RECEIVED

By Judith Wilson at 12:57 pm, Jan 28, 2016

IKE DEWINE M?e_ 

 

Obie Peace Of?cer Training Commission
Of?ce 800-346?7682
Fax 740-845 42.675

 

 

OHIO ATTORNEY GENERAL 

 

 

PO. Box 309-
London, OH 43140


 

NOTICE OF PEACE APPOINTMENT

 

tifthis 
2. Type or paint legibly and complete all blanks. Enter NM if not appiicable. 

3. Submit pages 1 and 2 when an of?cer is needyappeinted to your agency, or has previously left the agency and retums.

4. Submit only page 1 when an of?cer continues to be appointed by your agency. but has a change from one status. as listed in Box 15. to a different status.
5. Enter any necessary information for a Correction to Record, submitting all affected pages. and attach a letter explaining the requested change.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Name (Last) [Firsll {lliiddlejl 2. Social Security Nurrlbaf
Ermim?myfs meme 
. LBS {Immune}
Km ii. i 
4. Birth date (Medina) 5. Emaii Address 
on 
Home Mailing Address {#iSirestiF'O Box] [Utm- - tame, [Zip Code) (Caunly Hamel
3. Basic Training Academy (Academy Name} Wedsmy Number} {Dates of Training]
(Only compiete ill-lists the .
office?s ?rstilipointrnentor 
7 malaise
AGENCY Amsterdam Village Police
'lothgensyeihallhodraes? - 
AmsterdamPD24@Yahoo.Corn 740-543-3797
12. Agency Address {#fSh'eetl'PC Box) [City] [Zip Code] (County Home}
103 Spring?eld St. PO Box 115 Amsterdam 0h 43903
APPOINTMENT INFORMATION {Comet-items summons 13' img?m
15. Select Newslems _Full-Time Part-Time _Auxiliary Reserve Special fSeasonS
16. Selectliew 0RD
City Full-'IiinelPart-Time (737.02) City AuxiliaiyfReseryeiSpecial (737.051) City Chief (737.02)
if Village (737.16) Village AuxiliaryiReserye (737.161) Village Chief (737.15)
Township Police Of?cer (505.49) Township Constable (509.01) Other Chief - Lisl 
Other- List ORCiCharter Deputy Sheriff {311.04) Sheriff [311.01]
ihaye carefully read this document and fully understand its contents and I sign it of my
own free will and volition. attest that the information provided on this document is hue
AHESTATION REPORTING AUTHORITY and correct and is based on my personal knowledge or inquiry. I further understand and
acknowledge that submission of falsi?ed records is a criminal violation.
17. Signature of Rep humorily 13. Printed Name and Tilie 19. Date
David F. Cimperman. Jr., Chief of Police ,r iglce??:
21. Printed Name {First Middle, Last} 22. Date
Jack J. Justus, Deputy Chief 1?7 aim/?

 

39
E?elslive 07m1i'2015

 

Ol?eerNamelLaat) . (Fits!) (Middle). SecurityNumber

 

 

23. OATH OF OFFICE

 

 

I do solemnly swear or af?rm that I will support the Constitution and Laws of the United States of America, the Constitution and
Laws of the State of Ohio. and Laws and Ordinances of the political subdivision to which I am appointed and to the best of my
ability will discharge the duties of this of?ce.

Ganr Peppertino

Mover. of Amsterdam


 

 

 

OHIO PEACE OFFICER APPOINTMENT HISTORY
Mlbtafipnbrappm Useaddi?hneiwpiecofpagez esneeded, 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24.Appoi1ted By {homey Horne and 25. 
thtm-?H- t? i 'Q?Jr?i (3i IEL iJr?, u:
26. Appohtment Stains (Check Amriate Box)
Felt-Time Partva 
Appointed By (Agericy Name and County}: 23. 
i i 
29. Statue (Chad: Appropriate Box}
_.PeItT1me ?Mike ?Rm 
30. Appcimed By (Agemy Hans and Gently}: 31. MMW):
32. Appointment Stuns (Elm Appropriate Box) .
FutFt'lme Part-True Auxi?ay Reserve Speciai Seasonal
33. Appoirm By (agency Mane and County): 34. 
35. Appointment Status (cm Appropriate Box}
Full-Tune Part-Time Auxiliary Resewe Specid Seasonal
38. Appointed By (Agency Marne and County): 37. Tammi:
i 
38 Appointment Statics (Check Appropriate Box]
_Futl-Time Partiirne Wituxiliary Reserve Specie] Seasons!
39. Appointed By (Agency Name and County): 40. Tammy):
i i
41. Appointment Statue (Cited: Appropriate Box]
Full?Time Part-Tone Amelia? Special Seasonal
SFt-U?edm This form may be emailed to: 5F4uo@ohioattorneygeneral.gw

Page2of2