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GARFIELD HEIGHTS MUNICIPAL COURT CUYAHOGA COUNTY, OHIO City (Village of Walton Hills)

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BROWSE VILLAGE OF WALTON HILLS (OH) FORMS

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Traffic Cam - Transfer Liab.
Rev. 8/26/2020
GARFIELD HEIGHTS MUNICIPAL COURT
CUYAHOGA COUNTY, OHIO
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Case No. ____________________
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) TRANSFER OF LIABILITY FOR
) TRAFFIC CAMERA CITATION
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Village of Newburgh Heights
c/o Nicholas J. Celebrezze
3801 Harvard Ave.
Newburgh Hts., OH 44105
Village of Walton Hills
c/o Law Director, John Montello
7595 Walton Road
Walton Hills, OH 44146
City that issued the citation (Choose one)
Plaintiff,
v.
_____________________________________
Your Name or Company Name
_____________________________________
Your Address
_____________________________________
City, State Zip
______________________________
Cell/Text No.
______________________________
Email
Defendant.
AFFIDAVIT
I, the undersigned, seek to transfer liability from traffic camera citation
no. ____________________________________ that was issued to me and/or my company on
__________________________ (date) due to the following reason (pick one):
While I was the registered owner of the vehicle at the time of the violation, another person
was operating my vehicle at the time of the violation. As required by law, I am providing
the following information regarding the identify the driver (you must, at a minimum, provide
the drivers name and address): _________________________________
__________________________________________________________________________
__________________________________________________________________________
State of Ohio }
} SS. County of Cuyahoga
}
_____________________________________, being duly sworn, deposes and says that the facts above
set forth are true and correct, to the best of his knowledge.
_____________________________________________
Your Signature and Title
(if company agent)
Sworn to and subscribed before me, this __________day of __________________________, 20______.
_____________________________________________
Notary Public or Deputy Clerk
While I was the registered owner of the vehicle at the time of the violation, at the time of
the violation, the vehicle and/or the license plates to the vehicle were stolen and
therefore being used by an individual who did not have my permission to use the vehicle
and/or plates. As required by law, I have attached a copy of the police report filed prior to
the violation or withing 48 hours after the violation occurred.
I am an agent of a corporate entity issued the citation however the following employee was
operating the commercial vehicle cited at the time of the violation (you must provide the
name and address of your employee):
________________________________________________________________________
________________________________________________________________________
MOTOR VEHICLE LEASING OR RENT DEALERS ONLY (your signature need not be notarized):
The company cited is a motor vehicle leasing dealer or motor vehicle renting dealer. The
name and address of the lessee or renter at the time of the violation is as follows:
________________________________________________________________________
________________________________________________________________________
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GARFIELD HEIGHTS MUNICIPAL COURT CUYAHOGA COUNTY, OHIO City (Village of Walton Hills)

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Completed 24 January 2021

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