Docket Number 

Date Filed 

OTN/LiveScan Number 

Allegation Number 

Incident Number 

WRITTEN ALLEGATION

Juvenile Name 

First 

Middle 

Last 

AFFIDAVIT of PROBABLE CAUSE 

I verify that the facts set forth in this affidavit are true and correct to the best of my knowledge or 
information and belief. This verification is made subject to the penalties of Section 4904 of the Crimes 
Code (18 Pa.C.S § 4904) relating to unsworn falsification to authorities.

Affiant Name 

Affiant Signature 

Date 

AOPC J232A – Rev. 12/21   

Page __ of __ 



Written Allegation - Single Summary of Offenses

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About This Form:

• Sourced from www.pacourts.us (2023-03)
• Page(s): 1
• Fields(s): 14
• Average fields per page: 14
• Reading Level: Grade 11
• LIST Grouping(s): CR-00-00-00-00.

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