Affidavit of Non Prosecution Template

This Affidavit of Non Prosecution (the “Affidavit”) is made on [Date] by:

Affiant: [Full Name], date of birth: [DOB] (optional), address: [Address], phone/email: [Contact].
Role: ☐ Reporting party ☐ Alleged victim ☐ Witness ☐ Other: [Explain]

Defendant/Accused (If Known): [Full Name]
Case Number (If Any): [Case No.]
Agency/Report Number (If Any): [Report No.]
Court (If Any): [Court/County]

1. Purpose

1.1 I am submitting this Affidavit to request that the prosecutor consider declining to pursue charges related to the incident described below, where permitted.

2. Incident Information

2.1 Date of Incident: [Date]
2.2 Location: [Address/City]
2.3 Brief Description (Plain Language): [2–5 sentences].

3. Voluntary Statement

3.1 I am signing this Affidavit voluntarily.
3.2 I have not been threatened, forced, or offered anything of value to sign this Affidavit: ☐ Yes ☐ No (explain).
3.3 I understand that the prosecutor may still continue the case even if I request non-prosecution.

4. Restitution and Contact Preferences (Optional)

4.1 Restitution Requested: ☐ No ☐ Yes, amount/description: [__].
4.2 Preferred Contact Method: [Phone/Email/Mail].
4.3 No-Contact/Protective Order (If Any): ☐ None ☐ Yes (explain; this Affidavit does not change it).

5. Statement Under Oath

5.1 I declare under penalty of perjury that the statements in this Affidavit are true and correct to the best of my knowledge.

Signatures

Affiant: [Full Name]
Date: [Date]
Signature: ___________________________

Witnesses (If Required)

Witness Name: [Name]
Date: [Date]
Signature: ___________________________

Notary / Notarization (If Required)

State of [State]
County of [County]

On [Date], before me, [Notary Name], personally appeared [Affiant Full Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to this Affidavit, and acknowledged that they executed it for the purposes stated.

Notary Public Signature: _______________________
My Commission Expires: _______________________
Notary Seal (if applicable): ___________________