GENERAL SESSIONS COURT OF ________________________________ COUNTY TENNESSEE
State of Tennessee vs. _____________________________________________________________________________
State Control # _____________________	_______________________ County Case # _____________________
Attorney for Defendant _______________________________		Address ________________________________________
Court Date _________________________________________		_______________________________________________
State, Deft. to ________________________ at _____________am/pm	Phone ___________________ DL# _______________________
State, Deft. to ________________________ at _____________am/pm	DOB ____________________ SSN#______________________
State, Deft. to ________________________ at _____________am/pm	Sex____ Race____ Ht____ Wt____ Hair____ Eyes __________
State, Deft. to ________________________ at _____________am/pm	Work _______________________________________________
State, Deft. to ________________________ at _____________am/pm	____________________________________________________

AFFIDAVIT OF COMPLAINT

	I, the affiant named below, after being sworn, state under oath that on or about _________________________________ in ____________________________ County, Tennessee, ____________________________________________________ committed the offense(s) of violation(s) of T.C.A. § ______________________________________________________________.  I further state under oath that the essential facts constituting the offense(s), the sources of my information and the reasons why this information is believable and reliable are as follows:

Affiant’s Signature: ______________________________________		Sworn to and subscribed before me on
Name (Printed): _________________________________________		_________________________________, 20____
Address (Printed): _______________________________________		________________________________________
									Judge/Clerk/Judicial Commissioner 
______________________________________________________
Phone Number: _________________________________________

PROBABLE CAUSE DETERMINATION
Based on the affidavit of complaint, I find there is probable cause to believe that on the date set forth above in_______________ County, Tennessee the defendant committed the offense(s) of violation(s) of TCA § ________________________________________________________
____________________________________________________________________________________________________________________
 (   ) Defendant given citation or arrested without warrant      (   ) Arrest warrant shall issue      (   ) Criminal summons shall issue

Date __________________________________		Judge/Clerk/Judicial Commissioner ______________________________________

NOTIFICATION OF POSSIBLE EXPUNCTION OF CRIMINAL RECORDS
If the defendant’s charge is dismissed; a no true bill is returned by the grand jury; the defendant is arrested and released without being charged with an offense; or the court enters a nolle prosequi in the defendant’s case, the defendant is entitled, upon petition by the defendant to the court having jurisdiction over the action and pursuant to T.C.A. § 40-32-101, to the removal and destruction of all public records relating to the case without cost to the defendant.