PDF Court County, Ohio State of Ohio Ticket # Case # Name Street ...
[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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