The form of claim shall be as follows:
CLAIM FOR REWARD
I, , address hereby claim reward in the amount of $ for information that I have voluntarily furnished to the Pinole Police Department. This claim is made in accordance with Chapter 9.32 of the Pinole Municipal Code and Resolution No. 2231 of the Pinole City Council, a copy of which I have received.
That I will cooperate with the Pinole Police Department and the Office of the Contra Costa District Attorney to the extent of furnishing information and testifying at any hearing or trial.
I recognize the reward is limited to the amount set forth in the resolution and that other persons may claim this reward. In the event there is any dispute as to my entitlement to receive the reward or the amount, I agree to having this claim finally determined by the City Manager as set forth in Section 9.32.070 of the Pinole Municipal Code.
I understand that payment of the reward is conditional upon the information/testimony that I furnished leading to the arrest and the filing of a complaint charging a person with a crime.
There has been no other offer or promise to me except as contained in this claim and the described resolution.
Dated:
Signed:
(Ord. 517 (part), 1988).