney’s Signature Supreme Court ID #
________________________________________________________
Address/Phone Number
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APPLICATION FOR ADMISSION INTO THE INDIANA COUNTY COURTS (County of Indiana)

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Completed 6 August 2020

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