MAGISTRATE COURT OF GWINNETT COUNTY CRIMINAL ARREST WARRANT APPLICATION - CIVILIAN WARRANT NO. ____________________________________________ PROSECUTOR/APPLICANT: ADDRESS: CITY: STATE: PHONE NO.(HOME) ZIP: (W0RK) (MOBILE/PGR.) ACCUSED: ADDRESS: CITY: STATE: PHONE NO.(HOME) RACE AGE (W0RK) SEX HT ZIP: (MOBILE.PGR.) WT EYES HAIR DOB SSN AUTO TAG RELATIONSHIP TO PROSECUTOR: [ ] PRESENT SPOUSE [ ] FORMER SPOUSE [ ] LIVE TOGETHER [ ] FORMERLY LIVED TOGETHER [ ] NONE [ ] PARENTS OF SAME CHILD(REN) [ ] PARENT [ ] CHILD [ ] STEPPARENT [ ] STEPCHILD [ ] FOSTER PARENT [ ] FOSTER CHILD [ ] OTHER WITNESS: ADDRESS: CITY: STATE: PHONE NO.(HOME) ZIP: (W0RK) (MOBILE/PGR.) Have you ever applied for a warrant before for this person? Has this person ever taken out a warrant against you? Have you ever applied for a warrant before against anyone else? Have you ever asked for a warrant to be dismissed? How long has the accused lived at the above address? Has the accused lived outside Georgia within the past ten years? Does the accused have significant family ties outside Georgia? Has the accused used any false names or aliases? Yes Yes Yes Yes Years Yes Yes Yes No No No No ____ Months No No No ____ Unknown ____ Unknown ____ Unknown ____ Unknown If yes, list all such names known: _______________________________________________________________________________________________ Factors indicating the accused may be a threat while this case is pending: [ ] threats [ ] criminal history [ ] mental history [ ] probation/parole [ ] gang related [ ] accused use of intoxicants/drugs If any, please describe: ______________________________________________________________________________________________________ The accused is an immediate threat to the safety or well being of me or another Yes No ____ Unknown The accused will attempt to evade arrest or otherwise obstruct justice Yes No ____ Unknown The accused is incarcerated or otherwise in the custody of a law enforcement agency Yes No ____ Unknown The accused is a fugitive from justice Yes No ____ Unknown The accused has written me a bad check and I have sent a 10 day letter per OCGA 16-9-20 Yes No ____ Unknown Date of incident: _______________________ Time of incident: _________________________ Address (including county) where incident occurred: ____________________________________________________________________________________________________________________________ Have you reported this incident to the police? [ ] Yes [ ] No Name of Officer: ________________________________ Dept: _____________________ Give a brief summary of what happened: ___________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ I hereby swear or affirm that the above information is true and correct to the best of my knowledge. Sworn to and subscribed before me this _____ day of ___________________, ___________ at ______________ [ ] AM [ ] PM ___________________________________________________________ Prosecutor/Applicant ______________________________________________________________ Magistrate TO BE COMPLETED BY MAGISTRATE APPLICATION FEE: [ ] $15.00 REPEAT OFFENDER: [ ] PROBATION ARREST WARRANT ISSUED: [ ] YES [ ] NO [ ] WAIVED [ ] PAROLE [ ] NO INFORMATION [ ] REFERRED TO LAW ENFORCEMENT [ ] NONE [ ] HEARING OFFENSE(S): _____________________________________________________________________________________________________________ [ ] IMMEDIATE/CONTINUING THREAT [ ] EVADE ARREST/OBSTRUCT JUSTICE [ ] ACCUSED IN CUSTODY [ ] BAD CHECK – 10 DAY NOTICE GIVEN [ ] FAMILY VIOLENCE [ ] FUGITIVE FROM JUSTICE [ ] FELONY [ ] MISDEMEANOR [ ] FAMILY VIOLENCE [ ] SPECIAL CONDITIONS OF BOND MAG 20-20 Criminal Arrest Warrant Application-Civilian (12-08) American LegalNet, Inc. www.FormsWorkflow.com