STATE OF MINNESOTA		DISTRICT COURT	
COUNTY OF <NAME>		<NUMBER> JUDICIAL DISTRICT	
		COURT FILE NO.      	
		PROSECUTOR FILE NO.      	

State of Minnesota, 

	Plaintiff,

v.		
<Name of Defendant>(dob: <Defendant DOB>)	 Summons    Warrant	
<Defendant Address Line 1>	 Order of Detention	
<Defendant City>, MN  <Defendant Postal Code>,		
	 Amended	
Defendant.	 Tab Charge Previously Filed	

The Complainant, being duly sworn, makes complaint to the above-named Court and states that there is probable cause to believe that the Defendant committed the following offense(s):

COUNT I

Charge: <Charge Name>
Minnesota Statute:  § <Statutes_Charge>
Maximum Sentence:  <Max Sentence Description>	
	
COUNT II

Charge: <Charge Name>
Minnesota Statute:  § <Statutes_Charge>
Maximum Sentence:  <Max Sentence Description>
	
COUNT III

Charge: <Charge Name>
Minnesota Statute:  § <Statutes_Charge>
Maximum Sentence:  <Max Sentence Description>

STATEMENT OF PROBABLE CAUSE

The Complainant states that the following facts establish probable cause:

     

	
Complainant requests that Defendant, subject to bail or conditions of release, be:
(1) arrested or that other lawful steps be taken to obtain Defendant’s appearance in court; or
(2) detained, if already in custody, pending further proceedings; and that said Defendant otherwise be dealt with according to law.
	
	COMPLAINANT’S NAME:		COMPLAINANT’S SIGNATURE:		
	<Name>				
	Subscribed and sworn to before the undersigned this       day of           , 20     .	
	NAME/TITLE:		SIGNATURE:		
	     				

Being authorized to prosecute the offenses charged, I approve this complaint.	
Date:			PROSECUTING ATTORNEY'S SIGNATURE:	
						
			Name: <Prosecutor Name>		
			<Prosecutor Title>		
			<Prosecutor Address>		
			<Prosecutor Phone Number>		
			Attorney Registration #      		

FINDING OF PROBABLE CAUSE
From the above sworn facts, and any supporting affidavits or supplemental sworn testimony, I, the Issuing Officer, have determined that probable cause exists to support, subject to bail or conditions of release where applicable, Defendant’s arrest or other lawful steps be taken to obtain Defendant’s appearance in court, or Defendant’s detention, if already in custody, pending further proceedings.  Defendant is therefore charged with the above-stated offense.
	
  SUMMONS
THEREFORE YOU, THE ABOVE-NAMED DEFENDANT, ARE HEREBY SUMMONED to appear on the <#> day of <month>, 20 at <00:00>  before the above-named court at <location detail> to answer this complaint.

IF YOU FAIL TO APPEAR in response to this SUMMONS, a WARRANT FOR YOUR ARREST shall be issued.
	
  WARRANT
To the Sheriff of the above-named county; or other person authorized to execute this warrant: I hereby order, in the name of the State of Minnesota, that the above-named Defendant be apprehended and arrested without delay and brought promptly before the above-named court (if in session), and if not, before a Judge or Judicial Officer of such court without unnecessary delay, and in any event not later than 36 hours after the arrest or as soon as such Judge or Judicial Officer is available to be dealt with according to law.

 Execute in MN Only	 Execute Nationwide	      Execute in Border States
	
  ORDER OF DETENTION
Since the above-named Defendant is already in custody, I hereby order, subject to bail or conditions of release, that the above-named Defendant continue to be detained pending further proceedings.
	
Bail:	$     	
Conditions of Release:	     	
	
This complaint, duly subscribed and sworn to, is issued by the undersigned Judicial Officer this _____ day of ___________, 20            .	
	
JUDICIAL OFFICER:      	SIGNATURE:	
NAME:	     		
TITLE:	     			
	
Sworn testimony has been given before the Judicial Officer by the following witnesses:	
					
COUNTY OF <NAME>
STATE OF MINNESOTA	Clerk’s Signature or File Stamp:	
		
STATE OF MINNESOTA	RETURN OF SERVICE
I hereby Certify and Return that I have served a copy of this  upon the Defendant herein named.	
Plaintiff,		
vs.		
<Name>		
Defendant		
	    Signature of Authorized Service Agent:	

DEFENDANT DATA / charge SHEET – Attachment A

DEFENDANT NAME:	<LAST NAME>, <FIRST NAME> <MIDDLE NAME>	
Defendant alias name(s):	<Alias Names>	
Defendant DOB:	<Defendant DOB>	
Alias DOB(s):	<Alias DOBs>	
Defendant last known address:	<Defendant Address Line 1>	
	<Defendant City> MN, <Postal Code>	
State ID:	<SID Number>	

Other Defendant / Case Identifiers:	
Fingerprinted?	 No 		 Yes	
Handgun permit?	 No 		 Yes (Issuing Agency:      )	
Location of Violation:	     	
		
IF DRIVING OFFENSE:	
Driver's License	Number:	     	Issuing State:	     	
					
License Plate	Number:	     	Issuing State:	     	
					
Accident Type:
check all that apply		No injury/no damage		Property Damage	
		Personal Injury		Fatality	
		
Blood Alcohol Concentration (BAC):	     	

STATUTE AND OFFENSE GRID

Cnt Nbr	Statute Type	Offense Date(s)	Statute Nbrs and Text Descriptions	Offense Level	MOC	GOC	Controlling Agencies	Control Numbers	
1	Charge

	     	     
     
     	     	     		<Book ORI Nbr>
Booking
<Arrest ORI Nbr>
Arresting	<Ctrl Nbr>
Booking
<Ctrl Nbr>
Arresting	
2	Charge

	     	     
     
     	     	     		<Book ORI Nbr>
Booking
<Arrest ORI Nbr>
Arresting	<Ctrl Nbr>
Booking
<Ctrl Nbr>
Arresting	
3	Charge

	     	     
     
     	     	     		<Book ORI Nbr>
Booking
<Arrest ORI Nbr>
Arresting	<Ctrl Nbr>
Booking
<Ctrl Nbr>
Arresting	
4	Charge

	     	     
     
     	     	     		<Book ORI Nbr>
Booking
<Arrest ORI Nbr>
Arresting	<Ctrl Nbr>
Booking
<Ctrl Nbr>
Arresting	
5	Charge

	     	     
     
     	     	     		<Book ORI Nbr>
Booking
<Arrest ORI Nbr>
Arresting	<Ctrl Nbr>
Booking
<Ctrl Nbr>
Arresting	
6	Charge

	     	     
     
     	     	     		<Book ORI Nbr>
Booking
<Arrest ORI Nbr>
Arresting	<Ctrl Nbr>
Booking
<Ctrl Nbr>
Arresting	
7	Charge

	     	     
     
     	     	     		<Book ORI Nbr>
Booking
<Arrest ORI Nbr>
Arresting	<Ctrl Nbr>
Booking
<Ctrl Nbr>
Arresting	
8	Charge

	     	     
     
     	     	     		<Book ORI Nbr>
Booking
<Arrest ORI Nbr>
Arresting	<Ctrl Nbr>
Booking
<Ctrl Nbr>
Arresting