REQUEST FOR CRIMINAL COMPLAINT
To any Justice or Clerk-Magistrate of the Housing Court: _________________________________________________________________ on behalf of the Commonwealth, on oath complains that: Name and Address of Defendant: _____________________________ _____________________________ _____________________________ _____________________________ Statute violated: _________________________ Possible penalties: _________________________
_________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ and did so willfully, intentionally, recklessly or repeatedly. __________________________ Date: ______________________________ Complainant:
Assigned for hearing on _____________________,200__, at _________ o'clock. On hearing (Complainant)(Defendant)(both parties)(neither party), I find no probable cause for the Complaint. Process shall not issue. On hearing (Complainant)(Defendant)(both parties)(neither party), and Complainant having sworn or affirmed that the Complaint is true upon information and belief, I find probable cause, and order summons to issue returnable ____________________________. ________________________ Date: _________________________________ Clerk-Magistrate