EFTA00179496





<table border="1"><tr><td colspan="5">Co-Defendant(Last, First,Middle</td><td>Sex:</td><td>Race:</td><td>DOB</td></tr><tr><td>Arrested□</td><td>At Large□</td><td>Capias/Warrant Requested□</td><td>Felony□</td><td></td><td>Misdemeanor□</td><td></td><td>Juvenile□</td></tr><tr><td colspan="5">Co-Defendant(Last,First,Middle</td><td>Sex:</td><td>Race:</td><td>DOB</td></tr><tr><td>Arrested□</td><td>At Large□</td><td>Capias/Warrant Requested□</td><td>Felony□</td><td></td><td>Misdemeanor□</td><td></td><td>Juvenile□</td></tr></table>

<table border="1"><tr><td>STATUTE(subsec.)/ORD #</td><td>DV</td><td>CP</td><td>CHARGE STATUS</td><td>BOND SET</td><td>CHARGE</td><td>TRAFFIC CITATION #</td><td>DRUG ACT/TYPE</td></tr><tr><td>948.06</td><td>-</td><td>-</td><td>F</td><td></td><td>VOP FELONY PETIT THEET</td><td>-</td><td>-</td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td></td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr></table>

<table border="1"><tr><td>DESCRIPTION/AMOUNT PER UNIT</td><td>RECOVERED BY</td><td>GIVEN TO</td><td>PRESENT LOCATION</td></tr><tr><td>N</td><td></td><td>N</td><td></td></tr><tr><td></td><td>$\textcircled{1}$</td><td></td><td>E</td></tr></table>

You need not appear in Court, but must comply with instructions on Reverse Side. □

COURTHOUSE TOWER ANNEX, 801 E. TWIGGS STREET

(Corner of Jefferson & Twiggs Street), TAMPA, FLORIDA 33602

COURT INFORMATION: You must appear in County Court at the:

COUNTY OFFICE BUILDING, MICHIGAN & REYNOLDS STREET □

PLANT CITY. FLORIDA 33566



COURTROOM #



ON



,20 ___ , AT



I agree to appear at the time and place designated above to answer for the offense(s) charged or to pay the fine subscribed. I understand that if I willfully fail to appear before the Court as required by the Notice to Appear, I may be held in contempt of Court and a warrant for my arrest shall be issued. You may also be charged with the crime of Failure to Appear, F.S. 843.15. I certify that my address as listed above is correct and I further understand that I have a continuing duty to advise the Court of any changes in my address as set forth above.

Signature of Defendant/Avenue

| Parent or Guardian | W. Juvenile |
| :--- | :--- |