E-FILED IN COUNTY CLERK'S OFFICE PIERCE COUNTY, WASHINGTON February 14 2012 3:19 PM KEVIN STOCK COUNTY CLERK

NO: 11-1-03893-1

IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON IN AND FOR THE COUNTY OF PIERCE
STATE OF WASHINGTON,
Plaintiff,
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NO.

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NOTICE TO LAW ENFORCEMENT AUTHORITIES

Defendant.

TO: Pierce County Prosecuting Attorney, City of of the foregoing and (other):

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YOU ARE PUT ON NOTICE THAT: The undersigned asserts hisher right to remain silent pursuant to Washington and Federal Law. 1. The undersigned asserts hisher right to assistanceof counsel pursuant to Washington and Federal Law. 2. The undersigned does not wish to discuss or make statements of any kind regarding any subject matter. including, but not 3. limited to, statementspertaining to any alleged or suspected criminal activity. The undersigned demands legal counsel to be present during any and all contacts by poIice authorities andor their agents. 4. The undersigned does not at any time desire to discuss waiver of any legal rights except in writing in the presenceof legal counsel. 5. 6. The undersigned is indigent. The undersigned has requested representation and is represented at 7. Assigned Counsel, 949 Market Street, Tacoma, Washin The undersigned further requests that all future contacts 8. DATED:

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NOTICE IS FURTHER GIVEN THAT the Department of Assigned Counsel, 949 Market Street,Tacoma, WA, business hours phone (253)7986062, after hours phone (253) 383-6875, hereby demands to be present law enforcement/prosecutionauthorities andor their agents. DATED:

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DECLARATIO OF SERVICE

The undersigned declares under penalty of the laws of the State of washington that helshe is over the age of 18 years, and personally served a true of (agency) copy of the above notice on: (name) a.m.1p.m. on (date) and at that said person(s)is known by the affiant to be a representative, empoloyee of agent of said agency. Date: Department of Assigned Counsel Depanmcnt of Asngned Counsel
2-2612 (1rn2) 949 Market Street, Suile334

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Tacoma. Washington 98402-3696 Telephone: (253) 7984X2