COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: CRIMINAL 1 /1/2017 This cover sheet may be completed and filed for every defendant to allow for accurate recording of defendant and case information. The data contained herein shall not be admissible as evidence in any court proceeding or replace or supplement the filing and service of pleadings, orders, or other papers as required by law or Supreme Court rule. Instructions are available at www..gov County: District: Filing Date: Judge: Division: Case ID: Is this an amendment? Yes No If yes, reason: Case Type (choose one, based on the most serious charge): Does this defendant have other active cases? Yes No Case IDs: Is defendant being charged as habitual? Yes No Is victim under the age of 14 (V)? Yes No Defendant: Date of Birth: First Middle Last Suffix DLN or State ID #: State: SID #: Alias 1: Alias 2: Alias 3: Address: Street City State Zip Race: Ethnicity: Hispanic Non-Hispanic Sex: Male Female Plaintiff: State of Arkansas Prosecuting Attorney: Bar #: Email Address: Phone: Prosecutor File #: Interpreter needed for defendant? Manner of filing: American LegalNet, Inc. www.FormsWorkFlow.com COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: CRIMINAL 2 /1/2017 The charges in the attached information include (continue on an additional sheet if necessary): Code # A/S/C Counts F/M Class Arrest Date: Arrest Tracking #: Defendants Related Case IDs: (attach a cover sheet for each defendant): American LegalNet, Inc. www.FormsWorkFlow.com