Free DCCR34 Statement of Facts - Massachusetts


File Size: 19.3 kB
Pages: 1
Date: January 12, 2007
File Format: PDF
State: Massachusetts
Category: Court Forms - State
Author: Administrative Office of the District Court Department
Word Count: 97 Words, 2,930 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.mass.gov/courts/courtsandjudges/courts/districtcourt/statementfacts_dccr341.pdf

Download DCCR34 Statement of Facts ( 19.3 kB)


Preview DCCR34 Statement of Facts
STATEMENT OF FACTS
IN SUPPORT OF APPLICATION FOR CRIMINAL COMPLAINT

APPLICATION NO. (court use only)

PAGE ___ OF ___

Trial Court of Massachusetts District Court Department

The undersigned alleges the following as a full or partial statement of the factual basis for the offense(s) for which a criminal complaint is sought.

9

9

COURT DIVISION

_________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________
(Use additional sheets if necessary) PRINTED NAME SIGNATURE I AM A: DATE SIGNED

X

9 LAW ENFORCEMENT OFFICER 9 CIVILIAN COMPLAINANT OR WITNESS

ADDITIONAL FACTS FOUND BY CLERK-MAGISTRATE / ASST. CLERK / JUDGE BASED ON ORAL TESTIMONY

_________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________
REMARKS SIGNATURE OF CLERK-MAGISTRATE / ASST.CLERK / JUDGE DATE SIGNED

X
DC-CR-34 (7/04)