Page 130 - กฎหมายวิธีพิจารณาความอาญา

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ป.จ.ว.ขอ...................เวลา.........................น.
คดีอาญาที่....................................................
บัญชีของกลางลําดับที่...................................

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สถานที่บันทึก............................................................................................................................................
วัน/เดือน/ป ที่บันทึก...................................................................................................................................
วัน/เดือน/ป ที่จับกุม....................................................................................................................................

สถานที่จับกุม ที่.....................................................................บานเลขที่.......................หมู..................
ตรอก/ซอย......................................แขวง/ตําบล.....................................เขต/อําเภอ..................................
จังหวัด...................................นามเจาพนักงานตํารวจที่ทําการจับกุม.....(ระบุยศ ชื่อ นามสกุล ตําแหนง
สังกัด ของเจาพนักงานตํารวจที่ทําการจับกุม ทุกคน).......................................................................
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ไดรวมกันจับกุมตัว.........................................................................................................................
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พรอมดวยของกลางมี.........................................................................................................................
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(Ê õö - ò÷)