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MAGISTRATE COURT OF MCDUFFIE COUNTY CRIMINAL ARREST WARRANT APPLICATION - CIVILIAN WARRANT NO. PROSECUTOR/APPLICANT: ADDRESS: CITY: STATE: ZIP: PHONE NO.(HOME) (W0RK) (MOBILE/PGR.) ACCUSED: ADDRESS: CITY: STATE: ZIP: PHONE NO.(HOME) (W0RK) (MOBILE.PGR.) RACE AGE SEX HT WT EYES HAIR DOB SSN AUTO TAG RELATIONSHIP TO PROSECUTOR: [ ] PRESENT SPOUSE [ ] FORMER SPOUSE [ ] LIVE TOGETHER [ ] FORMERLY LIVED TOGETHER [ ] NONE [ ] PARENTS OF SAME CHILD(REN) [ ] PARENT [ ] CHILD [ ] STEPPARENT [ ] STEPCHILD [ ] FOSTER PARENT [ ] FOSTER CHILD [ ] OTHER WITNESS: ADDRESS: CITY: STATE: ZIP: PHONE NO.(HOME) (W0RK) (MOBILE/PGR.) Have you ever applied for a warrant before for this person? Yes No Has this person ever taken out a warrant against you? Yes No Have you ever applied for a warrant before against anyone else? Yes No Have you ever asked for a warrant to be dismissed? Yes No How long has the accused lived at the above address? Years Months Unknown Has the accused lived outside Georgia within the past ten years? Yes No Unknown Does the accused have significant family ties outside Georgia? Yes No Unknown Has the accused used any false names or aliases? Yes No Unknown If yes, list all such names known: Factors indicating the accused may be a threat while this case is pending: [ ] threats [ ] criminal history [ ] mental history [ ] probation/parole [ ] gang related [ ] accused use of intoxicants/drugs If any, please describe: The accused is an immediate threat to the safety or well being of me or another Yes No Unknown The accused will attempt to evade arrest or otherwise obstruct justice Yes No Unknown The accused is incarcerated or otherwise in the custody of a law enforcement agency Yes No Unknown The accused is a fugitive from justice Yes No Unknown The accused has written me a bad check and I have sent a 10 day letter per OCGA 16-9-20 Yes No Unknown Date of incident: Time of incident: Address (including county) where incident occurred: Have you reported this incident to the police? [ ] Yes [ ] No Name of Officer: Dept: Give a brief summary of what happened: I hereby swear or affirm that the above information is true and correct to the best of my knowledge. Prosecutor/Applicant Sworn to and subscribed before me this day of at [ ] AM [ ] PM Magistrate TO BE COMPLETED BY MAGISTRATE APPLICATION FEE: [ ] $20.00 [ ] WAIVED REPEAT OFFENDER: [ ] PROBATION [ ] PAROLE [ ] NO INFORMATION [ ] NONE ARREST WARRANT ISSUED: [ ] YES [ ] NO [ ] REFERRED TO LAW ENFORCEMENT [ ] HEARING OFFENSE(S): [ ] IMMEDIATE/CONTINUING THREAT [ ] EVADE ARREST/OBSTRUCT JUSTICE [ ] ACCUSED IN CUSTODY [ ] BAD CHECK – 10 DAY NOTICE GIVEN [ ] FAMILY VIOLENCE [ ] FUGITIVE FROM JUSTICE [ ] FELONY [ ] MISDEMEANOR [ ] FAMILY VIOLENCE [ ] SPECIAL CONDITIONS OF BOND MAG 20-20 Criminal Arrest Warrant Application-Civilian (5-10)