PETITION FOR REQUISITION

(PA Type 5-November 2017)

TO THE HONORABLETom Wolf, Governor of the Commonwealth of Pennsylvania.

THE PETITION OF(name), District Attorney of (name)County, Commonwealth of Pennsylvania, respectfully represents:

  1. That the full name, properly spelled, of the person for whom extradition is asked is (include all aliases - an example: Joseph W. Black a.ka. Joseph Black).
  1. That your petitioner verily believes said person is now in (name of city), (name of county), State of (name), which belief is founded on information from (asylum county’s contact name, office, and phone number who provided you the information).

Or Alternative Paragraph: That your petitioner verily believes said person was released on his own recognizance (or bail)(or bond) in the (name of city), (name of county), State of (name), and can now be found at the current address of (address), which belief is founded on information from (asylum county’s contact name, office, and phone number who provided you the information).

  1. That said person having pled or was found guilty and sentenced as appears by the annexed certified copy of Guilty Plea Agreement, Guilty Pleas Colloquy, Guilty Plea Disposition,Guilty Disposition, Judgment of Sentence or Abstract of Judgment, and Warrant of the crime(s) of (list name of crime(s))committed in the County of(name), Commonwealth of Pennsylvania, on or about the (date) day of (month) 20 (year) (or between month/year to month/year); (or on or about month and year) (or list multiple dates), has (escaped from confinement), (or broken the terms of his/her)(parole/probation), (sentence), (recognizance) or (bail) in that he/she (failed to comply with the rules and regulations of the (name of county)Adult Probation/Parole Office) (or state other reason(s));
  1. That said person has fled the jurisdiction of the Commonwealth of Pennsylvania; and

(Or Alternative Paragraph: That said person was permitted to reside in the State of (name) while under the supervision of the (name of county) County Adult Probation/Parole Department; and

  1. That no delay has occurred in the petition for requisition once the said person was located;

Or Alternative Paragraph: That any delay, which has occurred in the petition for requisition was unavoidable because (list reason(s));

  1. The name of the agent(s) proposed is/are (Sheriff Nicholas Chimenti Jr. and/or designated agent(s) of theDauphin County Sheriff’s Office),(and/orJoe Black and/or designated agent(s) of the Security Service Transport). The person(s) named as agent(s) is/are a law enforcement officer or a probation, parole or corrections officer, and that he/she (they) has (have) no private interest in the arrest of said person;
  1. That no former petition(s) for a requisition for said person, growing out of the same transaction, has been made;

(Or Alternative Paragraph: That one former petition for a requisition for said person, growing out of the same transaction, has been made to the County of (name) in the State of (name), and that extradition was never executed due to (state reason(s));

  1. That this petition is not made for the purpose of enforcing the collection of a debt, or for any private purpose whatever, and if the requisition now applied for be granted, the criminal proceedings shall not be used for any such object; and
  1. That I am satisfied that the expenses attending the extradition of said person shall be charged upon this county, or as otherwise provided by law, and I will take the proper means to obtain them.

WHEREFORE, your petitioner prays that a requisition may issue, directed to the Governor of the saidState of(name) for the arrest and delivery of the said person, and that(Sheriff Nicholas Chimenti Jr. and/or designated agent(s) of theDauphin County Sheriff’s Office), of the County of (name), Commonwealth of Pennsylvania, (and/or Joe Black and/or designated agent(s) of the Security Service Transport), may be appointed agent(s) on behalf of said Commonwealth to go after, receive and return the said person to the said County of (name) for revocation of probation/parole.

COMMONWEALTH OF PENNSYLVANIA

SS

COUNTY OF (Name)(Type Name of District Attorney Here)

being duly sworn (or affirmed) deposes and says that the facts contained in the foregoing petition are true and correct to the best of my information, knowledge and belief.

______

(Signature of District Attorney)

Sworn to (or affirmed) and subscribed before me

this ______day of______A.D., 20___

______

Signature and title of one of the following:

Clerk of the Court of Common Pleas

Prothonotary of the Court of Common Pleas

Director of Department of Court Records

Manager, Clerk of the Court of Common Pleas