Form 12 Transmittal Certification

________________________________ COURT

______________________ County, Arizona

STATE OF ARIZONA Plaintiff

[CASE/COMPLAINT NO.]

-vs-

TRANSMITTAL

CERTIFICATION

Defendant (FIRST, MI, LAST)

ORDER HOLDING DEFENDANT TO ANSWER BEFORE THE SUPERIOR COURT

I hereby certify that the enclosed items constitute a true and complete record of the preliminary proceedings held in the above-entitled case appearing in Docket No. _______________, at page ___.

The following items are included:

[ ]

The original complaint, including amendments;

[ ]

The supporting affidavits of the following witnesses:

[ ]

The arrest warrant or summons;

[ ]

The defendant's release questionnaire;

[ ]

The defendant's financial statement and request for appointment of counsel;

[ ]

A copy of the release order;

[ ]

The defendant's appearance bond;

[ ]

[ ]

Defendant's waiver of counsel;

[ ]

Order appointing counsel;

[ ]

Waiver of preliminary hearing;

[ ]

[ ]

Order holding the defendant to answer in superior court;

[ ]

Audio or video record of preliminary hearing, if any;

[ ]

Date

Signature of Judicial Officer

Printed Name and Title of Judicial Officer

Form 12