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Initial Application For Pre Trial Diversion Form. This is a Tennessee form and can be use in Trial And General Sessions Courts Statewide.
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Tags: Initial Application For Pre Trial Diversion, Tennessee Statewide, Trial And General Sessions Courts
INITIAL APPLICATION FOR PRE-TRIAL DIVERSION
IN THE CIRCUIT COURT FOR ________________________ COUNTY
STATE OF TENNESSEE
)
)
VS.
)
)
__________________________________ )
DOCKET NO._________________
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
DATA CONCERNING DEFENDANT No.
Index
:
Calendar No.
NOTE TO DEFENDANT: ALL QUESTIONS MUST BE ANSWERED COMPLETELY,
AND IF NECESSARY, ADDITIONAL PAGES MAY BE ATTACHED.
:
Plaintiff(s)
-against-
JUDICIAL SUBPOENA
:
1.
Full Name: ______________________________________________________________
Last
First :
Middle
2.
Aliases, nicknames, or changes in name: _______________________________________
:
Defendant(s)
:
. . 3. . . . . Birth. Date: ._____________________________________
..
.... ..... ...................................
Month
4.
Sex:
M( )
Day
Year
F( )
THE PEOPLE OF THE STATE OF NEW YORK
5.
Height: ________ Weight: _______ Color of eyes: ________ Color of hair: __________
TO
6.
Social Security Number: __________________ Dr. License Number________________
7.
Address________________________________________________________________
GREETINGS:
_________________________________________Telephone______________________
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
8.
located at
County ofMarital Status:
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
Never Married )
Married (
Spouse Deceased ( )
or adjourned date, to testify(and give evidence as a) witnessDivorced ( )on the part of the
in this action
If married, give spouse's name: ______________________________________________
Your failure to comply with this subpoena is punishable as Living ( )of court and will )make you liable to
9.
Parents: Father ______________________________ a contempt Deceased (
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.
Date of Birth: ____________ Place of Birth: ____________________________
Witness, Honorable
, one of the Justices of the
Mother _____________________________ Living ( ) Deceased ( )
Court in
County,
day of
, 20
Date of Birth: ____________ Place of Birth: ____________________________
10.
Children:
Yes ( )
No ( )
If yes, how many ________.
(INCLUDE (Attorney must sign above and type name below)
CHILDREN BY ADOPTION)
Give names and birth dates of each child:
Attorney(s) for
__________________________________
_________________________________
__________________________________ __________________________________
Office and P.O. Address
__________________________________ __________________________________
How many of these children live with you?_____________________
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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11.
Are you obligated by Court to pay child support to any of your children. Yes ( ) No ( )
If yes, are you current: Yes ( )
12.
Education:
No ( )
(Account for all schools and military academies)
Dates Attended
From To
Name and location of school
Diploma
Received?
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .______________
__________
. . . . . . . . _______________________________
. ..
........
:
Index No.
________________________________
_________________________________
______________
:
______________
__________
:
JUDICIAL SUBPOENA
______________
:
__________
Plaintiff(s)
_________________________________
-against-
__________
Calendar No.
:
13.
Intelligence level, (if known): _______________
14.
Has a psychiatric or psychological evaluation ever been performed?
15.
If "yes", what diagnosis, if any, was made? ____________________________________
:
Defendant(s)
:
......................................................
Yes ( )
No ( )
________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
________________________________________________________________________
TO
________________________________________________________________________
16.
Prior work record of defendant:
GREETINGS:
Name/Address
WE COMMAND YOU, that all business and excuses being laid aside, you and each Reason for before
of you attend
Type of Job
of Employment at the Supervisor Court Dates Held
Termination
,
the Honorable
located at
County of
a.
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
b.
________________________________________________________________________
c.
________________________________________________________________________
e.
________________________________________________________________________
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
d. ________________________________________________________________________
result of your failure to comply.
Witness, Honorable
, one of the Justices of the
Court in 1.
day of
, 20
Did County,employments require a security clearance?
any of
Yes ( ) No ( )
2.
Have you ever been refused an employment bond?
Yes ( )
No ( )
(Attorney must sign above and type name below)
3.
If the answer to any of the above is "yes", explain:
__________________________________________________________________
Attorney(s) for
__________________________________________________________________
__________________________________________________________________
Office and P.O. Address
17.
List any noteworthy physical characteristics or disabilities of the Defendant.
Telephone No.:
________________________________________________________________________
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
2
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18.
List all residences since age 18.
Dates
From - To
Streets and Numbers
City
State
_____________________
________________________________________________
_____________________
________________________________________________
COURT
_____________________
________________________________________________
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
_____________________
________________________________________________
Index No.
_____________________
:
Calendar No.
________________________________________________
_____________________
:
________________________________________________
JUDICIAL SUBPOENA
Plaintiff(s)
-against-
:
_____________________
________________________________________________
_____________________
________________________________________________
_____________________
________________________________________________
_____________________
________________________________________________
_____________________
________________________________________________
:
:
Defendant(s)
:
......................................................
THE PEOPLE OF THE STATE OF NEW YORK
_____________________
________________________________________________
TO
19.
Past and/or present membership in organizations, and community awards:
GREETINGS:
Name and Address
Social, Fraternal,
Date
__of Organization__
Professional or Other
Office Held
From - To
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.
________________________________________________________________________
20.
Witness, Honorable
, one of the Justices of the
Have you ever been detained, held, arrested, indicted or summoned into court as a
Court in defendant, or placed on probation, or have,you ever been ordered to deposit bail or
County,
day of
20
collateral for the violation of any law? Include all court martials while in military
service. Yes ( ) No ( )
(Attorney must sign above and type name below)
If "yes", list date, nature of offense or violation, name and location of the court or place
of hearing, and the penalty imposed or other disposition of each case.
________________________________________________________________________
Attorney(s) for
________________________________________________________________________
________________________________________________________________________
Office and P.O. Address
________________________________________________________________________
Telephone No.:
________________________________________________________________________
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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OFFENSE-RELATED DATA
21.
Were there any co-defendants in the case?
Yes ( )
No ( )
22.
What conviction and sentence, if any, were imposed on co-defendants?
________________________________________________________________________
COURT
________________________________________________________________________
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
________________________________________________________________________
Index No.
23.
:
Calendar No.
Have you been charged in this case with other separate (not lesser included) offenses?
Yes ( )
No ( )
:
If yes, list Plaintiff(s)_____________________________________
offenses:
JUDICIAL SUBPOENA
-against-
:
_______________________________________________________________________
:
_______________________________________________________________________
:
_______________________________________________________________________
Defendant(s)
:
......................................................
24.
If other separate offenses were charged, list disposition(s):
________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
________________________________________________________________________
TO
________________________________________________________________________
25.
Is the victim related by blood or marriage to defendant?
GREETINGS:
Yes ( )
No ( )
If the answer is YOU, that all the relationship? _________________________________
WE COMMAND"yes", what is 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
Is date, to testify and give or employee of defendant?
or26.
adjournedthe victim an employerevidence as a witness in this action on the part of the
No
( )
Employer
( )
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
Employee
( )
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.
27.
Is the victim acquainted with the defendant?
Witness, Honorable
No
Court in Casual acquaintance
County,
Friend
Intimate
(
(
(
(
, one of the Justices of the
)
day
) of
)
)
, 20
(Attorney must sign above and type name below)
28.
Was there evidence the defendant was under the influence of narcotics or dangerous
drugs that actually contributed to the offense? Yes ( ) No ( )
Attorney(s) for
29.
Was there evidence the defendant was under the influence of alcohol that actually
contributed to the offense? Yes ( ) No ( )
30.
Has the defendant ever received counseling for alcohol or drug abuse? Yes ( )
Office and P.O. Address
31.
Is the defendant a resident in the community?
Yes ( )
No ( )
No ( )
Telephone No.:
If "no", where does the defendant reside? ______________________________________
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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32.
Defendant's recitation of the facts of the offense: ________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
COURT
________________________________________________________________________
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
33. If restitution was ordered to be paid in this case, how :muchIndex No. could the defendant
restitution
pay monthly: $____________per month.
34.
:
Calendar No.
List five (5) references who have known defendant more than ten (10 ) years who are not
:
relatives:
JUDICIAL SUBPOENA
Plaintiff(s)
Name
-against-
:
Address
Phone
Years Known
:
________________________________________________________________________
:
Defendant(s)
:
. . . . . . . . ________________________________________________________________________
..............................................
________________________________________________________________________
THE PEOPLE OF THE STATE OF NEW YORK
________________________________________________________________________
TO
35.
________________________________________________________________________
Have you ever been adjudicated delinquent in Juvenile Court?
Yes ( )
No ( )
GREETINGS:
If "yes", list: _____________________________________________________________
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
________________________________________________________________________
36.
List all prior lawful spouses or significant others:
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
Name
Present Address
Date Married or Known
result of your failure to comply.
________________________________________________________________________
Witness, Honorable
, one of the Justices of the
Court in ________________________________________________________________________
County,
day of
, 20
________________________________________________________________________
(Attorney must sign above and type name below)
37.
Has any member of your immediate family ever been convicted of a felony?
Yes ( ) No ( )
Attorney(s) for
If yes, if you attend to live with this individual, give name, relationship, and present
address of such individual:
Office and P.O. Address
________________________________________________________________________
________________________________________________________________________
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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CHRONOLOGY OF THE CASE
A.
Date of offense ___________________________________________________________
B.
Date of arrest ____________________________________________________________
C.
Date of preliminary hearing _________________________________________________
COURT
D.
Date of arraignment _______________________________________________________
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......... ..
:
E.
Date of trial _____________________________________________________________
Index No.
:
Plaintiff(s)
-against-
Calendar No.
:
JUDICIAL SUBPOENA
:
:
Realizing that the above answers are material to this case and under penalty of perjury, I do
hereby swear to each of the above answers and that I have completed the report to the best of my
:
ability. I understand that I have a continuing duty to disclose if any of the information changes
Defendant(s)
:
. .while. my . . . . . . . . . . .for .diversion. is. pending. . . . . . . . . . . . .
. . . . . . . application . . . . . . . . . . . . . . . . . .
____________________
THE PEOPLE OF THE STATE OF NEW YORK
Date
TO
__________________________________________
Defendant
__________________________________________
County
GREETINGS:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
Sworn to and
,
the Honorable subscribed before me this
at the
Court
located at
County of
in_______day of _____________20_____.
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
NOTARY PUBLIC 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.
My Commission Expires: ____________
Witness, Honorable
Court in
County,
, one of the Justices of the
day of
, 20
(Attorney must sign above and type name below)
Attorney(s) for
Office and P.O. Address
Telephone No.:
Facsimile No.:
E-Mail Address:
Mobile Tel. No.:
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