Superior Court of California, County of Imperial Declaration and Probable Cause Determination ARRESTEE'S NAME (LAST.FIRST,MIDDLE) DOB BOOKING NUMBER RESIDENCE ADDRESS AGENCY CASE # BOOKING CHARGES REASON SUPPLEMENTAL HOLDS DATE/TIME OF ARREST O.R. RECOMMENDED 48 HOURS EXPIRATION (DATE/TIME) ARRESTING AGENCY/DIVISION ARRESTING OFFICER(S) ELEMENTS OF CRIME VICTIM'S AGE__________ VICTIM'S RELATIONSHIP TO ARRESTEE:_________________________________ VICTIM'S INJURIES:______________________________________________________________________________ I deem that there is probable cause to believe that the crime(s) have been committed by the arrestee as described. Additional page attached for additional information (Two (2) page limit) I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. EXECUTED ON ________________________AT IMPERIAL COUNTY, CALIFORNIA, DATE BY ____________________________________ SIGNATURE ________________________________ BADGE/EMPLOYEE NUMBER ON THE BASIS OF THE OFFICER'S DECLERATION IS REPORTS REVIEWED, I HEREBY DETERMINE THAT THERE COMMITTED A CRIME. ___________________ DATE Probable Cause Revised 08-15-13 P.C. 817 TIME IS NOT PROBABLE CAUSE TO BELIEVE THIS ARRESTEE HAS __________________________________________ SIGNATURE OF JUDICIAL OFFICER American LegalNet, Inc. www.FormsWorkFlow.com _______________________