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IN THE COUNTY COURT OF THE FOURTH JUDICIAL (Clay County Florida Clerk of Court and Comptroller)

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Note: If there is no objection by the Defendant, this affidavit will be presented to the Court along
with the Complaint. If there is an objection, the case may be continued by the Court to enable the
witness to appear.
IN THE COUNTY COURT OF THE FOURTH JUDICIAL CIRCUIT,
IN AND FOR CLAY COUNTY, FLORIDA
THE STATE OF FLORIDA, CASE NO.:
DIVISION:
vs.
,
Defendant.
/
AFFIDAVIT OF OFFICER
BEFORE ME, personally appeared , who having
been duly sworn, deposes and says:
1. My name is ; I am employed by
and I issued the above numbered
citation charging defendant with on .
2. I will be unavailable or out of Clay County from , to .
My hearing date is in Green Cove Springs, Florida at .
3. The above Alleged Offender committed the following infraction:
Explain in your own words, being as brief as possible, but omitting no material facts that will help
the Court arrive at a judgment in your case. If additional space is needed, please use additional
blank sheets.
Sworn to and subscribed before me this day of , 20 .
Signature
Deputy Clerk
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IN THE COUNTY COURT OF THE FOURTH JUDICIAL (Clay County Florida Clerk of Court and Comptroller)

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Completed 30 July 2021

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