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COVER SHEET STATE OF ARKANSAS CRIMINAL INFORMATION
This criminal information cover sheet or the standard criminal information form is required by Supreme Court Administrative Order Number 8 to be completed for every defendant and filed by the prosecutor. The data contained herein shall not be admissible as evidence in any court proceeding or replace or supplement the filing and service of pleadings, orders, or other papers as required by law or Supreme Court rule. Instructions are located on the back of the form. County Judge Style of Case Prosecutor Providing Information District Division Case Number Filing Date

Is this an Amended Information? If yes, are you Adding Offense(s)? Dropping Offense(s)? Changing Offense(s)?

9 Yes

Is D being charged as a Habitual? Are multiple D's charged in the information?

9 Yes 9 Yes 9 Yes

9 Yes 9 Yes 9 Yes

Is victim under the age of 14?

Defendant's Full Name

Date of Birth

Race

Sex

SID #

Arrest Date

Address (Street, City, State, Zip)

SS#

Driver's License No.

Arrest Tracking #

Prosecutor's File #

Alias 1

Alias 2

Alias 3

The attached information accuses the above named defendant of the following crime(s): Code # Offense A/S/C Offense Date Counts F/M Class

_____________________________________________ Circuit Clerk/Deputy Clerk AOC 2/07

________________________________________________ Prosecuting Attorney/Deputy Prosecuting Attorney

CRIMINAL INFORMATION IN THE CIRCUIT COURT OF _________________________ COUNTY, ARKANSAS ________________________ DISTRICT, ___________________ DIVISION

State of Arkansas vs

Case No.

Filing Date

Amended Information? If Yes: Adding Offense(s)? Dropping Offense(s)? Changing Offense(s)? D Charged As Habitual? Is victim under the age of 14?

9 Yes
Co-D's

Multiple D's Charged Together 9 -Or- Multiple D's Charged Separately 9 Related Case #'s

9 Yes 9 Yes 9 Yes 9 Yes 9 Yes

Defendant's Full Name

Date of Birth

Race

Sex

SID #

Arrest Date

Address (Street, City, State, Zip)

SS#

Driver's License No.

Arrest Tracking #

Prosecutor's File #

Alias 1

Alias 2

Alias 3

I, ___________________________________, Prosecuting/Deputy Prosecuting Attorney, __________ Judicial District, in the name of the State of Arkansas, ____________________________ County, accuse the above named defendant of the following crime(s):

Code #

Offense

A/S/C

Offense Date

Counts

F/M

Class

Committed as follows: Count # __________ Offense ______________________________________________________________ The defendant on or about ______________________ (date), in _________________________ County, Arkansas did unlawfully

against the peace and dignity of the State of Arkansas.

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Committed as follows: Count # __________ Offense ____________________________________________________________ The defendant on or about ______________________ (date), in _________________________ County, Arkansas did unlawfully

against the peace and dignity of the State of Arkansas.

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Committed as follows: Count # __________ Offense ____________________________________________________________ The defendant on or about ______________________ (date), in _________________________ County, Arkansas did unlawfully

against the peace and dignity of the State of Arkansas.
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By _______________________________________ Prosecuting/Deputy Prosecuting Attorney ______________________________________, Prosecuting Attorney.

Entered this ______ day of ________________________, 19_____.

AOC 2/07

INSTRUCTIONS FOR COMPLETING CRIMINAL INFORMATION

Pursuant to Supreme Court Administrative Order Number 8, the Office of the Prosecuting Attorney is responsible for the completion and filing of either the standard criminal information form or the criminal information cover sheet, a copy of which is to be forwarded by the circuit clerk to the Administrative Office of the Courts. Only one defendant shall be charged in each criminal information. Court Location. Fill in the name of the county, district, and division (if applicable) of the court in which the information is being filed. Style, Case #. Enter the name of the defendant for the style of the case, and the filing date (the month, day, and year the information is being filed). The clerk will assign and enter a case number upon filing. Amendment/Habitual. Complete each question only if the answer is "yes." If a previous information was filed against the same defendant for the same occurrence, indicate the type of changes from the original or most recent information. Indicate "yes" if the defendant is being charged as a habitual offender, pursuant to A.C.A. § 5-4-501 et. seq. Multiple Defendants. If the prosecutor checks "Multiple D's Charged Together" the clerk MUST assign the same case number to the information of each of the co-defendants listed on the information. If defendants will be charged in separate proceedings, the prosecutor should check "Multiple D's Charged Separately" and the related case numbers may be entered for case assignment and tracking purposes. Defendant Information. Enter all background and directory information about the defendant which is available. A.C.A. § 12-12-1007 requires that the arrest tracking number be provided at filing if the defendant has been arrested. Charging Information. Enter name of charging prosecutor, judicial district number, and county name. For each offense charged, list the Arkansas Code Annotated number of the offense, the title of the offense, whether the charge is for an attempt (A), solicitation (S) or conspiracy (C) (if none leave blank), the offense date, the number of counts, whether the charge is a felony (F) or misdemeanor (M), and its classification (Y, A, B, C, D, U). Narrative Statement. For each count or series of counts and offenses, complete the narrative description of the defendant's actions which constituted the offense. Complete the charging statement by entering the classification of the offense and the range of possible fine and incarceration for the offense. Use additional pages if necessary. Verification. Enter the date and the signature of the prosecuting authority. The clerk shall retain the original information in the case file and send a copy of the first page only of the information to the Administrative Office of the Courts.

CRIMINAL INFORMATION IN THE CIRCUIT COURT OF _________________________ COUNTY, ARKANSAS ________________________ DISTRICT, ___________________ DIVISION

State of Arkansas vs

Case No.

Filing Date

Amended Information? If Yes: Adding Offense(s)? Dropping Offense(s)? Changing Offense(s)? D Charged As Habitual? Is victim under the age of 14?

9 Yes
Co-D's

Multiple D's Charged Together 9 -Or- Multiple D's Charged Separately 9 Related Case #'s

9 Yes 9 Yes 9 Yes 9 Yes 9 Yes

Defendant's Full Name

Date of Birth

Race

Sex

SID #

Arrest Date

Address (Street, City, State, Zip)

SS#

Driver's License No.

Arrest Tracking #

Prosecutor's File #

Alias 1

Alias 2

Alias 3

I, ___________________________________, Prosecuting/Deputy Prosecuting Attorney, __________ Judicial District, in the name of the State of Arkansas, ____________________________ County, accuse the above named defendant of the following crime(s):

Code #

Offense

A/S/C

Offense Date

Counts

F/M

Class

Committed as follows: Count # __________ Offense ______________________________________________________________ The defendant on or about ______________________ (date), in _________________________ County, Arkansas did unlawfully

against the peace and dignity of the State of Arkansas.

444444444444444444444444444444444444444444444444444444444444444444444444444444444444

Committed as follows: Count # __________ Offense ____________________________________________________________ The defendant on or about ______________________ (date), in _________________________ County, Arkansas did unlawfully

against the peace and dignity of the State of Arkansas.

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Committed as follows: Count # __________ Offense ____________________________________________________________ The defendant on or about ______________________ (date), in _________________________ County, Arkansas did unlawfully

against the peace and dignity of the State of Arkansas.

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Entered this ______ day of ________________________, 20_____. ______________________________________, Prosecuting Attorney.

By _______________________________________ Prosecuting/Deputy Prosecuting Attorney