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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
COMMONWEALTH OF PENNSYLVANIA : CRIMINAL DIVISION
:
:
V. :
:
:
_______________________ : NO. _____________________
Petitioner :
:
WAIVER OF RIGHTS AND CONSENT TO HEARING BY VIDEO CONFERENCE
1. Do you understand that you have a right to appear in person before a judge as to the
upcoming hearing 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 when the
upcoming Hearing occurs? ___________
3. Do you understand that your court appearance will occur by video or telephonic
conference? _____________
4. Do you understand that you will not be able to appeal based upon your not being
physically present in court? ____________
5. Do you consent to the judge accepting your case at this stage via video or telephonic
conferencing? _____________
6. Do you understand that you have the right to confront your accusers, question witnesses,
and secure the presence of various witnesses? ____________
7. Do you understand that your present proceeding will occur without requiring the police
officers, witnesses and/or victims in your case to appear in court? ___________
8. Do you understand that the witnesses, victims, and/or police officers in your case will not
be present in court but all witnesses will participate in the video or telephonic conference?
___________
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 upcoming hearing will stop. If anyone has forced you
or attempted to force you to waive your physical appearance, your upcoming hearing will
be a nullity. Do you fully understand this? ________________
10. Has anyone forced you to waive your physical appearance in the courtroom ?
_____________
11. Are you waiving your physical appearance in the courtroom of your own free will?
______________
12. Have any threats been made to you to waive your physical appearance in the courtroom?
____________
13. Has anyone (including your attorney) promised you anything in exchange for waiving
your physical presence in the courtroom? _____________
14. Have you discussed with your attorney your right to appear in person? ____________
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
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.: ____________________
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 / DISAPPROVE this waiver.
___________________________________ ______________________________
Judge Date
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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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