IN THE JUSTICE COURT OF COUNTY, STATE OF MONTANA

BEFORE , JUSTICE OF THE PEACE

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STATE OF MONTANA, * CAUSE NO.

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Plaintiff, * INITIAL APPEARANCE

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vs. * ON A FELONY CHARGE

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, *

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Defendant. *

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LET THE RECORD SHOW that on the day of , 19 , Defendant appeared before the undersigned Court, in an Initial Appearance, in the custody of , was advised of the charges against him and of his constitutional rights. Defendant was also advised of his right to a Preliminary Hearing and had responded as follows:

1. Defendant requests a Preliminary Hearing.

2. Defendant waives his right to a Preliminary Hearing.

3. Defendant reserves his right to a Preliminary Hearing until such time as he has talked with legal counsel.

Signature of Defendant

Bond has been set by the undersigned Court in the amount of $ , or in the alternative, Defendant is released on O.R.

Yes No

SIGNED this day of , 19 .

Justice of the Peace

SEAL