Circuit/ District Court

Rev. 07/05

CIRCUIT/ DISTRICT COURT

In the matter of a Fugitive from Justice

APPLICATION FOR APPOINTMENT

OF AN OFFICER TO RETURN A

FUGITIVE FROM JUSTICE

The undersigned, , states he is now and has been at all times herein mentioned the duly elected, qualified and acting Attorney of County, Kentucky; and he states that stands charged with the felony charge of , which is alleged to have been committed by him/her in County, Kentucky, in as is shown by affidavit and warrant filed and issued by the County Court.

The undersigned states that said is alleged and believed to be now in the State of ; and the undersigned states that in his opinion the ends of justice require the arrest and return of said to this state for trial on said charge(s); and this proceeding is not instituted to enforce a private crime.

The undersigned states that said has been arrested on the above stated charge in the State of , and has waived extradition proceedings, agreeing by writing , he may be returned to this state to answer said charge(s) without extradition proceedings being instituted or approved by the Governors of Commonwealth of Kentucky and the State of .

The undersigned states that is now a of County, Kentucky, and is the proper person(s) to go to and return said to this county on the above charge(s).

Wherefore the undersigned asks that this court designate as an officer(s) to return said fugitive to County, Kentucky, without benefit of any procedure incidental to extradition proceedings.

Rev. 07/05

COUNTY OF

The affiant, , states he is the Attorney of County, Kentucky, and he has read the foregoing application for return of a fugitive, and the allegations contained therein are true as he verily believes.

Commonwealth / CountyAttorney

Subscribed and sworn to before be this day of , 20 .

NOTARY PUBLIC

COUNTY, KENTUCKY

My commission expires

STATE OF KENTUCKY

COUNTY OF

I, , Clerk of the Court, do hereby certify the foregoing is a true and correct copy of an application for appointment of an officer(s) to return said from to this state as was duly filed of record in my office on .

In testimony whereof witness my hand and seal of office this day of .

Clerk, County

COUNTY

In the matter of a Fugitive from Justice

ORDER APPOINTING OFFICER TO RETURN

FUGITIVE TO THIS STATE

Verified application having been filed by the _____ Attorney of this county asking for the appointment of an officer(s) to return to this state to answer felony charge(s) of with which he/she stands charged in County, Kentucky, by warrant alleging said crime to have been committed in this county in and said application stating that said fugitive was in the State of and has waived extradition and has agreed voluntarily that he/she may be returned to the State of Kentucky to answer said charge(s); and the Court being duly advised. It is now ordered and adjudged that , an officer(s) of______County, Kentucky, be appointed and be designated as officer(s) to return said fugitive to this state without extradition proceedings; and be directed and authorized to go to State of and to receive and return said to ______County, Kentucky, as agent(s) of the Commonwealth of Kentucky, to answer to the charge(s) mentioned above.

This the day of 20 .

County / Judge Executive

STATE OF KENTUCKY

COUNTY OF

I, , Clerk of the Court, do hereby certify that the foregoing is a true and correct copy of an order of the County /Judge Executive appointing an officer(s) to return a fugitive to this state, which order was duly entered of record in my office and is found of record therein in Order Book .

In testimony whereof witness my hand and seal of office this day .

Clerk, County