Criminal Arrest Warrant Application-Civilian

MAGISTRATE COURT OF GWINNETT COUNTY CRIMINAL ARREST WARRANT APPLICATION - CIVILIAN PROSECUTOR/APPLICANT: ADDRESS: CITY: PHONE NUMBERS: (HOME) ACCUSED: ADDRESS: CITY: PHONE NUMBERS: (HOME) RACE AGE SEX HT (WORK) WT (WORK) WARRANT NO:___________________________________ WARRANT APPLICATION NO:_______________________ STATE: ZIP:_______________________ (CELL) STATE: ZIP: (CELL) ____ EYES HAIR DOB SSN RELATIONSHIP TO APPLICANT: [ ] NONE AUTO MAKE/COLOR TAG [ ] PRESENT SPOUSE [ ] FORMER SPOUSE [ ] LIVE TOGETHER [ ] FORMERLY LIVED TOGETHER [ ] PARENTS OF SAME CHILD(REN) [ ] PARENT [ ] CHILD [ ] STEPPARENT [ ] STEPCHILD [ ] FOSTER PARENT [ ] FOSTER CHILD [ ] OTHER IF YES, WAS THE ACCUSED ON DUTY WHEN INCIDENT OCCURRED? [ ] YES [ ] NO IF YES, WAS THE ACCUSED ON DUTY WHEN INCIDENT OCCURRED? [ ] YES [ ] NO WITNESS: ________________________________________________ ADDRESS:_______________________________________________ CITY:____________________STATE:_______ ZIP: ______________ PHONE #_____________________CELL #_____________________ IS THE ACCUSED A POLICE OFFICER? [ ] YES [ ] NO IS THE ACCUSED A TEACHER? [ ] YES [ ] NO WITNESS: ______________________________________________ ADDRESS:____________________________________________ CITY:___________________STATE:______ ZIP: ______________ PHONE #___________________CELL #_____________________ Have you ever applied for a warrant before for this person? Yes No Has this person ever taken out a warrant against you? Yes No Have you ever applied for a warrant before against anyone else? Yes No Has the accused used any false names or aliases? Yes No ____ Unknown If yes, please provide other names/aliases used:___________________________________________________________________________ OFFENSE INFORMATION Did the incident occur in Gwinnett County? [ ] YES [ ] NO Address of Incident:__________________________________________________ Date of Incident: _________________________________ _________________________________________________________________ Have you reported this incident to the police? [ ] YES [ ] NO. Name of Officer: __________________________ Dept.: _______________________ TYPE OF OFFENSE (Check only ONE type and answer all questions related to this offense.) [ ] DAMAGES Who is the owner of the property that was damaged?______________________________________________________________ What is the estimate of the damages? _________________________________________________________________________ How was the property damaged?_____________________________________________________________________________ Give a description of the property damaged._____________________________________________________________________ [ ] THEFT Who is the owner of the property that was taken?_________________________________________________________________ Is the accused your spouse? [ ] YES [ ] NO. What is the value of the property taken?________________________________ Did the accused have permission to use the property? [ ] YES [ ] NO. If so, when was the property to be returned?____________ If this is for conversion of rental property, have you obtained a writ of possession? [ ] YES [ ] NO If this involves a lease or rental agreement, have you obtained a civil judgment? [ ] YES [ ] NO Give a description of the property taken._______________________________________________________________________ [ ] THEFT BY SHOPLIFTING Is there video evidence? [ ] YES [ ] NO What is the value of the property taken? _______________________________________________________________________ [ ] BATTERY/SIMPLE BATTERY/ASSAULT Describe what happened.__________________________________________________________________________________ ______________________________________________________________________________________________________ [ ] HARASSING COMMUNICATIONS Did you give the Accused notice not to contact you? [ ] YES [ ] NO. If so, how?_________________________________ Describe how the Accused contacted you (phone/text/email).______________________________________________________ Describe the communication._______________________________________________________________________________ Describe the number of contacts and purpose of contact._________________________________________________________ Civilian Warrant Application Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com [ ] DEPOSIT ACCOUNT FRAUD (BAD CHECK) ­ FOR ALL BAD CHECK CASES, YOU MUST COMPLETE A SUPPLEMENTAL APPLICATION [ ] CONCEALMENT OF A SECURITY INTEREST ­ FOR ALL CONCEALMENT CASES, YOU MUST COMPLETE A SUPPLEMENTAL APPLICATION [ ] ABANDONMENT -- FOR ALL ABANDONMENT CASES, YOU MUST COMPLETE A SUPPLEMENTAL APPLICATION [ ] OTHER What type of crime do you allege was committed by the Accused?____________________________________________________ Describe what happened?___________________________________________________________________________________ ________________________________________________________________________________________________________ I DO SOLEMNLY SWEAR (OR AFFIRM), UNDER PENALTY OF PERJURY, THAT I HAVE PERSONAL KNOWLEDGE OF THE INFORMATION CONTAINED HEREIN AND THAT THE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. AND, I FURTHER UNDERSTAND THAT GIVING FALSE INFORMATION TO THE COURT UNDER OATH COULD RESULT IN PROSECUTION FOR FALSE SWEARING (O.C.G.A. § 16-10-71) AND/OR PERJURY (O.C.G.A. § 16-10-70), WHICH ARE BOTH FELONY OFFENSES UNDER GEORGIA LAW, CARRYING A MAXIMUM PENALTY OF ONE (1) TO TEN (10) YEARS IN PRISON. IN ADDITION, APPLICANTS PURSUING CRIMINAL CHARGES THAT ARE ULTIMATELY TERMINATED IN FAVOR OF THE ACCUSED COULD, UNDER CERTAIN CIRCUMSTANCES, SUBJECT THE APPLICANT TO LIABILITY FOR MALICIOUS PROSECUTION. See O.C.G.A. § 51-7-40. Signed, this ____ day of __________________, 20____. ___________________________________________ Warrant Applicant ___________________________________________ Print name: TO BE COMPLETED BY MAGISTRATE APPLICATION FEE: [ ] $25.00 REPEAT OFFENDER: [ ] PROBATION ARREST WARRANT ISSUED: [ ] YES [ ] NO [ ] WAIVED [ ] PAROLE [ ] NO INFORMATION [ ] REFERRED TO LAW ENFORCEMENT [ ] NONE [ ] HEARING OFFENSE(S): _____________________________________________________________________________________________________________ [ ] IMMEDIATE/CONTINUING THREAT [ ] BAD CHECK ­ 10 DAY NOTICE GIVEN [ ] FELONY [ ] MISDEMEANOR [ ] EVADE ARREST/OBSTRUCT JUSTICE [ ] FAMILY VIOLENCE [ ] FAMILY VIOLENCE [ ] ACCUSED IN CUSTODY [ ] FUGITIVE FROM JUSTICE [ ] SPECIAL CONDITIONS OF BOND Civilia