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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
COMMONWEALTH OF PENNSYLVANIA CRIMINAL DIVISION
v. Case Number(s):
______________________________,
Defendant
WAIVER OF RIGHTS AND CONSENT TO PLEA/SENTENCING BY VIDEO
CONFERENCE
1. Do you understand that you have a right to appear in person before a judge when pleading guilty
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 when you to 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 your guilty plea and/or sentencing based upon
you not being physically present in court? ___________
5. Do you consent to the judge accepting your guilty plea 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 plea and sentencing 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, will not be subpoenaed, will not be called testify, and will not participate in the
video or telephonic conference? ___________
9. Do you understand that if you elected to exercise your right to a trial, whether by jury or judge,
the in-person testimony of these witnesses could be necessary to prove your guilt beyond a
reasonable doubt? ___________
10. Do you understand that if necessary witnesses did not appear at your trial listing, there is a
possibility your case would be dismissed? ___________
11. Do you understand that by accepting this guilty plea you will not be able to raise on appeal or
withdraw your guilty plea based on the fact witnesses were not present? ___________
12. 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?
___________
13. Has any forced you to waive your physical appearance in the courtroom? ___________
14. Are you waiving your physical appearance in the courtroom of your own free will?
___________
15. Have any threats been made to you to waive your physical appearance in the courtroom?
___________
16. Has anyone (including your attorney) promised you anything in exchange for waiving your
physical presence in the courtroom? ___________
17. Have you discussed with your attorney your right to appear in person for your guilty plea?
___________
18. Are you satisfied with the legal advice and legal representation of your attorney? ___________
19. Do you have any physical or mental illness that affects your ability to understand the rights you
are waiving? ___________
20. Are you presently taking any medication which affects your thinking or your free will?
___________
21. 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.: ____________________
Please email this completed form to the assigned Assistant District Attorney AND the staff of the assigned Judge.
(For the email address of judicial staff, go to www.AlleghenyCourts.us/Criminal
and select "Chambers E-mail Directory.")
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
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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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