Case Number ______________

State of Alabama Unified Judicial System Lee County Form CC- I AFFIDAVIT CHARGING CRIME

Before me __________________________ Clerk of the District Court of Lee County, Alabama, personally appeared ___________________________, who being first duly sworn, deposes and says on oath, that he / she has probable cause of believing and does believe that, ____________________________________, alias, _______________________________, alias, did give a false name or address to a law enforcement officer while said officer was in the course of official duties with the intent to mislead the officer, in violation of 13A-9-18.1 of the Code of Alabama, against the peace and dignity of the State of Alabama. This incident occurred in Lee County, Alabama on ____________.

PROBABLE CAUSE:

Sworn to and subscribed before me, this ___________ day of _____________ ______

_________________________________ Clerk, District Court

*__________________________________ ______________________ ID# ________

WARRANT

To any Lawful Officer of the State of Alabama, GREETINGS:

You are hereby commanded to arrest _______________________________, alias, and bring him before District Court of Lee County, Alabama, to answer the State of Alabama on the charge of Giving of False Name or Address to a Law Enforcement Officer (13A-9-18.1) said charges preferred by ___________________________ and have you then and there this Writ with your return thereon.

Witness my hand, this ____ day of ________________________ A.D. _______

________________________________Clerk, District Court

The State of Alabama LEE COUNTY

The State of Alabama LEE COUNTY

Case Number

THE STATE OF ALABAMA vs.

CHARGE:Giving of False Name or Address to a Law Enforcement Officer

(13A-9-18.1)

OFFICER'S RETURNI have executed this Writ by arresting the defendant and committing him/her to jail or allowing him/her to give bond.

ID#

STATE'S WITNESSES DEFENDANT'S INFORMATIONDOB:SSN:WGT:HGT:HAIR:RACE: GENDER

COMMITMENT

This ________ day of ________________ A.D. ________

_________________________________ Clerk, District/Circuit Court

The State of Alabama LEE COUNTY

TO THE JAILER OF LEE COUNTY:

On the examination of ____________________ charged with the offense of Giving of False Name or Address to a Law Enforcement Officer (13A-9-18.1) it appearing that such offense has been committed, and that there is sufficient cause to believe that he/she is guilty thereof, you are therefore commanded to receive him/her into your custody and detain him/her until he she is legally discharged.

BOND in this cause if fixed at the sum of $ ____________

The State of Alabama LEE COUNTY

This _______ day of ______________ , ______

Jay Jones - SHERIFF