Crim. Div. Form
Rev. April, 2021
IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA : SUMMARY APPEALS DIVISION
________________________________ SA No. _____________________ :
EXPLANATION OF DEFENDANT’S RIGHTS
You or your attorney have indicated to the officers of this Court that you wish to plead guilty to certain
specific criminal charges that the Commonwealth of Pennsylvania has brought against you.
In order to have your plea accepted by this Court here today, you must waive your right to confront the
prosecution witnesses against you and agree to a summary of the prosecution’s evidence to be placed on the
record. Your plea of guilty must be voluntary. If anyone has forced you to plead guilty or promised you
anything other than a plea bargain your plea will be rejected.
If you intend to plead guilty, please answer all the questions on this form. After you have read,
understood, and completed your answers to the questions, you must sign the form at the end.
You should initial each page at the bottom after you have read, understood, and completed your
answers to the questions on that page. When you have finished all of the questions, you must sign the
form at the end.
1. What is your full name? ________________________________________________
2. How old are you today? __________________________
3. What is the highest grade that you have completed in school? _______________________
Answer either "Yes" or "No" to the following questions:
4. Do you read, write, and understand the English language? ____________
5. Do you fully understand the factual basis of each charged offense? __________
6. Do you understa
nd that by pleading guilty, you give up the right to present or assert any defenses
may have on your behalf? ________