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HomeMy WebLinkAbout10-2097FLED-- OF THE f. '40TARY 2010 MAR 2S I'M 4: 0 `sYlvania In the Court of Common Pleas, CWWa +i 'i +J 1 v Civil DlvisI INNS YL ',%V Pennsylvania Dept of Transportation Plaintiff VS. Suzanne Martin-Ream No. l ' ?--Q q 7 G N' CL- PETITION TO PROCEED IN FORMA PAUPERIS Petitioner, Suzanne Martin-Ream requests the Court to allow her to proceed without payment of the costs in this matter and in support of such request, has completed the attached Affidavit of Financial Status. Date: ? ? ? Peh I ......... 1 7-- U- In the Court of Common Pleas, Cumberland County, Pennsylvania Civil Division Pennsylvania Dept of Transportation No._ Plaintiff CL- vs. Suzanne Martin-Ream AFFIDAVIT OF FINANCIAL STATUS 1. I am the Plaintiff in the above matter and because of my financial condition am unable to pay the fees and costs of prosecuting or defending the action or proceeding. 2. I am unable to obrain funds from anyone, including my family and associates, to pay the costs of litigation. 3. I represent that the information below relating to my ability to pay the fees and costs is true and correct. a. Name: Suzanne Martin-Ream Address: 202 North Pitt Street, Carlisle, PA, 17013 Social Security Number: 171-54-9564 b. Employment: None (disabled) c. Other income within the last twelve months Business of profession: none Other self-employment: none Interest: none Dividends: none Pensions and Annuities: none Social Security: 1893.00 Support payments: none Lycoming Law Library at James V. Brown Library In Forma Pauperis Petitions Disability payments 1 17%, 11 S , t-P Unemployment Compensation and supplemental benefits n-b"-lk Workers' Compensation payments h Public Assistance }oocErn?? ! l?„ . Other n M= d. Other contributions to household support: Wife / Husband Name „8-' t'06--u-w? If spouse is employed, state: Employer Salary or wages per month Type of work Contributions from children Other Contributions h SMC „ e. Property owned: Y'b?rlR- Cash Checking Account Savings Account Certificates of deposit Real estate (including home) Motor Vehicle Make Year Cost Amount owed f. Debts and Obligations Mortgage Rent eco Loans _ `L to Other g. Persons dependent upon you for support Wife / Husband name Children, K any ` Name '?JA?S. WI-A rJ Age Name Age Name Age Other persons Name Relationshi 0=1 4. 1 understand that I have a continuing obligation to inform the court of improvement in my financial circumstances which would permit me to pay the costs incurred herein. 5. 1 verify that the statements made in this affidavit are true and correct. I understand that false statements herein are made subject to the penalties of 18 PaCSA §4909, relating to unswom falsification to authorities. 4 Lycoming Law Library at James V. Brown Library In Forma Pauperi Petitions Date Petitioner Wachovia Online Services ( Account Activity ?.. A. ACCouNT ACTIVITY I want to... Account FREE CKG `0348 Go Action ?rtps://on'?ne'?an'cn^'..wac'?nv?a ?or±?/Aceo?!o*1?.e?v?fy.?s^Y Find Transactions Data Last 30 days - OR - to Range: IMWDDnYrn 1MM'Dt)/m'Y) Sort By: Deposits Note: You have up to 90 days of account history available. To view up to 7 years, gob) Posted Balance as of 03/242010: $87.88' Available Balance as of 0312',iR010 : $48.96 Transactions for: FREE CKG * 0348 03!24/2010 Deposit TRNSFR 3000171365781 03/24 $:'4.CO 03/19/2010 Deposit DEPOSIT CARLISLE 03/19#1040 $693.00 03/17/2010 Deposit NSF/OD REFUND $131.00 AUTOMATED CREDIT US TREASURY 303 03/17/2010 Deposit SOC SEC ?0 AUTOMATED CREDIT US TREASURY 303 $1 2. D 03117/2010 Deposit SOC SEC 03/11/2010 Deposit OVERDRAFT PROTECTION $2.00 03/09/2010 Deposit NSF/OD REFUND $75.00 03/0812010 Deposit COUNTER DEP $200.00 03/03/2010 Deposit OVERDRAFT PROTECTION $4.03 AUTOMATED CREDIT PA TREASURY $1.29 00 02/2512010 Deposit DEPT PA REFUND . 1 -10 of 10 • ttdodes transacborffi that have cleared your accourt as of the dose of the previous business day. See htdp with this page for more details. - Transactions that have been attimiaed but not yet posted are included. See help w b this page for Mons details. 1 of 2 3/25/2010 3:59 PM vorw 20 10 MA'7 25 PM 4: ;e 7 cuwrw, O IN THE COURT OF COMMON PLEAS OF W'?.g£ Q r t' L°kra t I eet:?wiw? CIVIL ACTION - LAW VS. No. COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF TRANSPORTATION, BUREAU OF DRIVER LICENSING APPEAL FROM THE SUSPENSION OF OPERATING PRIVILEGES TO THE HONORABLE, THE JUDGES OF SAID COURT: AND NOW comes Petitioner, S4?z.g P44r- who, respectfully (Your Name) avers as follows: 1. Petitioner-,<?:Az N,-, Av n err-, resides at OLD& 0,-?,L4+ ? ??t IPA (Your Name) (Your Complete Mailing Add ess) (? 0?3 Petitioner's Pennsylvania Operator's Number is 7 2. PennDOT proposes by Notice dated V46. X0101 0 to suspend Petitioner's driving privileges for a period of m`O.S. year(s), pursuant to Section of the Vehicle Code, effective 3. The withdrawal and suspension of Petitioner's operating privileges is unlawful, 'R.OII`? C? F U ?• C e? r\ Jt C.T t v b G for the following reasons: Ej ?s CSHC ? t? ox e, r ?S L ,A Sys ipp nS I tr ©(f WHEREFORE, Petitioner respectfully requests that this Honorable Court allow him/her to take an appeal from the suspension of his operating privileges. Submitted, \IL , Vr r w Name: ,3 , Address q'r Phone Number: Dated: rf\ t' Q? - vzo?o 11 CSHC COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION Bureau of Driver Licensing Mail Date: FEBRUARY 25, 2010 SUZANNE MARTIN-REAM WID # 100499283831291 001 202 N PITT ST PROCESSING DATE 02/18/2010 DRIVER LICENSE # 24698160 CARLISLE PA 17013 DATE OF BIRTH 11/19/1960 Dear MS. MARTIN-REAM: This is an Official Notice of the Suspension of your Driving Privilege as authorized by Section 1532B of the Pennsylvania Vehicle Code. As a result of your 02/17/2010 conviction of violating Section 1371 of the Vehicle Code DRIVE WHILE REG.SUSP/REVD on 01/02/2010: Your driving privilege is SUSPENDED for a period of 3 MONTH(S) effective 04/01/2010 at 12:01 a.m. Before PennDOT can restore your driving privilege, you must follow the instructions in this letter for COMPLYING WITH THIS SUSPENSION, PAYING THE RESTORATION FEE and PROVIDING PROOF OF INSURANCE. You should follow ALL instructions very carefully. Even if you have served all the time on the suspension/revocation, we cannot restore your driving priv- ilege until all the requirements are satisfied. COMPLYING WITH THIS SUSPENSION You must return all. current Pennsylvania driver's licenses, learner's permits, temporary driver's licenses (camera cards) in your possession on or before 04/01/2010. You may surrender these items before, 04/01/2010, for earlier credit; however, you may not drive after these items are surrendered. YOU MAY NOT RETAIN YOUR DRIVER'S LICENSE FOR IDENTIFICATION PURPOSES. However, you may apply for and obtain a photo identification card at any Driver License Center for a cost of $12.00. You must present two (2) forms of proper iden- tification (e.g., birth certificate, valid U.S. passport, marriage certificate, etc.) in order to obtain your photo identification card. You will not receive credit toward serving any suspension until we receive your license(s). Complete the following steps to acknowledge this suspension. 100499283831291 1. Return all current Pennsylvania driver's licenses, learner's permits and/or camera cards to PennDOT. if you do not have any of these items, send a sworn nota- rized letter stating you are aware of the suspension of your driving privilege. You must specify in your letter why you are unable. to return your driver's license. Remember: You may not retain your driver's license for identification purposes. Please send these items to: Pennsylvania Department of Transportation Bureau of Driver Licensing P.O. Box 68693 Harrisburg, PA 17106-8693 2. Upon receipt, review and acceptance of your Pennsylvania driver's license(s), learner's permit(s), and/or a sworn notarized letter, PennDOT will send you a receipt con- firming the date that credit began. If you do not re- ceive a receipt from us within 3 weeks, please contact our office. Otherwise, you will not be given credit toward serving this suspension. PennDOT phone numbers are listed at the end of this letter. 3. If you do not return all current driver license pro- ducts, we must refer this matter to the Pennsylvania State Police for prosecution under SECTION 1571(a) (4) of the Pennsylvania Vehicle Code. PAYING THE RESTORATION FEE You must pay a restoration fee to PennDOT to be restored from a suspension/revocation of your driving privilege. To pay your restoration fee, complete the following steps: 1. Return the enclosed Application for Restoration. The amount due is listed on the application. 2. Write your driver's license number (listed on the first page) on the check or money order to ensure proper credit. 3. Follow the payment and mailing instructions on the back of the application. Please note: Paying the restoration fee DOES NOT satisfy the requirement to acknowledge your suspension/ revocation. If you have not acknowledged your suspension/revocation, please follow the instructions listed under "Complying with this Suspension/Revocation". 100499283831291 PROVIDING PROOF OF TN U AN . Within the last 30 days of your suspension/ revocation, we will send you a letter asking that you provide proof of in- surance at that time. This letter will list acceptable documents and what will be needed if you do not own a vehicle registered in Pennsylvania. IMPORTANT: Please make sure that PennDOT is notified if you move from your current address. You may notify PennDOT of your address change by calling any of the phone numbers listed at the end of this letter. APPEAL You have the right to appeal this action to the Court of Common Pleas (Civil Division) within 30 days of the mail date, FEBRUARY 25, 2010, of this letter. If you file an appeal in the County Court, the Court will give you a time- stamped certified copy of the appeal. In order for your appeal to be valid, you must send this time-stamped certi- fied copy of the appeal by certified mail to: Pennsylvania Department of Transportation Office of Chief Counsel Third Floor, Riverfront Office Center Harrisburg, PA 17104-2516 Remember, this is an OFFICIAL NOTICE OF SUSPENSION. You must return all current Pennsylvania driver license products to PennDOT by 04/01/2010. Sincerely, Z g vir) Janet L. Dolan, Director Bureau of Driver Licensing SEND FEE/LICENSE/DL-16LC/T0: INFORMATION (8:00 AM TO 6:00 PM) Department of Transportation IN STATE 1-800-932-4600 Bureau of Driver Licensing OUT-OF-STATE 717-412-5300 P.O. Box 68693 TDD IN STATE 1-800-228-0676 Harrisburg, PA 17106-8693 TDD OUT-OF-STATE 717-412-5380