________________________________ COURT

______________________ County, Arizona

STATE OF ARIZONA Plaintiff

[CASE/COMPLAINT NO.]

-vs-

GRAND JURY

______________________

MINUTES

Defendant (FIRST, MI, LAST)

GJ No.

At a session of the Grand Jury of the County of held this ___ day of _____ , 20 ___ , the above defendant being accused of the crime(s) of:

[List each charge or count]

Based upon the following witnesses:

Name

I.D. #/

Agency / Address

Date Appeared

[List each witness:]

Having appeared before the Grand Jury and having given testimony under oath before the Grand Jury, which testimony was reported by __________, Reporter of the Grand Jury, on the day(s) that such testimony was given; the Grand Jury with ___ members present, and only members of the Grand Jury present, deliberated upon evidence and with ___ jurors voting, by a vote of ___ to ___ returned a true bill, or took the following action:

______________________________

______________________________

Clerk of the Grand Jury

Date