聲請案移法院併自訴案審理狀

Application to Transfer the Case to Another Court for the Combined Trial with Private Prosecution

股別：

Section:

貴署 年度 字第 號

一案，同一事實告訴人已向臺灣 地方法院提起自訴，請依刑事訴訟法第323條第2項規定，將案件移送該管法院併案審理。

In the Case year zhi No. of your Office

The person requesting for the prosecution has filed for a private prosecution based on the same facts and occurrence with the Taiwan
District Court. Please transfer this case to the said court for combined trial pursuant to Paragraph 2, Article 323 of the Code of Criminal Procedure.

此 致

臺灣宜蘭新北地方檢察署 公鑒

TO

Taiwan Yilan District Prosecutors Office

： （簽名蓋章）

Applicant: (Signature/Stamp)

國民身分證統一編號/護照號碼/居留證號

National ID No./Passport No./Alien Resident Certificate No.

住 址：

Address:

電 話：

Tel.:

中 華 民 國 年 月 日

Date: (mm)/ (dd), (yyyy)