SOP 209.01-att-10: Negotiated Plea Form

SOP 209.01
Attachment 10

11/6/17

NEGOTIATED PLEA FORM

Facility: Disciplinary Report #______________

Offender’s Name: Offender’s I.D. #: ______________

Disciplinary Charge Code_____

Code_____

Code_____

Code________

I, ______________________________ voluntarily enter a plea of guilty/no contest to the above stated
disciplinary charge(s) and I understand that Prosecutor___ ____ ______________________________
will recommend to the Disciplinary Hearing Officer that the following disciplinary sanction(s) be
imposed:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

___________________
Prosecutor’s Signature Date Offender’s Signature

__________________________
Advocate’s Signature Date

Approved: YES NO
Disciplinary Hearing Officer’s Date
Signature

Approved: YES NO
Warden’s/Superintendent’s Signature Date (Circle One)

(Reproduce locally)

Retention Schedule: Upon completion, this form shall be placed in the offender’s institutional file, except
for those overturned or dismissed, and shall be kept according to the official records retention schedule for
institutional files.