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
______ 
First Middle Last,
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/woman, 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 : _______________
First  Middle  Last
I verify all parties were sent a copy via first class mail through U.S.P.S. 
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 : ________________
First  Middle  Last