Criminal Complaint Affidavit (District Justice) Form. This is a Pennsylvania form and can be use in Erie Local County.
Tags: Criminal Complaint Affidavit (District Justice), Pennsylvania Local County, Erie
: : Plaintiff(s) -against- Calendar No. JUDICIAL SUBPOENA : CRIMINAL COMPLAINT AFFIDAVIT : AFFIANT/VICTIM DEFENDANT : NAME: _____________________________________ NAME: ______________________________________ ADDRESS: _________________________________ ADDRESS: __________________________________ Defendant(s) : ... .................................. ... CITY:. ______________________________________ . . . . . . . . . . . . .CITY: _______________________________________ PHONE: HOME______________________________ PHONE: HOME ______________________________ WORK ______________________________ WORK ______________________________ AGE: ____________________ AGE: ___________________ THE PEOPLE OF THE STATE OF NEW YORK AFFIANT (IF DIFFERENT FROM VICTIM) DATE OF INCIDENT: __________________________ TO NAME: _____________________________________ TIME OF INCIDENT: ___________________________ ADDRESS: __________________________________ CITY: _______________________________________ DATE OF FILING: _____________________________ PHONE: HOME: ______________________________ GREETINGS: ______________________________ WORK: YOUR RELATIONSHIP TO THE DEFENDANT: _________________________________________________________ HOW LONG KNOWN DEFENDANT: __________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before RELATIONSHIP TO VICTIM: ________________________________________________________________________ , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed LOCATION OF INCIDENT:__________________________________________________________________________ or adjourned date, to testify and give evidence as a witness in this action on the part of the WITNESSES NAME: _______________________________ NAME: ______________________________NAME: _______________ Your failure to comply with this subpoena is punishable as a contempt of ADD: ________________ ADD: ________________________________ ADD: _______________________________ court and will make you liable to PHONE: _____________________________ was issued for a maximum penalty of $50 and all damages sustained as a the party on whose behalf this subpoena PHONE: ____________________________ PHONE: ______________ result of your failure to comply. NOTE: IF YOU DO NOT HAVE A PHONE PUT IN A NUMBER WHERE YOU CAN BE CONTACTED. EITHER A WORK NUMBER, A FRIEND OR FAMILY MEMBER. of the Justices of the Witness, Honorable , one Court in County, day of , 20 WERE THE POLICE CALLED AS A RESULT OF THIS INCIDENT? _________________________________________ DID THE POLICE FILE CHARGES AS A RESULT OF THIS INCIDENT? _____________________________________ DID THE POLICE SUPPLY YOU WITH A REPORT NUMBER? _____________________________________________ OFFENSE TO BE CHARGED: _______________________________________________________________________ (Attorney must sign above and type name below) YOUR VERSION OF FACTS: Be specific. Include in detail what led up to the incident and what actually happened. Also, why you believe the defendant is the person responsible. Include your relationship with the Attorney(s) for defendant and any previous contact you may have had. PLEASE ATTACH ALL NECESSARY DOCUMENTATION INCLUDING BUT NOT LIMITED TO COPIES OF NOTICES SENT TO DEFENDANT, CERTIFIED RECEIPTS, CANCELED CHECKS AND FINGERPRINT CARDS. Write legibly. If your complaint cannot be easily understood it will be returned. Office and P.O. Address YOU MUST BE AS SPECIFIC AS POSSIBLE – IT IS IMPORTANT THAT YOU EXPLAIN HOW YOU KNOW THE DEFENDANT IS THE PERSON WHO COMMITTED THIS CRIME, AND HOW IT CAN BE PROVEN IN COURT. A Telephone No.: S E P A R A T E C O M P L A I N T M U S T B E F I L E D Facsimile No.: H D E F E N D A N T . FOR EAC (OVER) E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com : Calendar No. : JUDICIAL SUBPOENA Plaintiff(s) On or about, ________________________________________ at approximately _______________________ (a.m.) (p.m.) at (location) -against- : : : Defendant(s) : ...................................................... THE PEOPLE OF THE STATE OF NEW YORK TO GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. I ________________________________________ being duly sworn according to law, (print Witness, Honorable your name ) , one of the Justices of the depose and say theCounty, forth inof forgoing affidavit are true and correct to the best of my knowledge, facts set the Court in day , 20 information and belief. I further certify that these criminal proceedings are not being brought for purposes of collecting civil debt. (Attorney must sign above and type name below) CAUTION: SECTION 4904 OF THE PENNA. CRIMES CODE MAKES IT A CRIME PUNISHABLE BY UP TO TWO (2) YEARS IN PRISON TO MAKE UNSWORN FALSE STATEMENTS TO AUTHORITIES. SECTION 4903 MAKES IT A CRIME TO FALSELY SWEAR IN Attorney(s) for OFFICIAL MATTERS. Office and P.O. Address (your signature) SIGNED BEFORE A NOTARY OR Sworn to a subscribed before me this ____day of ________, A.D. 20 ___ ______________________ Telephone No.: DISTRICT JUSTICE. Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com (Rev. 1/00)