9-401A

[For use with Magistrate Court Rule 6-501,

Metropolitan Court Rule 7-501 and

Municipal Court Rule 8-501]

STATE OF NEW MEXICO

[COUNTY OF___________________]

[CITY OF_____________________]

__________________________ COURT                              No. ___________

[STATE OF NEW MEXICO]

[COUNTY OF __________________]

[CITY OF ____________________]

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 a misdemeanor] [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] [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.

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 this right.

                                                                        ______________________________

                                                                        Judge

                                                                        Date: ________________________

[Adopted effective September 15, 1997.]

See State v. Pino, 1997-NMCA-001, 122 N.M. 789, 932 P.2d 13 (1997) (cert. denied, 122 N.M. 589, 929 P.2d 981 (1997).