MINNESOTA COURT RULES

CRIMINAL PROCEDURE

Forms provided here are for reference purposes. To download forms to fill out please visit the Minnesota Courts website.

FORM 4A. GROSS MISDEMEANOR CHARGING BY TAB CHARGE

_
STATE OF MINNESOTA	DISTRICT COURT
COUNTY OF _	_ JUDICIAL DISTRICT
State of Minnesota,
Plaintiff,	TAB CHARGE PURSUANT TO
vs.	MINN. R. CRIM. P. 4.02, SUBD. 5(3)
_,
Defendant.

To:_County District Court and		_	County Jail
From: Arresting Officer: (Please Print) _			Badge Number: _
Pursuant to Minnesota Rules of Criminal Procedure 4.02, subd. 5(3), the above-named officer hereby requests that the named defendant be processed for the designated Gross Misdemeanor (GM) indicated below and as defined by Minnesota Rules of Criminal Procedure 1.04 (b).
Defendant Name: _			DOB: ____/____/____
Driver's License No. _		State: _	Date of Offense: __/__/__
City of Occurrence: _		Controlling Agency: MN - _
Control Number/ICR: _		Court File No. (Provided by Court/Jail): _

(Check Boxes)	Designated GM Offense	Charge	Penalty (must check one)		MOC
			2nd Degree (E)	3rd Degree (F)	Circle E or F
□	UI Alcohol	169A.20, 1(1)	□ 169A.25	□ 169A.26	J_____501 E F
□	UI Controlled Substance	169A.20, 1(2)	□ 169A.25	□ 169A.26	J_____601 E F
□	UI Hazardous Substance	169A.20, 1(3)	□ 169A.25	□ 169A.26	J_____H01 E F
□	UI Combination	169A.20, 1(4)	□ 169A.25	□ 169A.26	J_____G01 E F
□	Alcohol .08 or More Within 2 Hours of Driving	169A.20, 1(5)	□ 169A.25	□ 169A.26	J_____W01 E F
□	Alcohol .04 or More Within 2 Hours of Driving - Commercial Vehicle	169A.20, 1(6)	□ 169A.25	□ 169A.26	J_____K01 E F
□	Schedule I or II Controlled Substance	169A.20, 1(7)	□ 169A.25	□ 169A.26	J_____S01 E F
□	Refusal to Submit To Test	169A.20, 2	□ 169A.25	□ 169A.26	J_____R01 E F
□	Other (specify): _
Court Status: (Check one)
□	Defendant incarcerated in ______________ County Jail to be held in custody pending court appearance.
□	Defendant released on his/her own recognizance and assigned the following court date.
	Date: ____/____/____		Time: _
	Location: _			County Courthouse
	Address: _
Bail/Bond Status: (Check One)				Date: ___/___/___
□	Maximum $12,000 bail under Minnesota Statutes, section 629.471, or conditional release under Minnesota Statutes, section 169A.44.
□	Bail was posted in the amount of $________.
□	Bond was posted in the amount of $________.
□	No bail/bond was required.
Dated:	____/____/____		_
			Officer's signature
			_
			Officer's Name and Badge Number
			(if different from arresting officer)

(Added effective September 29, 2000; amended effective for criminal actions commenced or arrests made after 12 o'clock midnight March 1, 2006.)