STATE OF INDIANA)IN THE NOBLE
) SS:
COUNTY OF NOBLE)CAUSE NUMBER:
STATE OF INDIANA / ) / COUNT :)
-vs- / ) / AFFIDAVIT FOR PROBABLE CAUSE FOR
)
DEFENDANT'S NAME / ) / LEAVING THE SCENE OF AN ACCIDENT
D.O.B. / )
S.S.N. xxx-xx- / )
Officer’s Name / PE#says that he has good cause to believe that:
- The undersigned is a law enforcement officer with the Name of Department..
- On or about the Dateday of Month, 20Year, the undersigned investigated an automobile accident that occurred at the location ofClick here to enter text., Noble County, Indiana.
- The undersigned learned that the defendant had operated or was an occupant of a motor vehicle, to-wit: Describe Make and Model of Vehicle, and that said motor vehicle, Describe Brief of Accident..
- After the accident, the above named defendant failed to:
☐comply with I.C. 9-26-1-1.1(a)(1)(A), by immediately stopping the vehicle at the scene of the accident or as close to the accident as possible in a manner that does not obstruct traffic more than is necessary.
☐comply with 9-26-1-1.1(a)(2), by remaining at the scene of the accident until doing the following: (A) Give the driver’s name and address and the registration number of the vehicle the driver was drivingand (B) exhibits the driver’s license of the driver to the driver or occupant of or the person attending to any vehicle involved in the accident.
☐comply with I.C. 9-26-1-1.1(a)(3), in an accident involving the injury or death of a person, by providing reasonable assistance to each person injured in or entrapped by the accident; or immediately giving notice of the accident by the quickest means of communication to one (1) of the following: (A) the local police department if the accident occurs within a municipality: or (B) the office of the county sheriff or the nearest state police post if the accident occurs outside a municipality.
☐comply with I.C. 9-26-1-1.1(a)(4), in an accident involving a collision with an unattended vehicle or damage to property other than a vehicle, by taking reasonable steps to locate and notify the owner or person in charge of the damaged vehicle or property; or, if after reasonable inquiry the owner or person in charge cannot be found, by failing to contact a law enforcement officer or agency and provide the information required by this section.
- The undersigned believes the above facts to be true because:
☐ the undersigned personally observed the activity described herein.
☐the above was told to the undersigned by a sworn law enforcement officer, who the undersigned has been relied upon in the past for information and found the information to be credible with exemption.
☐ the above was told to the undersigned by the defendant, which was a statement made against the defendant’s penal interests. Further, defendant’s statements were corroborated by independent evidence, which was: Click here to enter text..
☐ the above was told to the undersigned by the apparent victim of a crime, who has no apparent motive to lie, and said information was given in a straightforward and non-evasive manner, which indicates that the information was credible.
☐ the above, or a portion of the above information, was told to the undersigned by witnesses who had the opportunity to observe what they described, those witnesses being: Names of Witnesses.
- The accident ☐ did ☐ did not result in bodily injury to another person. If injury, describe the injury and who was injured, and if it resulted in serious bodily injury.
I affirm, under the penalties for Perjury, as specified by I.C. 35-44.1-2-1, that the foregoing
representations are true.
Dated this Date day of Month, 20Year .
______
Officer/Affiant Officer’s Name / PE#
Leaving Scene (Attended Vehicle) - INFO (9-15)