GENERAL SESSIONS COURT OF ________________________________ COUNTY TENNESSEE

State of Tennessee vs. _____________________________________________________________________________

State Control # _____________________

_______________________ County Case # _____________________

Attorney for Defendant _______________________________

Court Date _________________________________________

Address ________________________________________
_______________________________________________

State, Deft. to ________________________ at _____________am/pm

State, Deft. to ________________________ at _____________am/pm
State, Deft. to ________________________ at _____________am/pm
State, Deft. to ________________________ at _____________am/pm
State, Deft. to ________________________ at _____________am/pm

Phone ___________________ DL# _______________________

DOB ____________________ SSN#______________________
Sex____ Race____ Ht____ Wt____ Hair____ Eyes __________
Work _______________________________________________
____________________________________________________

AFFIDAVIT OF COMPLAINT
I, the affiant named below, after being sworn, state under oath that on or about _________________________________
in

____________________________

County,

Tennessee,

____________________________________________________

committed the offense(s) of violation(s) of T.C.A. ______________________________________________________________.

I further state under oath that the essential facts constituting the offense(s), the sources of my information and the reasons why this
information is believable and reliable are as follows:

Affiants Signature: ______________________________________

Sworn to and subscribed before me on

Name (Printed): _________________________________________

_________________________________, 20____

Address (Printed): _______________________________________

________________________________________
Judge/Clerk/Judicial Commissioner

______________________________________________________
Phone Number: _________________________________________

PROBABLE CAUSE DETERMINATION

Based on the affidavit of complaint, I find there is probable cause to believe that on the date set forth above in_______________ County,
Tennessee the defendant committed the offense(s) of violation(s) of TCA ________________________________________________________
____________________________________________________________________________________________________________________
( ) Defendant given citation or arrested without warrant

Date __________________________________

( ) Arrest warrant shall issue

( ) Criminal summons shall issue

Judge/Clerk/Judicial Commissioner ______________________________________

Legal Authority: TCA 40-6-203, 40-6-204 ,TRCRP 3