9-401

[For use with District Court Rule 5-301]

STATE OF NEW MEXICO

COUNTY OF___________________

__________________________ COURT                              No. ___________

STATE OF NEW MEXICO

v.

________________________________, Defendant

WAIVER OF COUNSEL

(To be used only if, upon conviction, the

                        defendant may be deprived of liberty)

            I understand that I am charged with the following offense(s): _____________________________________________

__________________________________________________ which (strike inapplicable words or parts) (is) (are) misdemeanors under the law and that if I am found guilty I can be given a severe punishment, including imprisonment in (the New Mexico state penitentiary) (in the ____________________ (city) (county) jail) and a fine.

            I understand that under the Constitutions of the United States and the State of New Mexico, I have the right to be represented by a lawyer at all stages of the criminal case -- before trial, at the trial itself, during proceedings to determine what sentence should be imposed if I am found guilty, and any appeal. I understand that if I am unable, without undue hardship, to pay for all or a part of the expense of legal representation from available present income and assets, a lawyer will be furnished for me free of charge.

            After reading and understanding all of the above, I hereby give up my rights to a lawyer in this case, and to have a lawyer furnished for me free of charge if I cannot afford one.

DO NOT SIGN THIS FORM IF YOU WANT AN ATTORNEY. DO NOT SIGN THIS FORM UNLESS YOU HAVE READ IT AND UNDERSTAND IT.

                                                                        ______________________________

                                                                        Defendant

            I find that the defendant, knowingly, voluntarily and intelligently with full awareness of the right to counsel, has waived the right to counsel.

                                                                        ______________________________

                                                                        Judge

                                                                        Date: ________________________

[As amended, effective January 1, 1999.]