Each committing trial court judge at the time commitment papers are sent by her or him to the proper trial court, and the sheriff when an arrest is made, other than on a capias, shall transmit to the prosecuting attorney of the trial court having jurisdiction, a report in the following form:
Date: ____ Name and address of defendant: ____ Age: ____. If under 18, give name and address of parent, next friend, or guardian: ____ Name of offense, such as murder, assault, robbery, etc.: ____ Date and place where committed: ____ Value of property stolen: ____ Kind of property stolen: ____ Kind of building robbed: ____ Name and address of owner of property stolen or building robbed: ____ Name and address of occupant of building robbed: ____ Name of party assaulted or murdered: ____ Weapon used in assault or murder: ____ Exhibits taken at scene of crime or from defendant: ____ Name of custodian of such exhibits: ____ Location of building or place where offense committed: ____ Previous prison record of defendant: ____ Has defendant been arrested: ____ Does defendant desire to plead guilty: ____ Names and addresses of state witnesses: ____ Name of defendant’s lawyer: ____ If defendant is released on bond, names and addresses of sureties: ____ Brief statement of facts: ____ Name of committing trial court judge: ____ If additional space required, use reverse side of this sheet.
(Signature of party making this report.)