I verify that the facts contained in the above pleading are true and correct to the best of my knowledge, information, and belief. I understand that the facts herein are verified subject to penalties for unsworn falsification to authorities under Section 4904 of the Crimes Code (18 Pa. C.S. § 4904). I have been advised by the issuing authority of my right to a preliminary hearing. I understand that, by waiving my right to a preliminary hearing, I am precluded from raising the sufficiency of the Commonwealth's prima facie case. I voluntarily waive this hearing and agree for this matter to be bound over to court.

Dated: _____

_____ _____

Defendant

I represent that I am counsel of record in this matter and I concur in this waiver. I further represent that I will advise the defendant of the date of all future court proceedings before the Adams County Court of Common Pleas.

Dated: _____

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Attorney

This waiver of preliminary hearing is accepted.

Dated: _____

Magisterial District Judge

A. In all cases where defendants are held for court, the Magisterial District Judge shall provide the defendant and counsel of record notice of the dates of formal arraignment, non-trial disposition conference, DUI date or plea date, and criminal trial term including jury selection. Notice shall be given at the conclusion of the preliminary hearing. The notice (hereinafter “Written Notice”) shall be in the form set forth in Rule 542.1 and shall be signed by the defendant and counsel, if any. The defendant and defense counsel of record shall be given a copy of the Written Notice at the time of acknowledgement. In the event the preliminary hearing is waived, the Written Notice may be given solely to counsel who thereafter shall have the Written Notice executed