CIRCUIT COURT
DISTRICT COURT OF MARYLAND FOR
City/County
Located at STATE OF MARYLAND
Court Address
Case No.
vs.
Defendant
CONFIDENTIAL SUPPLEMENT
(Request for Shielding of Information) Victim Requests Shielding Due to: Complainant Requests Shielding Witness Requests Shielding
Threats to Safety Made by Defendant or Person(s) on Defendant's Behalf Act of Violence by Defendant or Person(s) on Defendant's Behalf Other
Victim/Complainant/Witness (Please print.)
Victim/Complainant/Witness (Please print.)
Address
Address
Telephone Number
Telephone Number
Victim/Complainant/Witness (Please print.)
Victim/Complainant/Witness (Please print.)
Address
Address
Telephone Number
Telephone Number
I solemnly affirm that the contents of this confidential supplement request are true to the best of my knowledge, information, and belief.
Date
Victim/Complainant/Witness Signature
Approved
Denied
Shielding Not Requested
Commissioner/Judge
I.D. No.
Date
NOTICE: Remote access to the name, address, telephone number, date of birth, e-mail address and place of employment of a victim or non-party witness is blocked. (Md Rule ยง 16-1008 (a)(3)(B))
CC-DC/CR 1S (Rev. 3/2008)
Reset