DISTRICT ATTORNEY CASE SUMMARY AND FILING FORM

Agency Case #:	Filing Officer:	Associated Case #'s:	DATE SCREENED	SCREENING DA
Method of Contact: Choose an item.
Filing Officer Email: Click or tap here to enter text.	Filing Officer Phone Number:
Preferred Business Hours to Contact:
Additional Comments:

___________________________________________________________________________________________________________

DEFENDANT

Name:	DOB:
AKA:	Cell phone:
Home Address:	Home phone:
Work Address:	Work phone:
Race:	Sex:	Ethnicity:	Height:	Weight:	Hair/Eyes:
FBI:	SID:	SSN:	DL:

___________________________________________________________________________________________________________

CO-DEFENDANT(s)

Name:	DOB:	Date Filed:
Name:	DOB:	Date Filed:
Name:	DOB:	Date Filed:

CHARGE INFORMATION

COUNT I

OFFENSE:	CRS:	CLASS:
Date/time:	Location of Occurrence:
ELEMENT INFO:
Victim(s):
Property Items (stolen, pawned or other):
Weapon Used:
Drug as listed in C.R.S. :

COUNT II

OFFENSE:	CRS:	CLASS:
Date/time:	Location of Occurrence:
ELEMENT INFO:
Victim(s):
Property Items (stolen, pawned or other):
Weapon Used:
Drug as listed in C.R.S. :

COUNT III

OFFENSE:	CRS:	CLASS:
Date/time:	Location of Occurrence:
ELEMENT INFO:
Victim(s):
Property Items (stolen, pawned or other):
Weapon Used:
Drug as listed in C.R.S. :

COUNT IV

OFFENSE:	CRS:	CLASS:
Date/time:	Location of Occurrence:
ELEMENT INFO:
Victim(s):
Property Items (stolen, pawned or other):
Weapon Used:
Drug as listed in C.R.S. :

COUNT V

OFFENSE:	CRS:	CLASS:
Date/time:	Location of Occurrence:
ELEMENT INFO:
Victim(s):
Property Items (stolen, pawned or other):
Weapon Used:
Drug as listed in C.R.S. :

CASE SUMMARY

Victim Information:

Name:	DOB:
Home Address:	Home Phone:
Work Address:	Work Phone:
Restitution Amount:	Nature of Loss:	Cell Phone:

Name:	DOB:
Home Address:	Home Phone:
Work Address:	Work Phone:
Restitution Amount:	Nature of Loss:	Cell Phone:

Name:	DOB:
Home Address:	Home Phone:
Work Address:	Work Phone:
Restitution Amount:	Nature of Loss:	Cell Phone:

Officers Involved:

Deputy:	Department:	LCSO
Deputy:	Department:	LCSO
Deputy:	Department:	LCSO
Deputy:	Department:	LCSO
Deputy:	Department:	LCSO
Deputy:	Department:	LCSO
Deputy:	Department:	LCSO
Deputy:	Department:	LCSO
Deputy:	Department:	LCSO
Deputy:	Department:	LCSO

Witness Information:

Name:	DOB:
Home Address:	Home Phone:
Work Address:	Work Phone:
Information:	Cell Phone:

BOND REQUEST:$____________ REASON:_________ WARRANT ________ SUMMONS ________

Pending Charges; 2) Seriousness; 3) Prior Convictions; 4) Danger to Society; 5) Defendant out of Jurisdiction

RETURNABLE _________ CO-DEFENDANTS:____________________________________________

WILL EXTRADITE: YES: ______, NO: ______ CCIC ONLY ___, NCIC ___,

COLORADO ONLY:____, COLO. AND BORDERING STATES PLUS S.DAK: ____

P/H OFFICERS PHONE: PAGER:______________, HOME:___________, OFFICE: _______________

JUVENILE FILING INFORMATION

Child’s Name:	DOB:	AGE:
Home Address:	Home Phone:
School:	Grade:

Mother’s Name:	DOB:
Home Address:	Home Phone:
Work Address:	Work Phone:

Father’s Name:	DOB:
Home Address:	Home Phone:
Work Address:	Work Phone:

Guardian’s Name:	DOB:
Home Address:	Home Phone:
Work Address:	Work Phone:

Previous record of child:

Comments:

Recommendation of officer:

END OF FILING