Wisconsin Affidavit Of Court Officer

							                                                                                                                            For Official Use
STATE OF WISCONSIN, CIRCUIT COURT,                                                                  COUNTY

                                                                                  Affidavit of
                                                                                 Court Officer

                                                                  Case No.
                         Name of Defendant




           Under oath, I state:

           I, a court officer, make this affidavit on information and belief. The defendant was personally

           served with a copy of the summons/citation on (date)                                                   .

           The arresting officer:

                       personally observed the defendant commit the violation.

                       based the citation on information provided by a reliable informant.

           The defendant failed to appear in court as summoned.




Subscribed and sworn to before me
on
                                                                                              Signature of Court Officer


                Judge/Commissioner/Clerk/Deputy Clerk




GF-143, 11/99 Affidavit of Court Officer                                                                              §968.04(3)(a), Wisconsin Statutes

                               This form shall not be modified. It may be supplemented with additional material.