Adams Cnty. C.P. Rules of Criminal Procedure Rule 541.1

The notice shall substantially be in the following form:

IN THE COURT OF COMMON PLEAS OF ADAMS COUNTY, PENNSYLVANIA

CRIMINAL

COMMONWEALTH OF PENNSYLVANIA MJ-513____-

VS.

_________________________________

I verify that the foregoing is true and correct to the best of my knowledge:

1. I am represented by counsel of record and wish to waive my preliminary

hearing.

2. If I am represented by counsel, my attorney concurs in this waiver.

3. I understand the nature of all charges against me.

4. I understand that I am required to report for formal arraignment before the

Adams County Court of Common Pleas on the date and time provided to my

attorney. In that regard, I will consult with my attorney concerning the date

which I must appear. I am further aware that my presence at formal

arraignment is required and if I fail to appear, the proceeding may be conducted

in my absence and a bench warrant will be issued for my arrest.

5. I understand that my bail has been set at ____________________ and that

failure to appear as directed at all future court proceedings or to otherwise

comply with the conditions of bail as set forth hereinbelow may result in

forfeiture of the bail bond and issuance of a warrant for arrest.

6. I understand that the conditions of my release as established in paragraph 5

above are as follows:

a. I must appear at all times required until full and final

disposition of the case(s).

b. I must obey all further orders of court.

c. I must provide a current address and must give written

notice to the bail authority/court bail agency/other

designated court bail officer, Adams County Clerk of

Courts and the Adams County District Attorney of any

change of address within 48 hours of the date of the

change. In this regard, if my address listed on the criminal

complaint is inaccurate, I must advise the bail

authority/court bail agency/other designated court bail

officer, Clerk of Courts and the District Attorney of the

correct address within 48 hours of the date this document is

executed by me.

d. I must neither do, nor cause to be done, nor permit to be

done on my behalf, any act as proscribed by Section 4952

of the Pennsylvania Crimes Code (relating to intimidation

of witnesses or victims) or by Section 4953 (relating to

retaliation against witnesses or victims), 18 Pa. C.S. §

4952, 4953.

e. I must refrain from criminal activity.

f. I must comply with any fingerprint order if issued by any

court.

I verify that the facts contained in the above pleading are true and correct to the

best of my knowledge, information, and belief. I understand that the facts herein are

verified subject to penalties for unsworn falsification to authorities under Section 4904

of the Crimes Code (18 Pa. C.S. § 4904). I have been advised by the issuing authority

of my right to a preliminary hearing. I understand that, by waiving my right to a

preliminary hearing, I am precluded from raising the sufficiency of the

Commonwealth’s prima facie case. I voluntarily waive this hearing and agree for this

matter to be bound over to court.

Dated: _______________ _____________________________________

Defendant

I represent that I am counsel of record in this matter and I concur in this waiver.

I further represent that I will advise the defendant of the date of all future court

proceedings before the Adams County Court of Common Pleas.

Dated: _______________ _____________________________________

Attorney

This waiver of preliminary hearing is accepted.

Dated: _______________ _____________________________________

Magisterial District Judge