Ind. Porter Cnty. Local Rule LR64-CR00-4400

HISTORY

At the time of the filing of a new infraction, misdemeanor or felony case, the State shall

file on green paper to be kept in the red confidential file, a complete and accurate criminal history

of the Defendant using the NCIC, MCF or other form developed by the prosecutor or directed by

the courts. If used, the NCIC shall indicate any history of convictions. In infraction matters, only

the driving record of the Defendant shall be provided as the criminal history. Prior to the filing of a

plea agreement, where no presentence investigation will be utilized, the Defendant shall file an

Affidavit of Prior Criminal Record indicating new arrests or convictions not disclosed by the State

in the filing mentioned above, using the following format:

AFFIDAVIT OF PRIOR CRIMINAL RECORD

I hereby disclose the following updated criminal history, including

recent arrests and convictions (including other counties or states) since

submission of the criminal history by the State:

ARRESTS/CONVICTIONS SINCE INITIAL HEARING

DATE COUNTY/STATE RESULT

On Probation now? Yes No

On Parole now? Yes No

Full Name

Birth Date

I AFFIRM, UNDER PENALTIES OF PERJURY, THAT THE ABOVE DISCLOSURE

IS TRUE AND COMPLETE, LISTING ALL CRIMINAL ACTIVITY WITH WHICH I HAVE

BEEN CHARGED, AND LISTING ALL CHARGES NOW PENDING AGAINST ME. I

UNDERSTAND THAT IN THE EVENT THIS DISCLOSURE IS INACCURATE IN ANY

RESPECT, THE STATE OF INDIANA SHALL BE PERMITTED TO REVOKE ANY PLEA

OFFER, OR WITHDRAW FROM ANY PLEA AGREEMENT.

I UNDERSTAND THAT MY ATTORNEY IS IN NO MANNER RESPONSIBLE FOR

THE ACCURACY OF THIS AFFIDAVIT.

Date Defendant