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7 UNITED STATES DISTRICT COURT
8 NORTHERN DISTRICT OF CALIFORNIA
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<< Plaintiff Long (CAPS) >>,
10 Case No. << Case Number >> (JST)
Plaintiffs, << Case Sealed Status >>
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v.
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Northern District of California
United States District Court
<< Defendant Long (CAPS) >>,
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Defendants.
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16 The defendant represents to the Court:
17 1. My full true name is ___________________________ . I am _____ years of age. I
18 have gone to school up to and including ____________________________. My most recent
19 occupation has been________________________________________. I request that all
20 proceedings against me be in my true name.
21 2. I am represented by a lawyer. His/her name is
22 ________________________________________.
23 3. I received and read a copy of the indictment/information. If applicable: An interpreter
24 who speaks_________________ read it to me in ___________________, and I have discussed it
with my lawyer.
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//
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1 I fully understand every charge made against me. I understand these charges to be as
2 follows:
3 _______________________________________________________________________________
4 _______________________________________________________________________________
5 _______________________________________________________________________________
4. I have told my lawyer all the facts and circumstances known to me about the charges
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made against me in the indictment/information. I believe that my lawyer is fully informed on all
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such matters.
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5. I know that the Court must be satisfied that there is a factual basis for a plea of
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“GUILTY” before my plea can be accepted. I represent to the Court that I took the following
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actions in connection with the charges made against me in Count[s] ______________ and that
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these facts are true and correct:
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Northern District of California
_______________________________________________________________________________
United States District Court
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_______________________________________________________________________________
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_______________________________________________________________________________
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6. My lawyer has counseled and advised me on the nature of each charge, all lesser
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included charges, all penalties and consequences of each charge, all possible defenses that I may
17 have in this case and constitutional rights I am waiving.
18 7. I understand that my constitutional rights are as follows:
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(a) the right to plead not guilty or, having already so pleaded, to persist in that plea;
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(b) the right to a jury trial;
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(c) the right to represented by counsel – and if necessary have the Court appoint
22 counsel – at trial and at every other stage of the proceeding; and
23 (d) the right at trial to confront and cross-examine adverse witnesses, to testify and
present evidence, to compel the attendance of witnesses, to be protected from
24 compelled self-incrimination, and to remain silent, such that if I do not take the
witness stand, no inference of guilt may be drawn from such failure and the jury
25 must be so advised.
8. I know that I may plead “NOT GUILTY” to any offense charged against me and
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exercise all of my rights as listed above.
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1 9. I know that if I plead “GUILTY,” I am giving up all of the trial rights enumerated in
2 paragraph 7 and that there will be no trial either before a court or jury.
3 10. I know that if I plead “GUILTY,” the result of my plea is more than just an admission
4 or confession of guilt. I understand that it will result in my conviction, and the Court may impose
5 the same punishment as if I had pleaded “NOT GUILTY,” stood trial and been convicted by a
jury.
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11. My lawyer has informed me that the maximum and minimum, if any, punishments
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which the law provides for the offense charged in Count(s) __________ are as follows:
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(For multiple counts, include the following information for each count)
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(a) Maximum prison sentence: ______ years
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(b) Mandatory minimum prison sentence (if applicable): ______ years
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(c) Maximum supervised release term: ______ years
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Northern District of California
(d) Minimum supervised release term (if applicable): ______ years
United States District Court
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(e) Mandatory special assessment: $__________
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(f) Restitution: $__________
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(g) Maximum fine equal to the greater of the following:
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17 (1) $__________________ (generally $250,000 for a felony, $100,000
for a Class A misdemeanor, or $5,000 for a
18 Class B misdemeanor or lower; see 18
U.S.C. § 3571)); or
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(2) $__________________ (twice the gross pecuniary gain I derived
20 from the offense); or
21 (3) $___________________ (twice the gross pecuniary loss caused by
the offense to another person or persons).
22 If applicable: I understand that, because I am pleading guilty to more than one count, the
23 Court may order the sentences on those counts to run consecutively.
24 I understand that if I violate any condition of supervised release, the release may be
25 revoked, and I may be sentenced to all or part of the term of supervised release imposed in
26 addition to any other term of imprisonment which I have received. I understand that if I violate
27 any term of probation, the probation may be revoked, and I may be sentenced up to the maximum
28 statutory term of imprisonment for the offense.
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1 I understand that I may be assessed the costs of confinement and/or supervision. I
2 understand I may be ordered to pay restitution in an amount determined by the Court.
3 12. I know that the sentence I will receive will be decided solely by the Judge. I
4 understand that the Judge will make no decision regarding my sentence until the Judge has read
5 and considered the pre-sentence investigation report prepared and submitted to the Court by the
Probation Department. I also understand that the Court and counsel cannot promise me now what
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sentence will be imposed. I understand that in deciding what sentence it will impose, the Court
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will calculate my sentencing range under the Sentencing Guidelines. I understand that while the
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Court is not bound to apply the Guidelines, it must take them into consideration when sentencing
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me, together with the factors set forth in 18 U.S.C. § 3553(a).
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13. I understand that under provisions of certain criminal statutes, certain property of mine
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may be forfeited to the United States. I have been advised by my lawyer whether, and to what
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Northern District of California
extent, my property may be subject to forfeiture.
United States District Court
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14. If I am on probation, supervised release or parole in this or any other Court, I know that
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by pleading guilty here, my probation, release or parole may be revoked, and I may be required to
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serve time in that case, which may be consecutive (that is, in addition to) any sentence imposed
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upon me in this case.
17 15. I declare that no officer or agent of any branch of government (federal, state or local)
18 has promised or suggested that I will receive a lighter sentence, or probation, or any other form of
19 leniency, nor have any other promises been made if I plead “GUILTY” except as follows:
20 _______________________________________________________________________________
21 _______________________________________________________________________________
22 _______________________________________________________________________________
(In the space below, insert any promises or concessions made to the defendant or to
23 his/her attorney).
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1 If anyone else made such a promise or suggestion, except as noted in the previous sentence, I
2 know that it was entirely without authority or effect.
3 16. I believe that my lawyer has done all that a lawyer could do to counsel and assist me,
4 and I am satisfied with the advice and help he/she has given me.
5 17. I know that the Court will not permit anyone to plead “GUILTY” who maintains
he/she is innocent and, with that in mind and because I am “GUILTY,” I respectfully request the
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Court to accept my plea of “GUILTY” and to have the clerk enter my plea of “GUILTY” as
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follows:
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_______________________________________________________________________________
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_______________________________________________________________________________
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_______________________________________________________________________________
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18. My mind is clear. I am not under the influence of alcohol or drugs, and I am not under
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Northern District of California
a doctor’s care. The only drugs, medicines, or pills that I have taken within the past seven days
United States District Court
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are:
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_______________________________________________________________________________
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_______________________________________________________________________________
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_______________________________________________________________________________
17 _______________________________________________________________________________
18 (If none, so state.)
19 19. I confirm that my decision to plead guilty is made voluntarily, and no one coerced or
20 threatened me to enter into this Agreement. I offer my plea of “GUILTY” freely and voluntarily
21 and of my own accord, and with full understanding of all the matters set forth in the
22 indictment/information, in this application, and in the certificate of my lawyer which is attached to
23 this application. In offering my plea of “GUILTY,” I freely and voluntarily waive (that is, give
24 up) the constitutional rights guaranteed to me as stated in paragraph 7 above.
25 20. I waive the reading of the indictment/information in open court, and I request the
26 Court to enter my plea of “GUILTY” as set forth in Paragraph 17 of this application.
27 21. I understand that the Court will address me personally in open court to determine the
28 voluntariness of my guilty plea and to establish a factual basis for it. I understand that the Court
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1 may place me under oath, and that the government may use any false statements that I make under
2 oath against me in a prosecution for perjury or false statement (which is a felony).
3 22. ________ I am proficient enough in English to read the above and have read and fully
4 understand it.
5 _________ I am not proficient enough in English. I speak and understand _____________,
which is my native language. The above was read to me in___________ and I fully understand it.
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Signed by me in open court in the presence of my attorney this____ day of__________, 20__.
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9 Defendant
CERTIFICATE OF COUNSEL
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I have fully explained to my client the charges in the indictment/information in the case, the
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defenses he/she may have to the charges, all of the information set forth in this application, and all
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Northern District of California
United States District Court
the rights that a criminal defendant has. In my opinion, my client understands the charges, the
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defenses, the information in this application, and the rights he or she is giving up by pleading
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guilty, and, based on the information now known to me, his/her decision to plead guilty is
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knowing and voluntary Signed by me in open court in the presence of the above-named defendant
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after a full discussion of the contents of this certificate with the defendant this________ day
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of____________, 20___ .
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19 ______________________________________
Attorney for the Defendant
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21 INTERPRETER CERTIFICATION
22 I, ________________________, hereby certify that I am a certified __________ language]
23 interpreter and that I accurately translated this plea agreement to the defendant, he/she told me that
24 he/she understood it, and I am satisfied that his/her answer is true and correct.
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Date__________________________ _____________________________________
26 Interpreter’s Signature
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1 ORDER
2 I find that:
3 1. The defendant enters this plea of guilty freely and voluntarily and not out of ignorance,
4 inadvertence, fear or coercion.
5 2. The defendant understands and knowingly, freely and voluntarily waives his/her
constitutional rights.
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3. The defendant freely and voluntarily executed the attached Application and fully
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understands its contents.
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4. The defendant has admitted the essential elements of the crime charged.
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IT IS THEREFORE ORDERED that the defendant’s plea of “GUILTY” entered in open court be
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accepted and entered as requested in this Application and as recommended in the certificate signed
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by the defendant’s lawyer.
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Northern District of California
Done in open court this___ day of____________ , 20__.
United States District Court
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Dated:
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16 JON S. TIGAR
United States District Judge
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