IN THE JUSTICE COURT OF COUNTY, STATE OF MONTANA

BEFORE , JUSTICE OF THE PEACE

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STATE OF MONTANA, * CAUSE NO.

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Plaintiff, * COMPLAINT

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vs. *

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, *

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Defendant. *

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The undersigned County Attorney of County, Montana, states: before the filing of this Complaint, the above-named Defendant(s) on or about the day of

at committed the offense of as specified in .

The facts constituting the offense are:

all of which is contrary to the form, force, and effect of the statute in such case made and provided, and against the peace and dignity of the State of Montana.

DATED this day of , 1993.

Lee R. Kerr

Treasure County Attorney

SUBSCRIBED AND SWORN this day of , 19 .

Justice of the Peace