A F F I D A V I T

STATE OF ILLINOIS            )

                                                ) SS

COUNTY OF PEORIA          )

REQUEST TO STATE'S ATTORNEY TO DISCONTINUE PROSECUTION

            I, the undersigned, being first duly sworn on oath state:

            That I am the complaining witness in the police report of the ___________________________

                                                                                                                  ^{(Police Agency/ Unit)}

involving ___________________________________ number _____________________, now pending

                                    ^{(Defendant)                                                              (Case Number)}

before the Circuit Court of Peoria County, Illinois which occurred on or about the ___________ day of 

__________________________, 20____;

            That my current address and phone number is ______________________________________

_________________________________________________________________________________;

            That the original complaint by me in said matter was made in good faith, and without malice and

not for the purpose of compelling or coercing the settlement of any civil matter;

            That I have not received nor agreed to receive any promise or thing of value in exchange for, as

an inducement to make, or as a condition of making this Affidavit;

            That I desire that said Defendant be not prosecuted at this time on said charge;

            That I make this Affidavit for the purpose of inducing the State's Attorney of Peoria County to strike

the charge now pending against said Defendant, with leave to the People to reinstate, and I agree, if said

charge is stricken and thereafter reinstated, to cooperate in the prosecution and testify willingly and

truthfully concerning the matters involved.

                                                                                                Assistant State's Attorney, Peoria County