Erie Cnty. C.P. FinalProposedCriminalLocalRules 14

____________________________________________________________________________________

____________________________________________________________________________________

NOTE: The information provided in this section will only be used for the purposes of evaluating this application and will not

be used against the defendant in any further criminal proceedings.

PLEASE SUBMIT COPY OF CRIMINAL COMPLAINT OR CRIMINAL INFORMATION WITH THIS

APPLICATION.

13. By applying for ECT Program and by signing this application I acknowledge, certify, and understand each

of the following rights and responsibilities:

A. I have been advised and I understand that I have a constitutional right to a speedy trial; that pursuant to

Pa.R.Crim P. 600 formerly Pa.R.Crim. P. 1100, the Commonwealth must bring my case to trial within 365

days from the filing of the Criminal Complaint, I understand I can ask the Court to dismiss all charges

against me. Furthermore, I understand that in the event I am incarcerated on these charges, the

Commonwealth must bring my case to trial within 180 days from the date of the filing of the Criminal

Complaint, if the Commonwealth fails to do so, I can ask the Court for nominal bail.

I hereby waive (give up) all of my constitutional rights to a speedy trial, as set forth, from the date I file

this Application until I either complete the ECT Program or am revoked from it, should I violate the conditions the

Court imposes on me. In the event my Application for ECT is denied, I waive (give up) all of my constitutional

rights to a speedy trial as set forth, from the date I file this Application until the date my application is denied. I

have been advised and I understand that by signing this waiver I am waiving (giving up) any and all rights I may

have to be tried within 180 (if in jail) or 365 days following the filing of the Criminal Complaint against me. I am

signing the waiver because I understand it is to my benefit to do so and to allow the District Attorney as much time

as he needs to evaluate my suitability for the ECT Program. I have not been made any promises, nor have I been

forced or coerced to sign this waiver.

B. I understand I have the right to be represented by an attorney on my charge(s) and also in connection with

my ECT Application. If I cannot afford counsel, the Court will provide me free counsel through the Erie

County Public Defender’s Office.

C. It is my responsibility to notify the District Attorney’s Office, in writing, of my arrest and/or conviction

for any offense occurring after this Application is made and before it is rejected or I am accepted into the

Program by the Court. Failure to comply with this requirement is grounds for refusal of the Application

and/or may be treated as a false statement subjecting me to prosecution and/or for removal from the

Program.

D. I acknowledge that I have completed (or will complete prior to my ECT hearing) all processing (e.g.

Fingerprinting, etc.) required of me. I understand that failure to do so may delay my acceptance into the program.

E. The information I have provided above is true and correct. I understand if I have provided false information

on this Application, that reason alone is sufficient to refuse this Application. In addition, I understand that

by providing false information I can be prosecuted for offenses including, but not limiting to, perjury, false

swearing and/or unsworn falsification to authorities.

DATE:_________________________ DEFENDANT:______________________________________________

DATE:_________________________ ATTY. FOR DEFENDANT:___________________________________

Please Print

Revised: 10/14/15

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Appendix 5

COMMONWEALTH OF PENNSYLVANIA: IN THE COURT OF COMMON PLEAS

: OF ERIE COUNTY, PENNSYLVANIA

: CRIMINAL DIVISION

v. :

: NO.:________________ OF 20_____

_____________________________________ : OTN:___________________________

APPLICATION FOR ERIE COUNTY VETERANS COURT

Application is hereby made for disposition of this case under the Erie County Veterans Court Program. To

assist the District Attorney’s Office in evaluating the suitability of this case for the Erie County Veterans Court,

the following information is provided:

INSTRUCTIONS: Answer all questions that apply. If a question does not apply, answer it with the initials N.A.

1. Full Name of the defendant: _____________________________________________________________

2. Maiden Name of defendant; or other last names previously used: ________________________________

3. Date of Birth: ___________________ Social Security Number: ____________________________

Gender (circle one): M/F Race/Ethnicity: _________________________________

4. Driver License Number: _____________________________ State Issued: ________________________

5. Present Address:_______________________________________________________________________

City: ________________________ State: ____________ Zip Code: _______________________

Phone: (Home) ( ) (Cell) ( )

Email Address: _________________________________

6. Present Employment: Work Phone ( )

7. Next of Kin or Emergency Contact: Name: Phone ( )

8. Education-Schools and Highest Year attained: _______________________________________________

9. Have you served in the Military? _______ If so, which branch? _________________________

Were you honorably discharged? _________________________

Are you eligible for services through the VA? ________

Are you enrolled in services through the VA? ________

2 of 3

**You are required to submit a copy of your DD Form 214, Certificate of Release or Discharge from Active Duty.

Please forward the DD Form 214 to Matthew Cullen at the District Attorney’s Office at the address

below.

Attn: Matthew Cullen

District Attorney’s Office Erie

County Courthouse

140 W. 6th St., Room 506 Erie,

PA 16501

The copy of the DD Form 214 will be forwarded to the Veteran’s Affairs office and the VA Veteran Justice Officer

for verification of eligibility for V A Services. If you do not have your DD Form 214, please contact Cherise

Gibbs Pope at the Veteran’s Affairs office or, if you were discharged after 2000 you can obtain a copy of

your DD Form 214 by visiting www.ebenefits.va.gov ** NOTE: The copy of the DD Form 214 will only be used for

purposes of declaring a candidate’s eligibility for V A benefits. If requested, the copy of the DD Form 214 will be returned to the candidate

after the application process. Otherwise, the DD Form 214 will be destroyed after a decision has been made regarding the application.

Cherise Gibbs Pope

Veteran’s Affairs

Erie County Courthouse, Room 101

140 West 6th St., Erie, PA 16501

Phone: (814) 451-6265

10. Do you have any other pending criminal charge(s)? If so, explain giving date, place, charges and

disposition:

____________________________________________________________________________________

____________________________________________________________________________________

11. Are you currently on supervision (probation or parole)? If so, explain whether it is county or state

supervised and the name of your probation/parole officer:

____________________________________________________________________________________

____________________________________________________________________________________

12. Do you have a history of drug/alcohol abuse and/or serious mental illness treatment? If so, give details.

(Use reverse side if needed):

____________________________________________________________________

____________________________________________________________________________________

13. Explanation of your present case, including all details (use reverse side if needed):

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

PLEASE SUBMIT COPY OF CRIMINAL COMPLAINT OR THE CRIMINAL INFORMATION WITH THIS

APPLICATION.

13. By applying for Erie County Veterans Court Program (“VTC”) and by signing this application I acknowledge,

certify, and understand each of the following rights and responsibilities:

A. I have been advised and I understand that I have a constitutional right to a speedy trial; that pursuant to

Pa.R.Crim P. 600 formerly Pa.R.Crim. P. 1100, the Commonwealth must bring my case to trial within 365

days from the filing of the Criminal Complaint, I understand I can ask the Court to dismiss all charges

against me. Furthermore, I understand that in the event I am incarcerated on these charges, the

Commonwealth must bring my case to trial within 180 days from the date of the filing of the Criminal

Complaint, if the Commonwealth fails to do so, I can ask the Court for nominal bail.

I hereby waive (give up) all of my constitutional rights to a speedy trial, as set forth, from the date I sign

this application until I either complete the VTC Program or am revoked from it, should I violate the conditions the

Court imposes on me. In the event my Application for VTC is denied, I waive (give up) all of my constitutional

rights to a speedy trial as set forth, from the date I file this Application until the date my application is denied. I

have been advised and I understand that by signing this waiver I am waiving (giving up) any and all rights I may

have to be tried within 180 (if in jail) or 365 days following the filing of the Criminal Complaint against me. I am

signing the waiver because I understand it is to my benefit to do so and to allow the District Attorney as much time

as he needs to evaluate my suitability for the VTC Program. I have not been made any promises, nor have I been

forced or coerced to sign this waiver.

B. I understand I have the right to be represented by an attorney on my charge(s) and also in connection with

my VTC Application. If I cannot afford counsel, the Court will provide me free counsel through the Erie

County Public Defender’s Office.

C. It is my responsibility to notify the District Attorney’s Office, in writing, of my arrest and/or conviction

for any offense occurring after this Application is made and before it is rejected or I am accepted into the

Program by the Court. Failure to comply with this requirement is grounds for refusal of the Application

and/or may be treated as a false statement subjecting me to prosecution and/or for removal from the

Program.

D. I acknowledge that I have completed (or will complete prior to my VTC hearing) all processing (e.g.

Fingerprinting, etc.) required of me. I understand that failure to do so may delay my acceptance into the program.

E. The information I have provided above is true and correct. I understand if I have provided false information

on this Application, that reason alone is sufficient to refuse this Application. In addition, I understand that

by providing false information I can be prosecuted for offenses including, but not limiting to, perjury, false

swearing and/or unsworn falsification to authorities.

F. By signing this document I authorize the VA to use the information contained in this application to confirm

the applicant’s eligibility for VA services. Applicant’s Initial: ________

DATE:_________________________ DEFENDANT:______________________________________________

DATE:_________________________ ATTY. FOR DEFENDANT:___________________________________

Please Print

Created: 4/1/2015

Appendix 6

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Appendix 7

COMMONWEALTH OF PENNSYLVANIA: IN THE COURT OF COMMON PLEAS

: OF ERIE COUNTY, PENNSYLVANIA

v. :

:

[ENTER NAME] : Docket No. [ENTER NUMBER]

SUBSTITUTION OF COUNSEL

TO THE CLERK OF COURTS:

Please withdraw my appearance as counsel for the above Defendant.

BY: ___________________________________

[ENTER NAME]

PA ID No. [ENTER NUMBER]

[ENTER ADDRESS]

[ENTER PHONE]

[ENTER E-MAIL]

Date: _____________________

Please enter the appearance of [ENTER NAME] as counsel for the above Defendant.

BY: ___________________________________

[ENTER NAME]

PA ID No. [ENTER NUMBER]

[ENTER ADDRESS]

[ENTER TELEPHONE NUMBER]

Date: ____________________ [ENTER E-MAIL]

CERTIFICATE OF SERVICE

The undersigned hereby certifies that on the ___

day of ________, 20___, a copy of the within

document was served on all counsel of record

and unrepresented parties in accordance with the

applicable rules of court.

/s/

Name

CERTIFICATE OF COMPLIANCE

The undersigned certifies that this filing

complies with the provisions of the Public

Access Policy of the Unified Judicial System of

Pennsylvania: Case Records of the Appellate

and Trial Courts that require filing confidential

information and documents differently than non-confidential information and documents.

/s/

Name