( RCr 2.02, SCR 5.030 )

DISTRICT COURT OF KENTUCKY

Ballard County

v. ) Complaint

____________________

Defendant.)

The affiant, ________________ says that on the

(Name of complainant)

__________ day of __________, 19__,in Ballard

County, Kentucky, the above named __________________

(Name of defendant)

unlawfully drove an automobile in a careless and reckless manner on a highway, U.S. Highway 60 about one mile west of La Center by racing at high speed with another automobile.

____________________

(Signature of Complainant)

Sworn to before me this _____ day of _____, 19_____.

KRS 189.290(1)

189.990(1)

____________________

Trial Commissioner,

Ballard County

District Court of Kentucky