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IFI'iEkLkY ?V Jii= lip
PENNSYLVANI A
IN THE COURT OF COMMON PLEAS ru rn g p KLAN 1> COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
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Terra?Ce-
Appellant
COMMONWEALTH OF PENNSYLVANIA,
DEPARTMENT OF TRANSPORTATION
Appellee
PETITION FOR APPEAL
AND NOW, this day of .20
, comes Appellant,
and files this Appeal of the Commonwealth of
Pennsylvania, Department of Transportation's decision recalling, suspending, revoking Appellant's
driving privileges or disqualifying the Appellant from receiving driving privileges and in support thereof.
represents as follows:
I . Appellant is -L'.. r ra nr e T. F 1e- , who resides at 4, C Q-Qi) P r Li-de b
(Marne) tStreetTA"ddmss)
C-ar) )Sl? Phi 1 I
1 rl 0 S Horne phone:, l rI
(Croty, State and?5p Cade)
Cellular Phone:
Work Phone- r7 I I - 3L9 D - a 4? S?
Appellant's Pennsylvania driver's license number is a 1 to d\() 9
Appellant has received notice that appellant's operating privileges have been cancelled, recalled
suspended, revoked or disqualified by DOT, effective /9 ` ) a,U / co. . A copy
tl3ate Acti-n Taken by DOTComemirg Your License Begins)
of said notice is attached.
?N'herefore, Appellant respectfully requests that this Honorable Court review the aforesaid action
of DOT and set a hearing date to do so.
Respectfully submitted,
11'?-v ?1 -411"4-LLZ r
A _ ellant, Pro Se (signature)
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IN THE COURT OF COMMON PLEAS OFClir% .A410COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
r__T?rr e? e- T Frye-_
Appellant
A.D.
COMMONWEALTH OF PENNSYLVANIA,
DEPARTINIENT OF TRANSPORTATION
Appellee
CERTIFICATE OF SERVICE - HEARING NOTICE
7R. r ra b r L _F1 Fr V _ ? petitioner in the above-captioned case, hereby eertifv that I
served a true and correct date-stamped copy of the Order scheduling a Hearing on my Petition for Appeal
by certified mail, return receipt requested on 20 to the Commonwealth of
Pennsylvania, Department of Transportation. The return receipt signed by a representative of the
Pennsylvania Department of Transportation is attached hereto.
Lsd?? L?l , :?L? -
Appellant, Pro Se (signaturf)
Date
` TRIF.ICATION
Tp rro_ n Fr U Q , verify that the statements made in this Petition for
(Name)
Appeal are true and correct to the hest of my knowledge, information and belief. I understand that .false
statements made herein are made subject to the penalties of 18 Pa.C.S.A. §4904 relating to L"nsworn
Falsifications to Authorities.
<>?ppellant, lira Se {signature.)
Fr - IS' --I I
Date
iN THE COURT OF COMMON PLEAS OF eu MDF RLANOCOUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
Appellant
A.D,
COMMONWEALTH OF PENNSYLVANIA,
DEPARTMENT OF TRANSPORTATION
Appellee
CERTIFICATE OF SERVICE - APPEAL PETITION
Te Petitioner in the above-captioned case, hereby certify that I
sexed a tnae and correct date-stamped copy of niy Petition for Appeal by certified nail, return receipt
requested on 20-_ to the Commonwealth of Pennsylvania, Department of
Trensportation_ The return receipt signed by a representative of the Pennsylvania Department of
Transportation is attached hereto.
?1 1-0-Cl , ap-
Appellant, Pro Se ` (signature
Date
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF TRANSPORTATION
Bureau of Driver Licensing
Harrisburg, PA 17123
AUGUST 04, 2011
TERRANCE T FRYE WID # 112096680978210 002
2 COOPER CIRCLE DR PROCESSING DATE 07/28/2011
DRIVER LICENSE # 21620905
CARLISLE PA 17015 DATE OF BIRTH 06/28/1965
LICENSE IN BUREAU
Dear Motorist:
This is an Official Notice of Disqualification of your com-
mercial driving privilege as authorized by Section 1611A of
the Pennsylvania Vehicle Code as a result of your pre-
adjudication, conviction, administrative adjudication, or
refusal in Pennsylvania.
Your driving record reflects one of the above adjudications
on 05/26/2011 of 3802A1, of the Pennsylvania Statutes, DUI
GENERAL IMPAIRMENT on 07/04/2010.
Your commercial driving privilege is disqualified for a pe-
riod of 1 YEAR(S) effective 06/14/2012 at 12:01 A.M.
The above mentioned sanction is in addition to any pre-
viously issued sanction(s).
You have the right to appeal the Department's action to the
Court of Common Pleas (Civil Division) within 30 days of the
mail date (AUGUST 04, 2011) of this notice. You must still
send in your license before the effective date of disquali-
fication unless you show the Court that you have a reason-
able likelihood of succeeding in the appeal and receive an
order permitting you to continue to drive. PLEASE NOTE that
this Civil Appeal is in addition to any appeal you have to
file from the criminal conviction.
AFTER THE APPEAL HAS BEEN FILED IN THE COUNTY COURT, A
TIME-STAMPED CERTIFIED COPY OF THE APPEAL MUST BE SENT BY
CERTIFIED MAIL TO:
PENNSYLVANIA DEPARTMENT OF TRANSPORTATION
OFFICE OF CHIEF COUNSEL
THIRD FLOOR, RIVERFRONT OFFICE CENTER
HARRISBURG, PA. 17104
112096680978210
SEND FEE/LICENSE/DL-16LC/T0:
Department of Transportation
Bureau of Driver Licensing
P.O. Box 68693
Harrisburg, PA 17106-8693
Sincerely,
Z g 0,jr)
Janet L. Dolan, Director
Bureau of Driver Licensing
INFORMATION (8:00
IN STATE -
OUT-OF-STATE
TOO IN STATE
TOO OUT-OF-STATE
AM TO 5:00 PM)
1-800-932-4600
717-412-5300
1-800-228-0676
717-412-5380
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF TRANSPORTATION
Bureau of Driver Licensing
Mail Date: AUGUST 04, 2011
TERRANCE T FRYE WID 4 112096680978210 002
2 COOPER CIRCLE DR PROCESSING DATE 07/28/2011
DRIVER LICENSE # 21620905
CARLISLE PA 17015 DATE OF BIRTH 06/28/1965
LICENSE IN BUREAU
Dear MR. FRYE:
This is an Official Notice of the Suspension of your Driving
Privilege as authorized by Section 3804E21 of the
Pennsylvania Vehicle Code. As a result of your 05/26/2011
conviction of violating Section 3802A1 of the Vehicle Code
DUI GENERAL IMPAIRMENT on 07/04/2010:
¦ Your driving privilege is SUSPENDED for a period of 1
YEAR(S) effective 12/14/2012 at 12:01 a.m.
This suspension is in addition to any other suspensions al-
ready on your record.
IGNITION INTERLOCK
Before your driving privilege can be restored you are re-
quired by law to have all vehicle(s) owned by you to be
equipped with an Ignition Interlock System. This is a result
of your conviction for Driving Under the Influence. You will
receive more information regarding this requirement approx-
imately 30 days before your eligibility date.
PROVIDING PROOF OF INSURANCE
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.
112096680978210
APPEAL
You have the right to appeal this action to the Court of
Common Pleas (Civil Division) within 30 days of the mail
date, AUGUST 04, 2011, 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 certified 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.
Sincerely,
Zee Vt..)
Janet L. Dolan, Director
Bureau of Driver Licensing
INFORMATION 8.00 a .m. to 5:00 p.m.
IN STATE 1-800-932-4600 TOO IN STATE 1-800-228-0676
OUT-OF-STATE 717-412-5300 TOO OUT-OF-STATE 717-412-5380
WEB SITE ADDRESS www.dmv.state.pa.us
I
COMMONWEALTH OF PENNSYLVANIA,
DEPARTMENT OF TRANSPORTATION
Appellee
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A
IN THE COURT OF COMMON PLEAS OFCuv\8eg *b 'OUNTY, PENNSY Nff
CIVIL ACTION - LAW ?C 72 72
C-- y)
Te- rrc?n ?F r I/ e- ,-,_ -
Appellant
. A.D. - ??S I?.lr
_,• ORDER
AND NOW, this A_ day of Pf -^11!7?? . 201-!-, upon presentation and
consideration of the within Petition, it is hereby ORDERED and DECREED that a Hearing can the appeal
shall be ld on the?day of 20L-ataoo'clock I m. in Courtroom
No. ofthe CVt1?10 ,9.i-FAN ?C?u.?T? Ct?•. ZTJ40i,'?r- COxr1iS)-C ?Pfl
X70)3- 9'-de iZ:00,0.
It is further ordered tha the, Appellant shall serve this notice upon t Con2monwealth of
Pe-insylvania, Department of "Iransportation, Office of Chief Counsel, Third Floor, Riverfront
Office Center, Harrisburg, PA 17104-2516, by certified mail, return receipt requested, within ten (10)
days. Appellant shall file a Certificate of Service with the Prothonotary.
It is further Ordered and Decreed that the instant. appeal shall act as a supersedeas so that the
Appellant shall retain Appellant's operating privileges pending the outcome of the within Appeal; unless
the appeal is from a suspension or, cancellation of a driver's license under Sections 1503 (relating to
persons ineligible for licensing, license issuance to minors; junior dri-ver's license), 1504 (relating to
classes of licenses), 1509 (relating to qualifications for school bus driver endorsement), 1514 (relating to
expiration and reneGval of driver's licenses), 1519 (relating to determination of incompetency) or 1572
(relating to cancellation of dri'ver's license). ht such cases the filing of the "Petition for Appeal" shall not
automw ically act as a supersedeas.
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