Statement Of Facts In Support OF Application For Criminal Complaint {DC-CR-34}

STATEMENT OF FACTS IN SUPPORT OF APPLICATION FOR CRIMINAL COMPLAINT APPLICATION NO. (court use only) PAGE ___ OF ___ Trial Court of Massachusetts District Court Department The undersigned alleges the following as a full or partial statement of the factual basis for the offense(s) for which a criminal complaint is sought. 9 9 COURT DIVISION _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ (Use additional sheets if necessary) PRINTED NAME SIGNATURE I AM A: DATE SIGNED X 9 LAW ENFORCEMENT OFFICER 9 CIVILIAN COMPLAINANT OR WITNESS ADDITIONAL FACTS FOUND BY CLERK-MAGISTRATE / ASST. CLERK / JUDGE BASED ON ORAL TESTIMONY _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ REMARKS SIGNATURE OF CLERK-MAGISTRATE / ASST.CLERK / JUDGE DATE SIGNED X DC-CR-34 (7/04) American LegalNet, Inc. www.FormsWorkflow.com