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(jurisdiction) of incident:
(city, county, state)
Law enforcement agency:
Court involved (e.g., municipal, circuit, appellate, etc.):
Case number:
Citation number:
Initial charge (write it out; do not cite statute or ordinance number):
Initial court date:
Amended charge:
What was the outcome (type of plea, pay fine, perform community service, serve time, etc.)?
Final court date:
You must provide a detailed narrative of the incident to fully explain the nature of the incident. Your...
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