violation of court order report form - Redding Police Department

VIOLATION OF COURT ORDER REPORT FORMCheck Appropriate Court Order:( ) Restraining Order( ) Custody/Visitation Order (information only)( ) Copy of Court Order Attached (optional)PLEASE TYPE OR WRITE LEGIBLYRPD Case No._____________Date of Report_____________Shasta County Superior Court File No: __________________Presiding Judge_________________REPORTING PARTY:Name:___________________________________Date of Birth:____________________________Address:________________________________________________________________________(City) (State) (Zip Code)Signature:_______________________________________Phone:_________________________________PERSON IN VIOLATION:Name:____________________________Date of Birth:___________________Phone No.:_____________Address:________________________________________________________________________(City) (State) (Zip Code)CHILDREN INVOLVED: (If Applicable)Name:________________________________________________Date of Birth:_____________________Name:________________________________________________Date of Birth:_____________________Name:________________________________________________Date of Birth:_____________________Name:________________________________________________Date of Birth:_____________________Address:________________________________________________________________________(City) (State) (Zip Code)Date and Time of Violation:_______________________________________________________________Location of Violation (Address):___________________________________________________________Approving Supervisor:____________________________District Attorney:_________________________Official Use OnlyC II__________FBI_________CDL_______________EYE_______HAI_______HGT_______WGT______Status of Violation: Arrested O/R Released Not Contacted CLETS Entry

Any additional information you feel is important (include witnesses’ addresses and phone numbers).____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________It is against the law to report a criminal offense knowing the report to be false. Penal Code 148.5AFFIRMATION: I, the undersigned, do hereby affirm, to the best of my knowledge, that the informationon this form is true and correct.Signature: _____________________________________________Date:________________________Police Department Use OnlyCase Number:_______________Date Received:_______________Investigator Assigned:______________Date Victim Contacted:_________________Follow-up:__________________________________________