Fill and Sign the For Complaint Form

APPLICATION FOR COMPLAINT G JUVENILE G ADULT APPLICATION NO. (COURT USE ONLY) PAGE __OF__ TRIAL COURT OF MASSACHUSETTS JUVENILE COURT DEPARTMENT_____________________DIVISION (FOR POLICE USE ONLY) G ARREST G SUMMONS G WARRANT G HEARING If you are requesting a Warrant, state the reason: ______________________ ______________________________________________________________ Arrest Status of Accused: G has G has not been arrested ADDRESS INFORMATION ABOUT ACCUSED NAME (FIRST MI LAST) AND ADDRESS BIRTH DATE SSN PCF NO. MARITAL STATUS DRIVERS LICENSE NO. STATE GENDER HEIGHT WEIGHT EYES HAIR RACE COMPLEXION SCARS/MARKS/TATTOOS BIRTH STATE OR COUNTRYDAY PHONE SCHOOL/EMPLOYER MOTHER’S NAME (FIRST MI LAST) (MAIDEN ) FATHER’S NAME (FIRST MI LAST) CASE INFORMATION COMPLAINANT NAME (FIRST MI LAST) AND ADDRESS COMPLAINANT TYPE G POLICE G CITIZEN G OTHER PD PLACE OF OFFENSE INCIDENT REPORT NO. OBTN CITATION NO(S) SID 1 G.L. c. and Sec. DESCRIPTION OFFENSE DATE VARIABLES (e.g. victim name, controlled substanc e, type and value of property, other variable information) 2 G.L. c. and Sec. DESCRIPTION OFFENSE DATE VARIABLES 3 G.L. c. and Sec. DESCRIPTION OFFENSE DATE VARIABLES REMARKS COMPLAINANT’S SIGNATURE xDATE FILED COURT USE ONLY G FELONY CHARGED AND POLI CE DO NOT REQUEST NOTICE G FELONY CHARGE BY CIVILIAN; NO NOTICE AT CLERK’S DISCRETION G APPLICATION DECIDED WITH NOTICE TO ACCUSED DATE COMPLAINT TO ISSUE COMPLAINT DENIED OTHERCLERK/JUDGE G PROBABLE CAUSE FOUND FOR ABOVE OFFENSE(S) NO(S). G 1. G 2. G 3. BASED ON G FACTS SET FORTH IN ATTACHED G STATEMENT(S) G POLICE REPORT G TESTIMONY RECORDED: TAPE NO. ________ START NO. ___________ END NO. _________ G WARRANT G SUMMONS TO ISSUE ARRAIGNMENT DATE: G NO PROBABLE CAUSE FOUND G REQUEST OF COMPLAINANTG FAILURE TO PROSECUTEG AGREEMENT OF BOTH PARTIES G OTHER: COMMENT: G CASE CONT’D BY AGREEMENT OF BOTH PARTIES (See Below ) ADDITIONAL COMMENTS: JV-CR-2 (10/04) COURT COPY