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IN THE WAYNE COUNTY MUNICIPAL COURT WAYNE COUNTY, OHIO State of Ohio Case Number(s): __________________ Plaintiff ________________________________ ________________________________ Vs. ___________________ Motion To/For: ___________________ (Print Name) Defendant ________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ _____________________ ___________________________________________ Date Signature CERTIFICATE OF SERVICE I hereby certify that a copy of this document was served upon the Wayne County Prosecutor on _________________________________ by: (Date) □ Regular Mail □ Certified Mail □ Fax □ Hand Delivery □ Other, explain: _______________________ ____________________ __________________________________________ Date Signature