COMMON LAW CLAIM

At the superior courthouse for the County known as County on the land of Your State.

Officer OFFICER NAME, (badge # 123)

Plaintiff and a public servant

______

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One of the People that creates the land, the County known as County and the town/city called
City / Town.

Case # CASE NUMBER

I, man, have had no interaction with Officer OFFICER NAME.

I require Officer OFFICER NAME to make a verified claim, and I will make him whole.

I, man, am not ready to proceed, and/or I require this case to be discharged.

I require proper counsel.

I verify all things said herein are true.

______________________ /date : _______________

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I verify all parties were sent a copy via first class mail through USPS.

Prosecutor: PROSECUTOR NAME Accuser: OFFICER NAME (Badge #123)

123 PROSECUTOR ADDRESS ST. 1234 POLICE ADDRESS ST.
CITY, ST 12345 (Refer to citation paperwork) CITY, ST 12345

________________ ____ /date : ________________

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