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SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL 650 Wake Avenue, El Centro, CA 92243 939 West Main Street, El Centro, CA 92243 2124 Winterhaven Drive, Winterhaven, CA 92283

DEFENDANT: REQUEST FOR HEARING CASE NUMBER: CHANGE OF PLEA FORM ADDENDUM

• I have met with my client via video conference and conveyed to him/her the settlement offer from the
People.

• Attached hereto as Exhibit A is the Change of Plea Form that sets forth all terms and conditions of the plea.

• I have gone over and advised my client regarding each term and paragraph of the change of plea form. My
client acknowledges to me he/she understood each term and paragraph of the plea form and orally assented
to each.

• I am requesting to place on calendar for disposition at which time client will execute the plea form as
attached.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date: ______________

Type or print name Signature of Attorney for Defendant

Adopted for Optional Use www.imperial.courts.ca.gov CR-17A (Adopted 01/01/22, Revised 01/01/24) CHANGE OF PLEA FORM ADDENDUM