Forms provided here are for reference purposes. To download forms to fill out please visit the
Minnesota Courts website.
| 1. | My full name is _______________ and I have been charged by Delinquency Petition in juvenile court with the offense(s) of: ________________________________ which would be a felony if committed by an adult. This felony carries a presumptive sentence of _________________months in prison under the Minnesota Sentencing |
| [range] |
| Guidelines and applicable statutes. |
| 2. | The offense(s) is alleged to have occurred on ________ and I was at least 14 years old at the time, having a date of birth of _________________. |
| 3. | For the purpose of this waiver only, I submit there is probable cause to believe I committed the offense(s). |
| 4. | I understand that I have a right to an attorney. |
| 5. | The prosecutor has brought a motion for extended jurisdiction juvenile prosecution, and I understand I have a right to a hearing before a judge. |
| 6. | At that hearing, the prosecutor must show by clear and convincing evidence that designating the proceeding as an extended jurisdiction juvenile prosecution serves public safety. I have discussed the public safety factors with my attorney. |
| 7. | I understand I could present witnesses and evidence at that hearing. |
| 8. | I understand I could cross-examine all witnesses who testify for the state. |
| 9. | I understand I could present arguments against the extended jurisdiction juvenile prosecution. |
| 10. | I understand that by waiving my right to a hearing I agree that my case can proceed to a jury trial on the above-named offense(s). If I am found guilty, I will be subject to the penalties of both juvenile and adult court, including a stayed sentence under Minnesota Sentencing Guidelines and criminal statutes. |
| 11. | I have discussed with my attorney and understand the potential maximum penalties under the Minnesota Sentencing Guidelines and criminal statutes. I have discussed and understand that if I violate the terms of the stayed adult sentence, I have a right to a hearing, but if the court finds the violation proven, I will be in the adult court system where a prison sentence could be imposed. We have discussed and I understand that there may be sentencing departures, either upward if the court finds aggravating circumstances, or downward if the court finds mitigating factors in the case. |
| □ | No promise of any agreement has been made to me. |
| □ | The following agreement has been reached in exchange for my waiver: |
| 12. | I understand I have a right to discuss my case with my parent(s), legal guardian(s), or legal custodian(s), and I have either done so or waive my right to do so. |
| 13. | I understand the court will find I represent a danger to the public safety if kept solely within the juvenile system and will order an extended jurisdiction juvenile prosecution. |
| 14. | If a psychological evaluation has been completed, I understand I may request additional psychological evaluations and explore alternative treatment programs to find a suitable juvenile disposition option and demonstrate to the court that I do not represent a danger to the public safety if I remain in the juvenile system. |
| 15. | Based upon all of this information and investigation, I am choosing to waive or give up my right to have an extended jurisdiction juvenile hearing. |
| 16. | No threats have been made to coerce me into waiving these rights. No promises have been made to me except as set forth in paragraph 11. |
| 17. | I am waiving or giving up my rights freely and voluntarily. I have had sufficient time to discuss my rights and options with my attorney. |
Minnesota Legislature