REQUEST FOR CRIMINAL COMPLAINT
To any Justice or Clerk-Magistrate of the Housing
Court:
_________________________________________________________________
on behalf of the Commonwealth, on oath complains that:
Name and Address of Defendant: Statute violated:
_____________________________ _________________________
_____________________________
_____________________________ Possible penalties:
_____________________________ _________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
and did so willfully, intentionally, recklessly or repeatedly.
__________________________ ______________________________
Date: Complainant:
Assigned for hearing on _____________________,200__, at _________
o’clock.
On hearing (Complainant)(Defendant)(both parties)(neither party),
I find no probable cause for the Complaint. Process shall not
issue.
On hearing (Complainant)(Defendant)(both parties)(neither party),
and Complainant having sworn or affirmed that the Complaint is
true upon information and belief, I find probable cause, and
order summons to issue returnable ____________________________.
________________________ _________________________________
Date: Clerk-Magistrate