Full text
Whereas (name of offender), before June 30, 2000,
Whereas (name of offender), before June 30, 2000,
I, (name of peace officer), have (state here whether you have acted in execution of a warrant under section 487.05 or an order under section 487.051 or 487.052, or under an authorization under section 487.055 or 487.091) of the Criminal Code.