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Affidavit of Non Prosecution Template
Provide a written statement requesting non-prosecution with this Affidavit of Non Prosecution Template.
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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): ___________________
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Affidavit of Non Prosecution Template
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For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
AFFIDAVIT OF NON PROSECUTION TEMPLATE FAQ
What is an affidavit of non prosecution?
An Affidavit of Non Prosecution is a sworn statement (often from an alleged victim or reporting party) asking a prosecutor not to pursue criminal charges. It may be used in certain misdemeanor cases, but laws and policies vary widely. Prosecutors can often proceed even if an affidavit is signed.
Does signing this stop the case?
Not necessarily. The prosecutor decides whether to file or continue charges. In some cases (especially domestic violence), prosecutors may continue even without victim cooperation. This template is a request only and avoids promising outcomes.
Who can sign it?
Typically the person who reported the incident or the alleged victim signs it. The signer should tell the truth and avoid pressure or coercion. If you feel unsafe, seek help from local support services.
What should be included?
Include: case/incident identifiers, a clear statement that the affidavit is voluntary, whether restitution is requested, and your contact information. This template includes a section to state whether there has been any pressure or threats.
Should it be notarized?
Often yes. Courts or prosecutor offices may require notarization. This template includes notarization and an optional witness section.
What if there is a protective order?
This affidavit does not change protective orders or court conditions. If there is a no-contact order, it must be followed unless a court changes it.
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