warning: filing false information with the court is a class a

Rockwall County
Defendant Information
Assessed: Court Cost _____________
Cause#____________________________
Fine _____________
Fee _____________
Community Service _____________
Defendant's Info
Name
Phone
Home__________________________ Cell____________________________
Address
Address
City, State, Zip
E-Mail Address
Social Security #
Driver's License #
State
Date of Birth
Marital Status (Circle):
Single
Married
Widowed
Divorced
Legally Separated
List Names, Addresses, and Phone Numbers of TWO (2) people NOT living with you, or each other, that know
who you are and can get a hold of you if needed.
By my signature below the information above is true and correct to the best of my knowledge.
(Con Mi Firma Abajo Declaro Que Esta Informacion Es Verdad Y Es Correcto Con El Mejor De Mi Cono Cimiento.)
WARNING: FILING FALSE INFORMATION WITH THE COURT IS A CLASS A
MISDEMEANOR PUNISHABLE BY UP TO ONE YEAR IN JAIL AND A MAXIMUM
FINE UP TO $4,000.
ADVERTENCIA: LA PRESENTACION DE INFORMACION FALSA CON EL TRIBUNAL ES
UNA CLASE A DELITO MENO PUNIBLE CON HASTA UN ANO DE CARCEL Y UNA
MAXIMA MULTA HASTA $4,000.
Date (Fecha)
Signature (Firma)