____________________COURT

[Precinct _____]

____________County, Arizona

_________________________

_________________________

_________________________

STATE OF ARIZONA Plaintiff

[CASE/COMPLAINT NO.]

-vs-

TRANSMITTAL

CERTIFICATION

APPEAL TO SUPERIOR

_________________________

COURT

Defendant (FIRST, MI, LAST)

_________________________

_________________________

_________________________

TRANSMITTAL OF RECORD ON APPEAL TO 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 arrest warrant, summons, or citation;

[ ]

The defendant’s release questionnaire;

[ ]

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

[ ]

If the defendant is or was in custody, a copy of the release order showing the conditions under which the defendant may be, or has been, released;

[ ]

The defendant’s appearance bond;

[ ]

Security deposited with the appearance bond: __________________________________________________

[ ]

Defendant’s waiver of counsel;

[ ]

Order appointing counsel or written appearance of counsel;

[ ]

Exhibits and items of physical evidence introduced at trial: ____________________________________-

; __________________________________________

[ ]

A copy of all proceedings had in the case, as shown by my docket;

[ ]

Audiotape or videotape of trial, if any;

[ ]

Other papers or items prepared in connection with the case: __________________________________

._________________________________________

_________________________

_________________________

Date

Signature of Judicial Officer

_________________________

Printed Name and Title of Judicial Officer