State of Alabama 
Unified Judicial System 

orm UTC-20              Rev.9/96 

WAIVER OF COUNSEL FOR DEFENDANT CHARGED 
WITH DRIVING UNDER THE INFLUENCE (DUI) 

CASE NUMBER 

N THE ________________________________________ COURT OF ________________________________ ALABAMA 
                                          (Circuit, District or Municipal)                                                           (Name of Municipality or County) 

 STATE OF ALABAMA         (cid:133)  MUNICIPALITY OF ____________________________________________________________________ 
V.__________________________________________________________________________________________________, DEFENDANT 
I, _______________________________, defendant in the above-styled case, having been charged with the offense of DUI in violation of §32-5A-
191, Code of Alabama 1975, or Ordinance Number _______________duly adopting §32-5A-191, Code of Alabama 1975 and in force at the time the 
offense  was  committed,  having  been  informed  of  my  RIGHT  TO  THE  ASSISTANCE  OF COUNSEL and advised that if I cannot afford counsel and I qualify   
for such representation, the court will appoint counsel, DO HEREBY VOLUNTARILY AND OF MY OWN FREE WILL FOREGO AND WAIVE MY RIGHT   
TO  THE  ASSISTANCE  OF  COUNSEL.  I  have  been  advised  of  the  penalties  which  may  be  imposed  upon  conviction  for  this  offense.      I  understand  that   
I  may  withdraw  this  waiver  upon  due  notice  to  the  court  at  any  time,  but  that  I  will  not  be  entitled  to  repeat  any  proceeding  held  or  waived  solely  on  the   
grounds of a subsequent or retention of counsel.  I have also been informed and understand that by waiving my right to counsel I am not  hereby waiving any 
of my other constitutional rights. 

_______________________________________________  
 
 

DATE 

 

 

 

 

_______________________________________________ 
SIGNATURE OF DEFENDANT 

 
 

 
 

 
 

 
 

 
 

 
 

_______________________________________________ 
ADDRESS 

 
 

 
 

JUDICIAL ORDER 

It appearing that the foregoing Waiver of Counsel is made by defendant knowingly, intelligently, and voluntarily, its is ORDERED that it 
be and the same is hereby ACCEPTED, subject to further orders of the court. 

It appearing that the purported Waiver of Counsel made by defendant is NOT made knowingly, intelligently, and voluntarily, the waiver 
is hereby DENIED, and, 

 
 
 

                 The case is continued to (Date) __________________ to afford defendant time to retain counsel. 
                 The Order Appointing Counsel heretofore entered in this cause remains in full fore and effect. 
             _____________________________________________________________________________ 
_____________________________________________________________________________ 
 

 
 
(cid:133) Municipal 
(cid:133) District 
(cid:133) Circuit  
                                                                                                              Judge                                                       Date  
     COURT: Original  

COURT OF _____________________________              _________________________              _________________ 

        DEFENDANT: Copy 

 

  F

  I

  (cid:133)

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