Filing # 86186412 E-Filed 03/1 1/2019 03:00:51 PM

IN THE CIRCUIT/COUNTY COURT FORIPINELLAS COUNTY, FLORIDA

v

SIXTH JUDICIAL CIRCUIT

CASENO. ’4 O 5mg m m
STATE OF FLORIDA

QIQVQV‘AL
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PE‘RSON ID: gfimfiév
RE UEST NOT TO PROSECUTE / RE UEST FOR CONTACT

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am tile victim in this

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equest that either, or both, of the following occur:

case and do not wish to prosecute.

I am the victim in this case and would like to have contact with the Defendant;
I am not in fear of violence fiom the Defendant.

NOTE: SIGNINGITHIS REQUEST DOES NOT EXCUSE YOU FROM

COURT HEARINGS OR SUBPOENAS. SIGNING THIS REQUEST DOES NOT
AUTHORIZE CONTACT. CONTACT REQUIRES AN ORDER FROM‘THE
COURT.

Under penalties ofpeljury, I declare

that I have read the foregoing, and
that the facts stated in it are true to
h

the best ofmy knowledge and belief.

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DATE
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L PRODUCQD
IDENTE:CATION
TYPE 0F LQOQKOB 103 (0L! $2275

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DATE
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***ELECTRONICALLY FILED 03/1 1/2019 03:00:51 PM: KEN BURKE, CLERK OF THE CIRCUIT COURT, PINELLAS COUNTY***