State of Washington

v.

A.  . . . . . B.  . . . . .

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Superior Court of

the State of

Washington for the

County of

. . . .

A. B. is accused by the grand jury of the . . . . . . . . . ., by this indictment, of the crime of [here insert the name of the crime, if it have one, such as treason, murder, arson, manslaughter, or the like; or if it be a crime having no general name, such as libel, assault and battery, and the like, insert a brief description of it as given by law], committed as follows:

The said A. B. on the . . . . day of . . . . . ., (year) . . . ., in the county of . . . . . ., aforesaid, [here set forth the act charged as a crime.]

Dated at . . . . . ., in the county aforesaid, the . . . . day of . . . . . ., A.D. (year) . . . .

(Signed) C. D., Prosecuting Attorney.

(Indorsed) A true bill.

(Signed) E. F., Foreperson of the Grand Jury.