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BEFORE ME, the undersigned authority, personally appeared VICTIMS NAME, who, after being by 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering 'VICTIM’S NAME' in the designated field. This identifies the individual making the affidavit.
  3. Next, input 'VICTIM’S DATE OF BIRTH' to confirm the age and identity of the affiant.
  4. In the section regarding the incident, specify the date of occurrence and details about 'PERSON ACCUSED OF DOMESTIC VIOLENCE'.
  5. Clearly state your intention regarding pursuing charges against 'PERSON ACCUSED OF DOMESTIC VIOLENCE' in the provided text area.
  6. Review all statements for accuracy and completeness before signing. Ensure you check that you are signing voluntarily without coercion.
  7. Finally, add your signature and date at the bottom of the form where indicated.

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personally appeared before me the undersigned authority

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