Confidential Disclosure Of Personal Identifiers (Traffic Criminal)
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Confidential Disclosure Of Personal Identifiers (Traffic Criminal) Form. This is a Ohio form and can be use in Marietta City (Municipal Court).
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MARIETTA MUNICIPAL COURT
Traffic / Criminal
CONFIDENTIAL DISCLOSURE OF PERSONAL IDENTIFIERS
Supreme Court of Ohio, Rules of Superintendence, Rule 45(D)
Complete all applicable information (PLEASE PRINT)
Defendant Name____________________________ DOB_____________________
Social Security Number___________________________
Citation No________________ Charge(s)__________________________________
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Juvenile Victim Name_____________________________________________________
Address________________________________________________________________
Phone Number__________________________
Other Information_________________________________________________________
________________________________________________________________________
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Department__________________________________
Officer Name________________________________
Unit Number_______________
Required to be filed with each citation / complaint.
Revised: 6/25/09
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