NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

New Albany Police Department
Chief of Police
Mark A. Chaney
Addendum B
CONSTITUTIONAL RIGHTS FORM – JUVENILE
Name:
Date of Birth:
Date: Place: Time:
Before we ask you any questions, you must understand your rights. You have the right to remain silent. Anything you say can and
will be used against you in court. You have the right to talk to a lawyer for advice before we ask you any questions, and to have
him/her present with you during questioning. If you or your parents or guardian are unable to pay a lawyer, a public defender will be
appointed for you prior to any questioning, if you desire. If you wish to answer questions now without a lawyer present, you have the
right to stop answering questions at any time. You also have the right to stop answering at any time until you talk to a lawyer. Do you
understand your rights?
Officer (Signature)
X
Juvenile (Signature)
WAIVER OF RIGHTS
I have read the statement of my rights shown above. I understand what my rights are. I am willing to answer questions and
make a statement. I do not want a lawyer. I understand and know what I am doing. No promise or threats have been made to me and
no pressure of any kind has been used against me.
Can you read and write? Yes No Years of education?
Officer (Signature)
X
Juvenile (Signature)
PARENT / GUARDIAN
I have read the statement of the rights shown above. I understand what my rights are. I am willing to have my child answer
questions and make a statement. I do not want a lawyer for either my child or myself. I understand and know what I am doing. No
promises or threats have been made to me and no pressure or coercion of any kind has been used against me.
Parent / Guardian (Print)
X
Parent / Guardian (Signature)
__
Witness (Printed)
X
Witness (Signature)
PD-08-171
Revised December 22, 2010