COURT COUNTY, OHIO STATE OF OHIO TICKET # CASE # NAME …

[Pages:10]PRESENT ADDRESS

STATE OF OHIO City

NAME

Village

COURT

TICKET # Township

CASE #

STREET

CITY, STATE OPERATOR LICENSE / State ID#

None* BIRTH DATE

COUNTY, OHIO

ZIP ISSUE DATE

STATE

SIGNATURE X

CLASS

EXPIRES

ENDORSEMENT(s) / RESTRICTION(s)

SS# (last 4 digits)

CDL MC Other SEX HEIGHT WEIGHT EYES HAIR RACE FINANCIAL RESPONSIBILITY PROOF?

Yes

No

N/A

* If no OL/State ID; required documentation attached:

Yes

TO DEFENDANT: COMPLAINT ON

, 20

AT

Operated/Passenger/Parked/Walked a Passenger Motorcycle Bicycle

Am/Pm, YOU Other

Commercial DOT#

26,001 lbs. ................
................

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