UNITED STATES DISTRICT COURT CENTRAL DISTRICT OF CALIFORNIA CASE NUMBER: V. Plaintiff(s) WARRANT FOR ARREST Defendant(s). TO: UNITED STATES MARSHAL AND ANY AUTHORIZED UNITED STATES OFFICER Indictment YOU ARE HEREBY COMMANDED to arrest and bring him/her forthwith to the nearest Magistrate Judge to answer a(n): Complaint Order of Court Violation Petition Violation Notice Information charging him/her with (ENTER DESCRIPTION OF OFFENSE BELOW) in violation of Title Kiry K. Gray NAME OF ISSUING OFFICER United States Code, Section(s) Clerk of Court TITLE OF ISSUING OFFICER DATE AND LOCATION OF ISSUANCE By: SIGNATURE OF DEPUTY CLERK NAME OF JUDICIAL OFFICER RETURN THIS WARRANT WAS RECEIVED AND EXECUTED WITH THE ARREST OF THE ABOVE-NAMED DEFENDANT AT (LOCATION): DATE RECEIVED NAME OF ARRESTING OFFICER DATE OF ARREST TITLE DESCRIPTIVE INFORMATION FOR DEFENDANT CONTAINED ON PAGE TWO SIGNATURE OF ARRESTING OFFICER G-04 (10/15) WARRANT FOR ARREST American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 UNITED STATES DISTRICT COURT CENTRAL DISTRIC OF CALIFORNIA CASE NUMBER: Plaintiff(s) V. WARRANT FOR ARREST Defendant(s) ADDITIONAL DEFENDANT INFORMATION RACE: SEX: HEIGHT: WEIGHT: HAIR: EYES: OTHER: DATE OF BIRTH: PLACE OF BIRTH: SOCIAL SECURITY NO.: DRIVER'S LICENSE NO.: ISSUING STATE: ALIASES: SCARS, TATTOOS OR OTHER DISTINGUISHING MARKS: AUTO YEAR: AUTO MAKE: AUTO MODEL: AUTO COLOR: AUTO LICENSE NO.: ISSUING STATE: LAST KNOWN RESIDENCE: LAST KNOWN EMPLOYMENT: FBI NUMBER: ADDITIONAL INFORMATION: INVESTIGATIVE AGENCY NAME INVESTIGATIVE AGENCY ADDRESS: NOTES: G-04 (10/15) WARRANT FOR ARREST American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2