Application for requisition. To the Honorable, _________, Governor of _________. The Prosecuting Attorney for the County of _________, State of _________, respectfully applies for your requisition upon the Governor of the State of _________ for the arrest and rendition of _________(state full name and any aliases of fugitive in capital letters), late of the above County and State and charged _________ in due form of law with having on _________[date] committed the crime of _________. The prosecuting attorney alleges that the accused (was) (was not) present in the State of _________ at the time of the offense above charged (if accused was present at time crime was committed, add "and that the accused then fled;" if accused is sought for acts committed in another state, add “but the accused's acts committed in another state: _________ resulted in the crime in the State of _________”) and that the accused is now believed to be in the _________(City) (County) of _________ in the State of _________. The prosecuting attorney further alleges that this proceeding is not instituted to enforce a private claim and that in the prosecuting attorney's opinion the ends of justice require the arrest and return of the accused to the State of _________ for trial on the charged crime. The prosecuting attorney recommends _________(state full name of each agent in capital letters) as agent—, and certifies that agent— (has) (have) no private interest in the arrest of the accused and (is a) (are) proper person— to act as agent— for the County and State. Accompanying this application are duly certified copies of the (complaint or affidavit made and warrant issued; indictment returned or information filed) stating the offense with which the accused is charged. Further accompanying this application (is an) (are) affidavit—, showing the circumstances of the commission of the crime and the connection of the accused in the commission of the crime;* the presence of accused in the state of _________ at the time previously stated and that accused then fled from the state of _________(strike words between asterisks if accused is sought for acts committed in another state)* and that the accused is now believed to be in the _________(City) (County) of _________ State of _________, and the grounds for this belief are as follows: A communication from authorities of the _________(City) (County) of _________, State of _________, stating that the accused is in custody or has been located there.
Further accompanying this application are certifications by proper authorities that the public officials signing and acknowledging the documents were qualified and acting as public officials on the date the documents were issued. Further accompanying this application is an affidavit of identification showing that the accused _________(state full name and any aliases of the fugitive in capital letters), now believed to be in the _________(City) (County) of _________, State of _________(is) (are), the same person— named in the (complaint or affidavit made and warrant issued; indictment returned or information filed). Reference is made to the particular statute bearing upon the criminal offense charged: _______________ Prosecuting Attorney of _________(County)