Fill and Sign the West Virginia Criminal Form

Complaint for Warrant State of West Virginia County of __________________ To wit: _____________________________ , upon oath complains that: Within one year past, on the _______ day of _______________ , 20 _______ , in the county stated above, _____________________________ , ("the maker") unlawfully issued and delivered to _____________________________ a check, draft or order with the following words and figures: (1) _______ day of _______________ , 20 _______ (2) Check No _______ (3) _____________________________ (Name of Bank) (4) Pay to the Order of ________________________ , $ _______ Dollars (5) For _____________________________ when the maker did not have funds on deposit in or credit with this bank with which to pay the check, draft or order upon presentation against the peace and dignity of the State of West Virginia. The complainant therefore prays a warrant issue and that the maker be apprehended and held to answer the warrant and dealt with in relation thereto according to the law. At the time the check, draft or order was delivered and before it was accepted there was either on the check or on a record in the possession of the complainant the following information regarding the identity of the maker: (1) Name _____________________________ (2) Residence address __________________________ _______________ (3) Business address _____________________________ _______________ (4) Mailing address _____________________________ _______________ (5) Motor vehicle operator's number _______________ (6) Home phone _______________ (7) Work phone _______________ (8) Place of employment _____________________________ That since the time the check, draft or order was delivered the complainant has ascertained to the best of his or her knowledge and belief the following facts concerning the maker: (1) Full name _____________________________ (2) Home address _____________________________ _______________ - 1 - (3) Home phone no. _____________ Business phone no. _____________ (4) Place of employment _____________________________ (5) Race _______ Sex _______ Height _______ (6) Date of birth _______________ ( Day/Month/Year) _____________________________ , Complainant _____________________________ _______________ _______________ Address Phone No. The complainant's bank or financial institution has imposed on or collected from the complainant a service charge in the amount of $ _______ in connection with the check, draft or order described above. Mail or deliver the total amount to the following:                               Notice Issued by: Signature: ________________________________ Print Name: _______________________ Title: _______________________ Taken, subscribed and sworn to before me, this _______ day of _______________ , 20 _______ _____________________________ (Name) _____________________________ (Title) My commission expires the _______ day of _______________ , 20 _______ - 2 -