Affidavit Of Complaint Worthless Check (Criminal)

GENERAL SESSIONS COURT OF ________________________________ COUNTY TE NNESSE E State of Tennessee vs. ____________________________________________________________________ _________ State Control # _____________________ _______________________ County Case # _____________________ Attorney for Defendant _______________________________ Address ________________________________________ Court Date _________________________________________ _______________________________________________ State, Deft. to ________________________ at _____________am/pm Phone ___________________ DL# _______________________ State, Deft. to ________________________ at _____________am/pm DOB ____________________ SSN#______________________ State, Deft. to ________________________ at _____________am/pm Sex____ Race____ Ht____ Wt____ Hair____ Eyes __________ State, Deft. to ________________________ at _____________am/pm Work _______________________________________________ State, Deft. to ________________________ at _____________am/pm ____________________________________________________ AFFIDAVIT OF COMPLAINT WORTHLESS CHECK/Sight Order T.C.A. 39-14-121 The undersigned affiant, after being duly sworn according to the law, states that the Defendant, whose name is otherwise unknown to the affiant, committed the offense of issuing or passing a worthless check, a violation of T.C.A. 39-14-121, in the _____________________ County on or about ______________________________, for the amount of $____________________ and service charge of $____________________________. Further, affiant makes oath that the essential facts constituting said offense, the source of affiants information, and the reasons why his/her information is believable concerning said facts are as follows: personal knowledge; or that he has received information from ________________________________ who he knows to be a reliable and credible informant because said informant had previously given him information of a similar nature which had been subsequently verified and/or that said informant had been an employee in good standing of ______________________________ for more than __________ years and ___________ months, and that said informant told said affiant that Defendant did make or draw the check/order, a copy of which is attached hereto and made part of this Affidavit of Complaint, for the payment of money for the purpose of paying any fine, fee, tax, license or obligation to any government entity or for the purpose of obtaining money, services, labor credit and/or valuable property from said affiant or business and did pay for aforesaid items/services with said check/order and did obtain by the use of said check/order the aforesaid items/services. That in due course of business the check was returned, within thirty (30) days after issue, unpaid, marked ___________________________________. Unless the check/order was marked Account Closed, affiant sent notice in writing of this check being returned for the aforesaid reason by certified United States mail. Return receipt requested, addressed to the maker of said check at the address as it appears on said check/order which is the last known address of said maker. Said maker has failed to make said check good for more than ten (10) days after receipt of said notice and that said check still remain unpaid. Affiants Signature: ______________________________________ Sworn to and subscribed before me on Name (Printed): _________________________________________ _________________________________, 20____ Address (Printed): _______________________________________ ________________________________________ Judge/Clerk. Judicial Commissioner ______________________________________________________ Phone Number: _________________________________________ PROBABLE CAUSE DETERMINATION Based on the affidavit of complaint, I find there is probable cause to believe that on the date set forth above in County,. Tennessee the defendant committed the offense(s) of violation(s) of TCA _________________________________________ __________________________ ________________________________________________________________________ ____________________________________________ ( ) Defendant given citation or arrested without warrant ( ) Arrest warrant shall issue ( ) Criminal summons shall issue Date __________________________________ Judge/Clerk/Judicial Commissioner ______________________________________