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CRIMINAL INFORMATION SHEET

For Office Use Only

The criminal information sheet neither replaces nor supplements the filing and service of pleadings or other papers as required by law. This form is required for use by the Clerk of the District Court for the purposes of initiating the criminal docket sheet. This information will not be available to the public and this document will be stored in a separate location from the case file and then destroyed within a reasonable time. A new case will not be accepted without a cover sheet attached. (THIS FORM MUST BE TYPED OR PRINTED LEGIBLY). This form can be found at www.kscourts.org.

DEFENDANT'S INFORMATION
(ATTACH ADDITIONAL SHEET, IF NECESSARY)

COMPLAINT INFORMATION
VIOLATION DATE: ______________________ OFFICER:

DEFENDANT'S INFORMATION NAME: ADDRESS:

(ATTACH ADDITIONAL SHEET, IF NECESSARY)

_______________________

OFFICER NO: __________________________ PHONE: ____________________SEX: DL OR STATE ID NO: SSN: RACE:
White Black
State and Number

ATTORNEYS (if known) DOB:
(Firm Name, Address, Telephone Number and Supreme Court ID Number)

Asian

American Indian/Alaskan Unknown

Pacific Island

_____________________________________ _____________________________________ _____________________________________

ETHNICITY:

Hispanic

Non-Hispanic

Unknown

ALIAS NAMES USED:

KDR Transaction Number_____________________

The requirement that Social Security numbers be included on criminal cases is not mandatory. The number is used for purposes of identification and may be disclosed as permitted by law. This form is not considered to be a public record. 07-11-2006