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FE)), FEB 22 WIN, F11.:smfbLRtgr1HIO.IN THE CONNECT MUNICIPAL COURT ASHTABULACOUNTY, OHIO CIIL JAN 19 A q: 30CONNEAUT MU!.local COURT It is hereby Ordered, pursuant to Ohio Revised Code Section 2924.091(A)(I)

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6. If applicable, provide information about any professional licenses or certifications you hold.
7. Fill out the FE form's sections related to any disciplinary actions or ethical violations, if applicable.
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9. Sign and date the completed FE form.
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