Free Microsoft Word - 2274_012709 - Pennsylvania

COMMONWEALTH OF PENNSYLVANIA COUNTY OF:
Affiant Information Affiant Name: Address: City/State/Zip: Telephone: ( )

WRITTEN ALLEGATION
In the Interest of: JUVENILE:
First Name Address: City/State/Zip: Telephone: ( Middle Name Last Name Gen.

)

JUVENILE IDENTIFICATION INFORMATION
RACE ETHNICITY GENDER White Black Hispanic Male Asian Female NonHispanic American Indian/Alaskan Hawaiian/Pacific Islander Unknown EYE COLOR BLK (Black) GRY (Gray) PNK (Pink) BLU (Blue) HAZ (Hazel) XXX (Unknown) BRO (Brown) MAR (Maroon) GRN (Green) MUL (Multicolored) SID: JOTN: DOB #1: A.K.A / / Place of Birth for DOB #1: Middle Name DOB #2: Last Name / /

First Name

HAIR COLOR: GRN (Green) BLK (Black) GRY (Gray) WHT (White) ONG (Orange) BLU (Blue) PLE (Purple) BRO (Brown) PNK (Pink) Request Lab Services? YES NO Fingerprints taken? YES NO

RED (Red/Auburn) SDY (Sandy) BLN (Blonde/Strawberry) XXX (Unknown/Bald) Provided By: Photographs taken?

WEIGHT (lbs.) Ft. HEIGHT In.

YES

NO

DATE/TIME TAKEN INTO CUSTODY BY POLICE NAMES AND AGES OF CO-CONSPIRATORS:

DATE/TIME ADMITTED TO DETENTION NAME AND ADDRESS OF GUARDIAN, OR IF UNKNOWN, NAME AND ADDRESS OF NEAREST ADULT RELATIVE:

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Acts of the accused and location associated with this Offense:

AOPC 2274 REV. 01/07/2009

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WRITTEN ALLEGATION
I,
Affiant (print or type)

represent that it is in the best interest of the juvenile

and the public that the proceedings be brought, and the juvenile is in need of treatment, supervision, or rehabilitation. 1. I allege that the above named juvenile who lives at the address set forth above I allege that the juvenile whose name is unknown to me but who is described as

I allege that the juvenile whose name and popular designation or nickname are unknown to me and whom I have therefore designated as John Doe or Jane Doe has violated the penal laws of the Commonwealth of Pennsylvania at in
subdiv. code place-polictical sub div.

County

on or about
Day ­ Date and Time

2. This allegation is comprised of the preceding page, as well as the attached pages that follow, through specifying offenses. numbered The acts committed by the accused, as listed and hereafter, were against the peace and dignity of the Commonwealth of Pennsylvania and were contrary to the Acts(s) of the Assembly, or in violation of the statutes cited or in violation of an ordinance of a political subdivision. ,
Month Day Year (Signature of Affiant)

(Title of Affiant)

AOPC 2274 REV. 01/07/2009

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JUVENILE NAME: JOTN: IN THE COURT OF COMMON PLEAS OF AFFIDAVIT OF PROBABLE CAUSE COUNTY, PENNSYLVANIA

I verify that the facts set forth in this petition are true and correct to the best of my knowledge or information and belief. This verification is made subject to the penalties of Section 4904 of the Crimes Code (18 Pa.C.S § 4904) relating to unsworn falsification to authorities.

SIGNATURE OF AFFIANT: TITLE OF AFFIANT:

DATE:

AOPC 2274 REV. 01/07/2009

Page _ of _

JUVENILE NAME: JOTN: IN THE COURT OF COMMON PLEAS OF ADDITIONAL CHARGES
Inchoate Offense
Lead?

COUNTY, PENNSYLVANIA

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

Inchoate Offense
Lead?

Attempt 18 901A

Solicitation 18 902A

Conspiracy 18 903 of the

A1 (Engaging)

A2 (Aiding)

B (Knowledge)

Permitting (Title 75 Only) 75 1575A

Offense#

Section

Subsection

PA Statute (Title)

Counts

Grade

JOTN

NCIC Offense Code

UCR/NIBRS Code

AOPC 2274 REV. 01/07/2009

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