IN THE CIRCUIT COURT, SIXTH JUDICIAL CIRCUIT
IN AND FOR PASCO AND PINELLAS COUNTIES, FLORIDA
ADMINISTRATIVE ORDER NO. 2014-058 PI-CIR
RE: AMENDED ORDER AUTHORIZING USE OF A REVISED COMPLAINT/ARREST
AFFIDAVIT
Administrative Order 2014-013 revised the Adult and Juvenile Complaint/Arrest Affidavit
forms that are the official complaint/arrest instruments within Pinellas County where an arrest is
involved. Administrative Order 2014-039 directed all agencies authorized to issue complaint/arrest
affidavits in County or Circuit Court to begin exclusively using the new forms at 9:00 p.m. on July
2, 2014, the date view only mode was initiated in Pinellas County’s Consolidated Justice
Information System (CJIS) for the transition to the new case management system, Odyssey.
It is necessary to amend Administrative Order 2014-013 to clarify that all law enforcement
personnel are to complete a separate affidavit for each charge for both adult and juvenile arrests in
the Virtual Inmate Processing and Reporting System (VIPAR). Amended Adult and Juvenile
Complaint/Arrest Affidavit forms are forthcoming to comply with this directive.
In accordance with Article V, section 2, Florida Constitution, Rule of Judicial
Administration 2.215, and § 43.26, Florida Statutes,
IT IS ORDERED:
Paragraph 2 of Administrative Order 2014-013 is amended as follows:
2. Complaint/Arrest Form
a. The Adult and Juvenile Complaint/Arrest Affidavit forms contained in Attachment B have
been approved by the Court as the official complaint/arrest instruments within the
jurisdiction of Pinellas County where an arrest is involved. All agencies in Pinellas County
that are authorized to issue complaint/arrest affidavits must exclusively use the forms
contained in Attachment B in the manner specified in subsection b.
b. Beginning September 22, 2014, at 8:00 a.m., all authorized agencies must use a separate
affidavit for each charge for adult and juvenile arrests. Law enforcement personnel may not
input multiple charges on the same affidavit. On the same date and time, the Pinellas County
Sheriff’s Office is instructed to disable the feature in VIPAR that allows law enforcement
personnel to input multiple charges in a single affidavit.
All other provisions of Administrative Order No. 2014-013 remain in full force and effect.
Administrative Order 2014-039 is hereby rescinded.
DONE AND ORDERED in Chambers, Clearwater, Pinellas County, Florida this _____ day of
September, 2014.
ORIGINAL SIGNED ON SEPTEMBER 19, 2014
BY J. THOMAS MCGRADY, CHIEF JUDGE
Attachment B: Adult Complaint/Arrest Affidavit form
Juvenile Complaint/Arrest Affidavit form
cc: All Pinellas Judges
The Honorable Bernie McCabe, State Attorney
The Honorable Bob Dillinger, Public Defender
The Honorable Ken Burke, Clerk of the Circuit Court, Pinellas County
The Honorable Bob Gualtieri, Sheriff, Pinellas County
Gay Inskeep, Trial Courts Administrator
Ngozi Acholonu, Assitant Regional Counsel
Myriam Irizarry, Chief Deputy Director, Pinellas County Clerk’s Office
Tonya Rainwater, Justice CCMS Project Sponsor
Ed Hansen, CJIS Coordinator
Law Enforcement Agencies, Pinellas County
Bar Associations, Pasco and Pinellas Counties
Law Libraries, Pasco and Pinellas Counties
COMPLAINT/ARREST AFFIDAVIT – CIRCUIT/COUNTY COURT – PINELLAS COUNTY, FLORIDA
PAGE ONE OF Pages See Supplemental for Additional Charges and/or Additional Co-Defendants
OBTS #
REPORT #
DOCKET #
Person ID
SSN#
Charge Description Felony Misdemeanor Warrant Traffic Ordinance
Seq #
Traffic Citation # (if any)
Court Case #
Main Charge (if multiple charges) or Charge
1
Defendant’s Name (Last, First, Middle)
DOB
Sex
Race
Ht
Wt
Hair
Eyes
Skin
Alias
DL #
State
Scars/Marks/Tattoos/Physical Features
Local Address (Street, City, State, Zip Code)
Telephone
Place of Birth
Citizenship
Permanent Address (Street, City, State, Zip Code)
Telephone
Employed by / School
Weapon Seized Type
Yes No
Indication of Y N UNK
Drug Influence
Indication of Mental Y N UNK
Health Issues
Indication of Y N UNK
Alcohol Influence
Co-Defendant’s Name (Last, First, Middle)
DOB
Sex
Race
In Custody Yes No
Felony Misdemeanor
Co-Defendant’s Name (Last, First, Middle)
DOB
Sex
Race
In Custody Yes No
Felony Misdemeanor
The undersigned swears that he/she has reasonable grounds to believe that the above named defendant on the day of , ,
at approximately a.m. p.m., at ,in Pinellas County did:
Contrary to Florida Statute/Ordinance .
ARREST DATE: Time a.m. p.m. Aggravating/Mitigating Factors .
Booking Officer: Amount of Bond Bond Out Date Time a.m. p.m.
Victim Notified of Advisory? Yes No Injuries to Victim? Yes No Medical Treatment to Victim? Yes No
The Court reviewed this complaint and finds there: is probable cause is not probable cause to detain defendant Bond Action, if any: .
The probable cause determination is passed for: 24 Hrs 24 Hrs on showing of extraordinary circumstances
If Additional Charge: Felony Misdemeanor Warrant Traffic Ordinance
Sequence #
Traffic Citation # (if any)
Charge Description
2
The undersigned swears that he/she has reasonable grounds to believe that the above named defendant on the day of , ,
at approximately a.m. p.m., at ,in Pinellas County did:
Contrary to Florida Statute/Ordinance .
ARREST DATE: Time a.m. p.m. Aggravating/Mitigating Factors .
Booking Officer: Amount of Bond Bond Out Date Time a.m. p.m.
Victim Notified of Advisory? Yes No Injuries to Victim? Yes No Medical Treatment to Victim? Yes No
The Court reviewed this complaint and finds there: is probable cause is not probable cause to detain defendant Bond Action, if any: .
The probable cause determination is passed for: 24 Hrs 24 Hrs on showing of extraordinary circumstances
COCRR59 (Revised 02/14) COPIES TO: COURT JAIL STATE ATTORNEY LAW ENFORCEMENT AGENCY DEFENDANT
Pursuant to F.S. 92.525 and under penalty of perjury, I declare that I have
read the foregoing document and that the facts in it are true.
Declarant Signature Agency
Printed Name Declarant ID#
REQUEST FOR INVESTIGATIVE COSTS, F.S. 938.27(1)
DATE OFFICER HOURS X PAY RATE OR COST
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
OTHER – Describe __________________________ ___________________________ .
Continuation sheet ______Yes ______ No TOTAL $_____________
ADULT / JUVENILE COMPLAINT/ARREST AFFIDAVIT – CIRCUIT/COUNTY COURT -PINELLAS COUNTY, FLORIDA
SUPPLEMENTAL COMPLAINT SHEET FOR ADDITIONAL CHARGES OR CO-DEFENDANTS
PAGE OF
Defendant/Child Name (Last, First, Middle)
Defendant/Child Person ID#
Court Case #
ADDITIONAL CHARGE(S)
If Additional Charge: Felony Misdemeanor Warrant Traffic Ordinance JUVENILE
Sequence #
Traffic Citation # (if any)
Charge Description
The undersigned swears that he/she has reasonable grounds to believe that the above named defendant on the day of , ,
at approximately a.m. p.m., at ,in Pinellas County did:
Contrary to Florida Statute/Ordinance .
ARREST DATE: Time a.m. p.m. Aggravating/Mitigating Factors .
Booking Officer: Amount of Bond Bond Out Date Time a.m. p.m.
Victim Notified of Advisory? Yes No Injuries to Victim? Yes No Medical Treatment to Victim? Yes No
If Adult: The Court reviewed this complaint and finds there: is probable cause is not probable cause to detain defendant Bond Action, if any: .
The probable cause determination is passed for: 24 Hrs 24 Hrs on showing of extraordinary circumstances
If Additional Charge: Felony Misdemeanor Warrant Traffic Ordinance JUVENILE
Sequence #
Traffic Citation # (if any)
Charge Description
The undersigned swears that he/she has reasonable grounds to believe that the above named defendant on the day of , ,
at approximately a.m. p.m. at ,in Pinellas County did:
Contrary to Florida Statute/Ordinance . See Supplemental for Additional Charges
ARREST DATE: Time a.m. p.m. Aggravating/Mitigating Factors .
Booking Officer: Amount of Bond Bond Out Date Time a.m. p.m.
Victim Notified of Advisory? Yes No Injuries to Victim? Yes No Medical Treatment to Victim? Yes No
If Adult: The Court reviewed this complaint and finds there: is probable cause is not probable cause to detain defendant Bond Action, if any: .
The probable cause determination is passed for: 24 Hrs 24 Hrs on showing of extraordinary circumstances
ADDITIONAL CO-DEFENDANTS See Supplemental for Additional Co-Defendants
Co-Defendant’s Name (Last, First, Middle)
Charge Sequence(s)
DOB
Sex
Race
CUSTODY STATUS
In Custody Yes No
Felony Misdemeanor
In Custody Yes No
Felony Misdemeanor
In Custody Yes No
Felony Misdemeanor
COPIES TO: COURT JAIL STATE ATTORNEY LAW ENFORCEMENT AGENCY DEPT OF JUVENILE JUSTICE DEFENDANT
Created 02/14
Pursuant to F.S. 92.525 and under penalty of perjury, I declare that I have read the foregoing document and that the facts in it are true.
Declarant Agency
Printed Name Declarant ID
Defendant Court Case No:
ADVISORY AND SOLVENCY HEARING
The above named Defendant came before me for Advisory and Solvency hearing and was advised by me of the charge(s)
against him; his right to remain silent; that any statements by him may be used against him; his right to counsel, and, if he is
financially unable to afford counsel, that counsel forthwith will be appointed; of his right to communicate with his counsel,
family or friends, and that reasonable implementation will be afforded him to contact the foregoing.
I FURTHER CERTIFY THAT:
❒ A. Defendant has advised the Court that he has retained counsel or will retain counsel.
❒ B. The Court investigated Defendant’s solvency and found the Defendant financially able to secure counsel.
❒ C. The Court investigated Defendant’s solvency and provisionally appointed the Public Defender.
❒ D. The Defendant waived the right to counsel at the first appearance only.
DATE AND TIME JUDGE
❒ I hereby waive the right to counsel at the first appearance only.
❒ I, having been found solvent and financially able to secure counsel, hereby waive counsel until my attorney files
an appearance in this case or until I file a written request for a review of my solvency and ability to secure counsel.
DEFENDANT’S SIGNATURE
Thumb Print
I HEREBY acknowledge receipt of a copy of the foregoing Complaint and Advisory.
DEFENDANT’S SIGNATURE DEFENDANT’S ATTORNEY’S SIGNATURE DATE
COCR59(B) (Revised 02/14) CoCr(a, B, c, d)
VICTIM NOTIFICATION INFORMATION
Defendant’s Name Court Case #
1. Victim’s Name Race Sex DOB
Social Security # Party ID Person ID
Address
City State Zip
Home Telephone-Work Telephone Email
Other Contact Telephone
(Cell Phone, Relative, Neighbor)
Other Address for Victim
Is the victim a witness ❒ Was Victim Rights brochure given? ❒ Is the victim in a hospital? ❒
Name of Hospital?
2. Victim’s Name Race Sex DOB
Social Security # Party ID Person ID
Address
City State Zip
Home Telephone-Work Telephone Email
Other Contact Telephone
(Cell Phone, Relative, Neighbor)
Other Address for Victim
Is the victim a witness ❒ Was Victim Rights brochure given? ❒ Is the victim in a hospital? ❒
Name of Hospital?
3. Victim’s Name Race Sex DOB
Social Security # Party ID Person ID
Address
City State Zip
Home Telephone-Work Telephone Email
Other Contact Telephone
(Cell Phone, Relative, Neighbor)
Other Address for Victim
Is the victim a witness ❒ Was Victim Rights brochure given? ❒ Is the victim in a hospital? ❒
Name of Hospital?
4. Victim’s Name Race Sex DOB
Social Security # Party ID Person ID
Address
City State Zip
Home Telephone-Work Telephone Email
Other Contact Telephone
(Cell Phone, Relative, Neighbor)
Other Address for Victim
Is the victim a witness ❒ Was Victim Rights brochure given? ❒ Is the victim in a hospital? ❒
Name of Hospital?
CoCr59C (Revised 02/14) CoCr59(a,b,C,d)
J-007MasFil/Clk-Forms/Juv (Revised 02/14)
Page One of _____Pages See Supplemental for Additional Charges and/or Additional Co-Defendants
OBTS #
Law Enforcement Report # Docket #
Date Arrested Date Referred
Child: Admits Denies Misdemeanor Felony Ordinance Seq# Court Case #
Alleged Main Charge (if multiple charges) or Charge
1
Child’s Name (Last, First, Middle)
Person ID SSN#
Alias DOB Sex
Race
HT
WT
Hair
Eyes
Skin
DL # / State ID (if any)
State School Attends Grade
Local Address (Street, City, State, Zip Code)
Home or Contact Telephone
Father Name
Address (Street, City, Zip Code)
Mother Name
Address (Street, City, Zip Code)
Physical Custodian /Other - Name
Address (Street, City, Zip Code)
Co-Defendant (Last, First, Middle)
Co-Defendant is:
Child Adult
The undersigned swears that he/she has reasonable grounds to believe that the above named defendant on the day of , ,
at approximately a.m. p.m., at ,in Pinellas County did:
Contrary to Florida Statute/Ordinance .
Additional Charge (if any) SEQ # Child: Admits Denies
Alleged Charge (if Multiple Charges)
2
Misdemeanor Felony Ordinance
The undersigned swears that he/she has reasonable grounds to believe that the above named defendant on the day of , ,
at approximately a.m. p.m., at ,in Pinellas County did:
Contrary to Florida Statute/Ordinance .
)
JUVENILE COMPLAINT/ARREST AFFIDAVIT – CIRCUIT COURT – UNIFIED FAMILY COURT, IN AND FOR PINELLAS COUNTY, FLORIDA
COURT COPY
Pursuant to F.S. 92.525 and under penalty of perjury, I declare that I have
read the foregoing document and that the facts in it are true.
Declarant Agency
Printed Name Declarant ID#
Request for Investigative Costs, F.S. 938.27(1)
Date Officer Hours X Pay Rate or Cost
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Other – Describe _________________________________________________________.
Continuation Sheet Y__ N__ Total $____________________
J-007MasFil/Clk-Forms/Juv (Revised 02/14)
Page One of _____Pages See Supplemental for Additional Charges and/or Additional Co-Defendants
OBTS
#
Law Enforcement Report # Docket #
Date Arrested Date Referred
Child: Admits Denies Misdemeanor Felony Ordinance Seq# Court Case #
Alleged Main Charge (if multiple charges) or Charge
1
Child’s Name (Last, First, Middle)
Person ID SSN#
Alias DOB Sex
Race
HT
WT
Hair
Eyes
Skin
DL # / State ID (if any)
State School Attends Grade
Local Address (Street, City, State, Zip Code)
Home or Contact Telephone
Father Name
Address (Street, City, Zip Code)
Mother Name
Address (Street, City, Zip Code)
Physical Custodian /Other - Name
Address (Street, City, Zip Code)
Co-Defendant (Last, First, Middle)
Co-Defendant is:
Child Adult
The undersigned swears that he/she has reasonable grounds to believe that the above named defendant on the day of , ,
at approximately a.m. p.m., at ,in Pinellas County did:
Contrary to Florida Statute/Ordinance_________________________
Additional Charge (if any) SEQ # Child: Admits Denies
Alleged Charge (if Multiple Charges)
2
Misdemeanor Felony Ordinance
The undersigned swears that he/she has reasonable grounds to believe that the above named defendant on the day of , ,
at approximately a.m. p.m., at ,in Pinellas County did:
Contrary to Florida Statute/Ordinance .
Pursuant to F.S. 92.525 and under penalty of perjury, I declare that I have
read the foregoing document and that the facts in it are true.
Declarant Agency
Printed Name Declarant ID#
Request for Investigative Costs, F.S. 938.27(1)
Date Officer Hours X Pay Rate or Cost
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Other – Describe ________________________________________________________ .
Continuation Sheet Y__ N__ Total $___________________
JUVENILE COMPLAINT/ARREST AFFIDAVIT – CIRCUIT COURT – UNIFIED FAMILY COURT, IN AND FOR PINELLAS COUNTY, FLORIDA
STATE ATTORNEY COPY
VICTIM NOTIFICATION INFORMATION
Defendant’s Name Court Case #
1. Victim’s Name Race Sex DOB
Social Security # Party ID Person ID
Address
City State Zip
Home Telephone-Work Telephone Email
Other Contact Telephone
(Cell Phone, Relative, Neighbor)
Other Address for Victim
Is the victim a witness ❒ Was Victim Rights brochure given? ❒ Is the victim in a hospital? ❒
Name of Hospital?
2. Victim’s Name Race Sex DOB
Social Security # Party ID Person ID
Address
City State Zip
Home Telephone-Work Telephone Email
Other Contact Telephone
(Cell Phone, Relative, Neighbor)
Other Address for Victim
Is the victim a witness ❒ Was Victim Rights brochure given? ❒ Is the victim in a hospital? ❒
Name of Hospital?
3. Victim’s Name Race Sex DOB
Social Security # Party ID Person ID
Address
City State Zip
Home Telephone-Work Telephone Email
Other Contact Telephone
(Cell Phone, Relative, Neighbor)
Other Address for Victim
Is the victim a witness ❒ Was Victim Rights brochure given? ❒ Is the victim in a hospital? ❒
Name of Hospital?
4. Victim’s Name Race Sex DOB
Social Security # Party ID Person ID
Address
City State Zip
Home Telephone-Work Telephone Email
Other Contact Telephone
(Cell Phone, Relative, Neighbor)
Other Address for Victim
Is the victim a witness ❒ Was Victim Rights brochure given? ❒ Is the victim in a hospital? ❒
Name of Hospital?
J-007MasFil/Clk-Forms/Juv (Revised 02/14)
J-007MasFil/Clk-Forms/Juv (Revised 02/14)
Page One of _____Pages See Supplemental for Additional Charges and/or Additional Co-Defendants
OBTS #
Law Enforcement Report # Docket #
Date Arrested Date Referred
Child: Admits Denies Misdemeanor Felony Ordinance Seq# Court Case #
Alleged Main Charge (if multiple charges) or Charge
1
Child’s Name (Last, First, Middle)
Person ID SSN#
Alias DOB Sex
Race
HT
WT
Hair
Eyes
Skin
DL # / State ID (if any)
State School Attends Grade
Local Address (Street, City, State, Zip Code) Home or Contact Telephone
Father Name
Address (Street, City, Zip Code)
Mother Name
Address (Street, City, Zip Code)
Physical Custodian /Other - Name
Address (Street, City, Zip Code)
Co-Defendant (Last, First, Middle)
Co-Defendant is:
Child Adult
The undersigned swears that he/she has reasonable grounds to believe that the above named defendant on the day of , ,
at approximately a.m. p.m., at ,in Pinellas County did:
Contrary to Florida Statute/Ordinance_________________________
Additional Charge (if any) SEQ # Child: Admits Denies
Alleged Charge (if Multiple Charges)
2
Misdemeanor Felony Ordinance
The undersigned swears that he/she has reasonable grounds to believe that the above named defendant on the day of , ,
at approximately a.m. p.m., at ,in Pinellas County did:
Contrary to Florida Statute/Ordinance .
JUVENILE COMPLAINT/ARREST AFFIDAVIT – CIRCUIT COURT – UNIFIED FAMILY COURT, IN AND FOR PINELLAS COUNTY, FLORIDA
DEPARTMENT OF JUVENILE JUSTICE COPY
Pursuant to F.S. 92.525 and under penalty of perjury, I declare that I have
read the foregoing document and that the facts in it are true.
Declarant Agency
Printed Name Declarant ID#
Request for Investigative Costs, F.S. 938.27(1)
Date Officer Hours X Pay Rate or Cost
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Other – Describe _________________________________________________________ .
Continuation Sheet Y__ N__ Total $____________________
