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Y. If you were not sentenced to jail/prison/incarceration time, probation, or a fine, write "n/a" (not applicable) in the appropriate spaces. If you have no other arrests, cross out numbers 10 through 13. 10. I was arrested/ taken into custody on , in N.J. (municipality) and charged with , in (name of offense) violation of N.J.S.A. . (statute) 11. The original Indictment/Accusation/Summons/Warrant/Complaint/Docket number was . *12. On , the charge of (name of offense) was dismissed by.

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