Affidavit From Victim Requesting Dismissal

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IN THE DISTRICT COURT IN AND FOR TULSA COUNTY

STATE OF OKLAHOMA

STATE OF OKLAHOMA, )
Plaintiff, )
vs. )
______________________________, )
Defendant. ) Case No.

COMPLAINING WITNESS VOLUNTARY APPLICATION TO DISMISS

I, ____________________________, of lawful age, having been duly sworn


do hereby certify and state that I am the Prosecuting Witness or Victim in the above
named case, wherein the Defendant has been charged with a crime.

That I hereby certify under oath that I am not under the influence of any drugs
or alcohol, there are no medications which I have been prescribed that I have not
taken, that I have not been promised anything, threatened, forced, or otherwise
unduly influenced to execute this document requesting that the above referenced
charge(s) be dismissed. Further, I certify that I am competent and fully understand
the consequences of this document and I am aware that I have the right to seek
independent legal advice regarding this matter and that I have or can do so to my
satisfaction. I am also aware that the attorney for the Defendant does not represent
me or my interests. I also understand that the District Attorney’s office may choose
not to dismiss this case even though I am requesting that it be dismissed. Further, I
understand that this case cannot be re-filed at any time if it is dismissed upon my
request.

I freely and voluntarily request that the case against the Defendant named above be
dismissed and I request the District Attorney’s office not prosecute the Defendant for
the following reason(s):
___________________________________________________________________

___________________________________________________________________

Signature:________________________________
Complaining Witness

Print Name:______________________________

SUBSCRIBED AND SWORN to before the undersigned notary public on this _____
day of ______________, 200___.

My commission expires:________________ _____________________________


NOTARY PUBLIC

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