2011 Florida Statutes
Date: Name and address of defendant: Age: . If under 18, give name and address of parent, next friend, or guardian: Name of offense, such as murder, assault, robbery, etc.: Date and place where committed: Value of property stolen: Kind of property stolen: Kind of building robbed: Name and address of owner of property stolen or building robbed: Name and address of occupant of building robbed: Name of party assaulted or murdered: Weapon used in assault or murder: Exhibits taken at scene of crime or from defendant: Name of custodian of such exhibits: Location of building or place where offense committed: Previous prison record of defendant: Has defendant been arrested: Does defendant desire to plead guilty: Names and addresses of state witnesses: Name of defendant’s lawyer: If defendant is released on bond, names and addresses of sureties: Brief statement of facts: Name of committing trial court judge: If additional space required, use reverse side of this sheet.
(Signature of party making this report.)