IN THE CIRCUIT/COUNTY COURT OF THE SECOND JUDICIAL

CIRCUIT IN AND FOR LEON COUNTY, FLORIDA

STATE OF FLORIDA Case No:_____________________

VS
______________________________ Citation: _____________________

MOTION TO/FOR ________________________________________________________________________________

(Indicate above what action(s) you are requesting of the court)

Statement of facts: ___________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

__________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________
(Attach any documentation or additional pages to this form)

Signature: _____________________________________________________ Date: ___________________________

Please Print:
Name: _______________________________________________ Phone(day-time)___________________________

Current Address: _______________________________________ (PDLO$GGUHVV________________________BB__B

City/State/ZIP: _________________________________________

If your mailing address is different than the address listed on your citation or in your case, you must submit a Change
of Address form. The form is available in any division of the Clerk’s Office, or online at www.leonclerk.com, located
under Online Forms / County/Circuit Criminal/Traffic Change of Address. It is your responsibility to keep your address
updated in this office.

IF YOUR LICENSE IS SCHEDULED TO BE SUSPENDED OR HAS ALREADY BEEN SUSPENDED,

FILING A MOTION WILL NOT STOP THE SUSPENSION OR CLEAR THE SUSPENSION. BE ADVISED
IT MAY TAKE UP TO TWO WEEKS FOR YOUR MOTION TO BE RETURNED.

***********************************************************************************************

___ Granted ___ Denied Other: ______________________________________________________

__________________________ _____________________________________
DATE CIRCUIT/COUNTY JUDGE