CAUSE #:________________________

State of Texas § In the Justice Court

vs § Precinct 4 Place 2

_______________________ § County of Hidalgo, Texas

ED. 25.093 Parent Contributing Failure To Attend

PROBABLE CAUSE AFFIDAVIT

The undersigned Affiant, who after being duly sworn by me, makes the following statement:

I, the undersigned affiant, am duly employed by ___________________________________ and amcharged with the duties of attendance officer. Affiant is also responsible for compliance with the statelaws regulating Compulsory School Attendance by students residing within the above-named schooldistrict. I have good reason to believe and do believe that ______________________ on or about the ______day of ________________________, did commit the offense of Parent Contributing to Nonattendance. My belief of the foregoing statement is based upon the information contained in the attached schoolreferral form, which I prepared and know to be true and correct. The parent with Criminal Negligencefailed to require _______________________ (the child) to attend school as required by law, and thechild has absences for:

Ten or more days or parts of days in a six month period, or

Three or more days or parts of days in a four week period,

and no reason for the absences have been provided to the District by the parent or person standing inparental relation to the Defendant and the absences are unexcused.

_____________________________ Affiant

Sworn to and subscribed before me by a credible person, on this ____ day of ______________, 20____

__________________________Notary PublicHidalgo County, Texas

On this the _____ day of _____________, 20 ____, I hereby acknowledge I have examined theforegoing affidavit and have determined that probable cause exists for the issuance of an arrest warrantfor the individual accused therein.