In the top left corner of the first page fill out the following: Your name; Address;. City; State and Zip Code; Telephone Number; and your ATLAS Number, if you.PREJUDICE with the Clerk of the Court and ask to have the copies of the Notice stamped. Unless otherwise stated in the notice or order of dismissal, the dismissal is without prejudice. Please note that each court might have their own preferred forms. IT IS ORDERED dismissing with prejudice the indictment and pending charges against. Sanford. This matter will be dismissed with prejudice upon resolution of attorneys' fees. You are responsible for filing your case in the correct court. 3. We will not provide consultation as to how to complete this form. The mayor of Surprise, Arizona had Rebekah Massie arrested in front of her 10-year-old daughter for questioning a city attorney's pay at a council meeting.