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IN THE COURT OF COMMON PLEAS OF ALLEGHENY (Fifth Judicial District of Pennsylvania)

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IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA
CRIMINAL DIVISION
COMMONWEALTH OF PENNSYLVANIA
vs. CC NO.__________________________
Charge(s):________________________ ___________________________________
WAIVER OF RIGHTS AND CONSENT TO NON-JURY TRIAL AND
POTENTIAL SENTENCING BY VIDEO CONFERENCE
1. Do you understand that you have a right to appear in person before a judge for the purpose of a
non-jury trial or when being sentenced under Article 1, Section 9 of the Pennsylvania Constitution,
as well as Pa.R.Crim.P. 602 (Presence of the Defendant)? ___________
2. Do you agree to waive your right to be physically present in a courtroom during the non-jury trial
or if you plead guilty and/or are sentenced? ___________
3. Do understand that your court appearance will occur by video or telephonic conference?
___________
4. Do understand that you will not be able to appeal the outcome of your non-jury trial or guilty plea
and/or sentencing based upon you not being physically present in court? ___________
5. Do you consent to the judge presiding over your non-jury trial and imposing your sentencing via
video or telephonic conferencing? ___________
6. Do understand that you have a right to confront your accusers, question witnesses, and secure the
presence of various witnesses? ___________
7. Do you understand that your constitutionally guaranteed ability to confront your accusers, cross-
examine all witnesses called by the Commonwealth; call witnesses to testify and present evidence
in your defense, and to testify, if you should choose to do so, would be via video conference?
_______
8.13.2020
8. Do you understand that by waiving the requirement of physical presence in a courtroom by the
parties and witnesses you will not be able to raise this issue on appeal? ___________
9. Your decision to waive your right to be physically present in the courtroom must be knowingly,
intelligently, and voluntarily waived. If anyone has promised you anything to waive your physical
presence, your plea will be rejected. If anyone has forced you or attempted to force you to waive
your physical appearance, your plea will be rejected. Do you fully understand this? ___________
10. Has anyone forced you to waive your physical appearance in the courtroom? ___________
11. Are you waiving the requirement of physical presence in the courtroom by the parties and
witnesses of your own free will? ___________
12. Have any threats been made to you to waive the requirement of physical presence in the
courtroom? ___________
13. Has anyone (including your attorney) promised you anything in exchange for waiving the
requirement of physical presence in the courtroom? ___________
14. Have you discussed with your attorney your right to appear in person and require all witnesses
and parties to appear in person for your non-jury trial? ___________
15. Are you satisfied with the legal advice and legal representation of your attorney? ___________
16. Do you have any physical or mental illness that affects your ability to understand the rights you are
waiving? ___________
17. Are you presently taking any medication which affects your thinking or your free will?
___________
18. Do you understand the rights you are waiving today? ___________
I AFFIRM THAT I HAVE READ THIS DOCUMENT IN ITS ENTIRETY, ANSWERED ALL OF THE
QUESTIONS TRUTHFULLY, AND FULLY UNDERSTAND EACH STATEMENT.
___________________________ ________________________
Defendant Date
8.13.2020
Attorney Certification
I certify that I am an attorney admitted to practice law by the Supreme Court of Pennsylvania and
represent the defendant herein. I have reviewed the above document with the defendant and the
answers recorded belong to the defendant. I made no threats or promises to the defendant to
execute this document. I know of no reason that the defendant cannot and is not knowingly,
intelligently, and voluntarily waiving his or her physical presence and waiving the presence of the
witnesses/victims in this case.
I certify that this filing complies with the provisions of the Public Access Policy of the Unified
Judicial System of Pennsylvania: Case Records of the Appellate and Trial Courts that require filing
confidential information and documents differently than non-confidential information and
documents.
________________________________ ________________________
Defense Counsel Date
Attorney No.: ____________________
8.13.2020
Court Approval
The Court, having ascertained on the record that the Defendant knowingly and intelligently waives
his/her right to be physically present and require the presence of the witnesses/victims in this
case, hereby does APPROVE / DISAPPROVES this waiver.
___________________________________ ______________________________
Judge Date
8.13.2020
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IN THE COURT OF COMMON PLEAS OF ALLEGHENY (Fifth Judicial District of Pennsylvania)

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Completed 16 May 2021

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