Issuance Of A Bad Check Form - County Of Jefferson printable pdf download

AFFIDAVIT – ISSUANCE OF A BAD CHECK

CAUSE NO. ____________

IN THE NAME AND BY AUTHORITY OF THE STATE OF TEXAS

PERSONALLY APPEARED before me the undersigned authority, this

affiant, who after being by me duly sworn, deposes and says your

affiant has good reason to believe and does believe that one

(DEFENDANT’S NAME)____________________________________

hereinafter styled Defendant, heretofore on or about the _______day

of _____________ A.D., 20 ____ in the County of Jefferson and

State of Texas, did unlawfully and knowingly within Justice of the

Peace, Precinct One, of said county and state, then and there issue

and pass to (MERCHANT’S NAME) __________________________

a check for payment of money being of the tenor following:

(MERCHANT’S NAME, ADDRESS, AND PHONE NUMBER)

______________________________________

PHONE # ______________________________

CHECK NO. ________ DATED____________ PAYABLE TO THE

ORDER OF ___________________________ IN THE AMOUNT OF

$____________ SIGNED BY _______________________________

DRAWN ON THE ________________________________________

BANK OF _____________________ ACCOUNT NO ____________

and the said defendant knowing at the time of issuance and passing

of the aforesaid check that he did not have sufficient funds on deposit

with the bank on which said check was drawn for the payment in full

of the check as well as all other checks and orders then outstanding.

Against the peace and dignity of the State.

Sworn to and subscribed before me this ___ day of _________________, 20___.

_______________________

AFFIANT SIGNATURE

_________________________

_______________________

NOTARY PUBLIC IN AND FOR

ADDRESS & PHONE NO.

JEFFERSON COUNTY, TEXAS

====================================================

ORDER

Based on the above affidavit and the facts in this cause, I have made

determination that probable cause exists and instruct the clerk to

issue a warrant for the arrest of the Defendant.

Signed the _________ day of _______________________, 20 ____.

___________________________

Kenneth Dollinger, Justice of the Peace

====================================================

INFORMATION ON DEFENDANT (WE NEED AS MUCH OF THE

FOLLOWING INFORMATION AS POSSIBLE)

RES. ADDRESS __________________

BUS. ADDRESS ________________

________________________________

______________________________

PHONE NO. _____________________

PHONE NO. ___________________

TDL # __________________________

DOB________________ AGE _____

RACE __________________________

DATE CERT. LTR. SENT _________

NAME OF WITNESS THAT CAN IDENTIFY SUBJECT

____________________________________________

Issuance Of A Bad Check Form - County Of Jefferson

Related Articles

Related forms

Related Categories