Full Legal Name of Business or Person
on
Date
Drawn by:
Name and Address of Bank
presented to:
DISTRICT COURT OF MARYLAND FOR
LOCATED AT (COURT ADDRESS)
DISTRICT COURT CASE NUMBER
(City/County)
RELATED CASES:
COMPLAINANT/APPLICANT |
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DEFENDANT |
Printed Name |
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Printed Name |
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Address |
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Address |
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City, State, Zip |
Telephone |
City, State, Zip |
Telephone |
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CC# |
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Agency, Sub-agency, and I.D. # |
(Officer Only) |
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DEFENDANT'S DESCRIPTION: Driver's License # |
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Sex |
Race |
Ht |
Wt |
Hair |
Eyes |
Complexion |
Other |
D.O.B |
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ID |
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APPLICATION FOR STATEMENT OF CHARGES FOR BAD CHECK
(CRIMINAL LAW § 8-103)
I, the undersigned, apply for statement of charges or warrant which may lead to the arrest of the above named
Defendant because on or about |
at |
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Date |
Place |
the above named Defendant did unlawfully obtain |
Property or Services |
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having a value of $ |
from |
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Full Legal Name of Business or Person |
by issuing |
passing a certain bad check dated: |
Check No: |
ACCOUNT NO: on the:
in the sum of $
Payable immediately to:
Above named Defendant intended or believed that payment would be refused.
Said check was returned from bank marked:
CERTIFIED MAIL SENT: |
RETURNED MARKED: |
Date |
|
(Continued on attached |
pages) (DC-CR-044A) |
I solemnly affirm under the penalties of perjury that the contents of this Application are true to the best of my knowledge, information, and belief.
Printed Name
I have read or had read to me and I understand the Notice on the back of this form.
Date |
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Applicant's Signature |
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Printed Name |
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Subscribed and sworn to before me this |
day of |
, |
at |
AM |
PM |
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Month |
Year |
Time |
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Judge/Commissioner |
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I.D. Number |
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I understand that a charging document will be issued and that I must appear for trial
Date
when notified by the Clerk, at the court location shown at the top of this form.
Time |
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I have advised applicant of shielding right. |
Applicant declines shielding. |
I declined to issue a charging document because of lack of probable cause.
Date
DC-CR-044 (Rev. 08/2017)
NOTICE TO APPLICANT FOR A CHARGING DOCUMENT
You are making an application for a charging document which may lead to the arrest and detention of the individual you are charging. If, as result of your application, the commissioner issues a charging document, it will be impossible for the commissioner to withdraw the document. The charge may only be disposed of by trial or by action of the State's Attorney.
You will be required to appear at the trial as a witness. Failure to appear on the date set by the court could result in your arrest for failure to obey a court order.
The application which you are filing is being filed under oath. Criminal Law Article § 9-503 of the Annotated Code of Maryland provides that any person who makes a false statement or report of a crime or causes such a false report or statement to be made to any official or agency of this State, knowing the same, or any material part thereof, to be false and with intent that such official or agency investigate, consider or take action in connection with such statement or report, shall be subject to a fine of not more than $500, or be imprisoned not more than six months, or be both fined and imprisoned, in the discretion of the court.
It is essential that you furnish as much information as possible about the offense. To be sure that your information is adequate, your application should clearly state the following:
1.WHO?
Identify the accused, (the person about whom you are complaining), and identify yourself.
2.WHEN?
The time, day, month and year of the offense.
3.WHERE?
The exact address and street, the city, county and state where the offense happened. Also state whether the offense happened in a private home or in some public place.
4.WHAT?
State exactly what was done to you. For example: if property was taken, describe it and its value; or, if property was damaged or destroyed, indicate the original cost of the item or its replacement value. If you do not know the exact value, estimate it as accurately as possible.
5.WHY?
The facts you give must show the accused intended to commit a criminal act.
6.HOW?
How the accused committed the offense. For example, if you were physically assaulted, were you struck with a fist, a flat hand, kicked, or pushed, or were you struck with an object, such as a club or pipe, etc.? If property was taken, how did the accused get it? If it was destroyed or damaged, how did the accused cause the damage?
7.At the top of the application, you will notice a space marked "DESCRIPTION." The information in this space refers to the accused. It is important that you furnish as much of this as possible so that the accused may be easily identified.
8.Check only one (Issuing OR Passing). These are defined as:
a)Check "Issuing" if the Defendant gave you a check from the Defendant's own account. The act of a check-writer who (1) delivers the check to a person who acquires a right against the writer' or (2) writes the check intending that it be delivered to a person who would acquire a right to the check-writer and the check is delivered to that person.
b)Check "Passing" if the Defendant gave you a third-party check signed over to you. Delivering the check by a payee, holder, or bearer of the check, if: (1) the check was, or purports to have been written by a person other that the person delivering the check; and (2) delivery was made to a third person who acquires a right to the check.
If you need further assistance in completing your application, please feel free to ask the commissioner.
You are entitled to request that address and telephone number of a victim, complainant, or a witness be considered for shielding at the filing of this application.
NOTICE: Remote access to the name, address, telephone number, date of birth, e-mail address, and place of employment of a victim or non-party witness is blocked. (Md. Rule 16-910)
