Atlanta Police Department

Waiver of Counsel by Defendant in Custody

I,	, have been informed by the undersigned law enforcement officers

prior to being questioned by them, that I am suspected of the offense of

in Fulton/ DeKalb County, State of Georgia, on the	day of	,20

and have been informed of my constitutional rights, as follows:

(1)	That I may remain silent and do not have to make any statement at all.

That any statement that I make may be used against me in a court of law.

That I have the right to consult with an attorney before making any statements and to have said

attorney present with me while I am making a statement.

That if I do not have enough money to employ an attorney, I have the right to have one

appointed by the court to represent me; to consult with him before making any statement, and

to have him present with me while I am making a statement.

That if I request an attorney, no questions will be asked of me until an attorney is present to

represent me.

After having my constitutional rights explained to me, I freely and voluntarily waive my right to an attorney. I am willing to make a statement to the officers. I (can) (can’t) read and write the English Language and fully understand my constitutional rights to an attorney. I have read/ have had read to me this waiver of counsel and fully understand it.

No threats or promises have been made to me to induce me to sign this waiver

This	day of	, 20	Time

All of the above constitutional rights in the above waiver of counsel were read to the above defendant by me, and he/she freely and voluntarily waived his/her right to an attorney. No threats, promises, tricks or persuasions were employed by me or anyone in my presence to induce him/her to waive his/her rights to an attorney and to make a statement without an attorney. He/she freely and voluntarily signed the above waiver of counsel in my presence after having read it.

Officer/ Detective’s Name

Title

Witness

Witness
Parent/ Guardian

Form APD 905 revised 5/9/05

Atlanta Police Department

AJordan

2005-05-18

Atlanta Police Department