2. I request that charges be filed as set out on this form. I understand that if charges are filed, I agree to be present and prosecute these charges until final determination. I further understand that the City of Seabrook Municipal Court may not allow me to dismiss these charges, if I should change my mind at a later time.

4. Your Information

6. FIRST NAME*
7. LAST NAME*
9. STREET ADDRESS*
11. MAILING ADDRESS

    If different from your street address

13. CITY*
14. STATE*
15. ZIP*
17. PLACE OF EMPLOYMENT
18. DRIVER'S LICENSE or ID*

    Please upload a copy of your VALID Texas Driver's License or Identification Card

20. PRIMARY PHONE NUMBER*
21. SECONDARY PHONE NUMBER

25. Defendant's Information

27. FIRST NAME*
28. LAST NAME*
30. STREET ADDRESS*
32. MAILING ADDRESS

    If different from the street address

34. CITY*
35. STATE*
36. ZIP*
38. EMPLOYMENT INFORMATION
40. WHAT CHARGES DO YOU DESIRE TO FILE?*

44. PLEASE STATE WHAT HAPPENED

    State specifically what occurred, the date, time of day, and names of any witnesses. You must also include the location (address) of the offense.

46. DATE & TIME*
    DATE & TIME

    DATE & TIME
47. LOCATION*
49. DETAILS*

53. WITNESS INFORMATION

55. Witness #1

57. FIRST NAME
58. LAST NAME
60. ADDRESS
62. CITY
63. STATE
64. ZIP
66. PLACE OF EMPLOYMENT
68. IS THIS WITNESS WILLING TO APPEAR VOLUNARILY?

    1. YES
    2. NO

    If no, this witness will require a subpoena to be issued, please state where and when a subpoena can be served.

69. WHAT WILL THIS WITNESS TESTIFY TO?

    State specifically ONLY what this witness said and observed, not what he/she was told. Also, state the date and time this witness made this observation.

71. WHEN AND WHERE CAN A SUBPOENA BE SERVED TO THIS WITNESS?

73. Witness #2

75. FIRST NAME
76. LAST NAME
78. ADDRESS
80. CITY
81. STATE
82. ZIP
84. PLACE OF EMPLOYMENT
86. IS THIS WITNESS WILLING TO APPEAR VOLUNTARILY?*

    1. YES
    2. NO

    If no, this witness will require a subpoena to be issued, please state where and when a subpoena can be served.

87. WHAT WILL THIS WITNESS TESTIFY TO?

    State specifically ONLY what this witness said and observed, not what he/she was told. Also, state the date and time this witness made this observation.

89. WHEN AND WHERE CAN A SUBPOENA BE SERVED TO THIS WITNESS?
91. ADDITIONAL WITNESSES

    If there are additional witnesses, please upload a document with the required information here.

95. SIGNATURE OF COMPLAINING WITNESS*
96. DATE OF REQUEST*
    DATE OF REQUEST
Leave This Blank:


98. 1. Receive an email copy of this form.
99. Email address

    This field is not part of the form submission.

100. Submit

* indicates a required field