FORM SUMMARY Name of Form: Affidavit of Court Officer Form Number: GF-143 Statutory Reference: §968.04(3)(a), Wisconsin Statutes Purpose of Form: When an arrest warrant is being issued based on a citation (not a criminal complaint), the affidavit sets out the jurisdictional facts that the defendant was personally served with the citation and whether the citation was issued by the issuing officer on personal observation or information and belief. Who Completes It: The court officer. Distribution of Form: Court file Accompanying Forms: This affidavit and a copy of the citation are attached to the arrest warrant. New Form/Modification: Modification; last update 4/93. Modification: Added a file/date stamp area to upper left corner. Added a statement on the bottom indicating that the form shall not be modified. About this form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court’s Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 11/19/99 2001 © American LegalNet, Inc. For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Affidavit of Court Officer Case No. Name of Defendant Under oath, I state: I, a court officer, make this affidavit on information and belief. The defendant was personally served with a copy of the summons/citation on (date) . The arresting officer: personally observed the defendant commit the violation. based the citation on information provided by a reliable informant. The defendant failed to appear in court as summoned. Subscribed and sworn to before me on Signature of Court Officer Judge/Commissioner/Clerk/Deputy Clerk GF-143, 11/99 Affidavit of Court Officer §968.04(3)(a), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. 2001 © American LegalNet, Inc.