Haw. R. Pen. P. Form E
IN THE DISTRICT COURT OF THE
______________ CIRCUIT
_____________ DIVISION
WAIVER OF PHYSICAL PRESENCE: SUBMISSION OF PLEA; PRO SE DEFENDANT; ATTACHMENT "A" Case Number:
STATE OF HAWAI'I vs. (DEFENDANT) Police Report Number:
CHARGE(S): VIOLATION OF H.R.S. SECTION(S) AMENDED CHARGE(S):
In accordance with Rule 43, Hawai'i Rules of Penal Procedure:
[ ] I understand that the maximum possible penalties are:
OFFENSE # 1: __________________ H.R.S. Section: ____________________
$___________ Fine or _____ days/months/year in jail or both.
OFFENSE # 2: __________________ H.R.S. Section: ____________________
$___________ Fine or _____ days/months/year in jail or both.
OFFENSE # 3: __________________ H.R.S. Section: ____________________
$___________ Fine or _____ days/months/year in jail or both.
OFFENSE # 4: __________________ H.R.S. Section: ____________________
$___________ Fine or _____ days/months/year in jail or both.
OFFENSE # 5: __________________ H.R.S. Section: ____________________
$___________ Fine or _____ days/months/year in jail or both.
OFFENSE # 6: __________________ H.R.S. Section: ____________________
$___________ Fine or _____ days/months/year in jail or both.
OFFENSE # 7: __________________ H.R.S. Section: ____________________
$___________ Fine or _____ days/months/year in jail or both.
OFFENSE # 8: __________________ H.R.S. Section: ____________________
$___________ Fine or _____ days/months/year in jail or both.
OFFENSE # 9 __________________ H.R.S. Section: ____________________
$___________ Fine or _____ days/months/year in jail or both.
OFFENSE #10: __________________ H.R.S. Section: ____________________
$___________ Fine or _____ days/months/year in jail or both.
DATED this _______________ day of _______________, 20___.
________________________________________
Signature of Defendant
Haw. R. Pen. P. Form E