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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 2 ~"
~h~ ,~/~~~.'.fy'L/"LI~Fi No. IOC' S~$~ ~l~l ~ ~ ~
(Type your name) r j `-
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Vs. Driver's Ucense/Auto Registration Appeal ~ w
. ~.~ ~~
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Drivers Ucensing
APPEAL OF DRIVER'S IiCEN/SE/AUTO REGISTRATION SUSPENSION
AND NOW, this (enter today's date) t~ ~ t0 20 ,comes the Appellant, (Type',your name)
_,~~~ S ,Z~~~ , by his/her attorney, ~~~ and states as folic
1. Appellan PA ~pe~at~or's ~ ~be~r automobile registration number is:
// ..~ [9 ~
2. PennDOT proposes, by Notice dated (insert "mailing" date here) ~~ 17 , 20 ~a . to
Appellants driving privileges ~ automobile registration for a period of (Insert length df su
(? /l1L~ir~ pursuant to Section /S"3a c of the Vehicle Code, which
suspension is to be effective {Insert suspension effective date) (D ~ 20 ~~
****A copy of the Notice sent by PennDOT is attached to this Appeal****
3. The suspension of Appellants operating privileges is contrary to law in that:
(Check those which apply)
The police lacked reasonable grounds to stop Appellant and / or request Appellant to submit to a
test.
Appellant did not knowingly or intelligently refuse a chemical test;
The conviction on which Appellant's suspension is based was overturned by successful appal, OR is
under appeal. (Attach a copy of the court docket this Appeal).
Other (Specify reason:)
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-OR-
The suspension of Appellant's automobile registration is contrary to law in that:
My failure to have insurance was for a period of less than 31 days AND 1 did not
drive nor permit anyone else to drive my vehicle during the time it was without
insurance. (Attach proof of insurance to this Appeal and either a notarized
statement of PennDOT form MV-221 to document non-operation of the vehicle).
Other (specify reason:
WHEREFORE, Appellant respectfully requests this Honorable Court to sustain the appeal from the
of operating privileges or automobile registration.
Respectfully submitted,
(Sign name her
~o h,~ S ~~fG%~l~
(Type name here)
VERIFICATION
The undersigned hereby states that the statements made in the attached Appeal of
or
Registration are true and correct to the best of my knowledge, information and belief. The undersigned understjands
that the statements in the attached Appeal are made subject to the penalties of 18 Pa. C.S. Sec. 4904 relati
unsworn falsification to authorities.
Signature:
Type Name:
Address:
City /State /Zip Code:
Telephone Number:
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~~~-as -3~~~
Email address: @
to
2
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
~A/ : Sl~~ Lih~L'%ti(a~f
(Type your name)
Vs.
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Driver Licensing
No.
Driver's License/Auto Registration ~Ippeal
CERTIFICATE OF SERVICE
The undersigned hereby certifies that on /~(Jt~ l(0 , 20 lQ~, I caused to be
mailed by regular mail, postage prepaid, a copy of the Appeal, Order Scheduling Hearing, and
all attachments, to:
Office of Chief Counsel
Vehicle and Traffic Law Division
Riverfront Office Center, 3'~ Floor
1101 South Front Street
Harrisburg, PA 17104-2516
Date: / ' `" U ~(p , 20 ~
Signature:
~"
Type your Name: ~ ~
Address:
City /State /Zip Code: ~~~ ~~ Q
Telephone: ~~ ~ ~ ~..5 d '~
** This form must be completely filled out and filed in the Prothonotary's office
77
promptly after mailing the documents to PennDOT **
COMMONWEALTH OF PENNSYLVANIA ~-
DEPARTMENT OF TRANSPORTATION
Bureau of Driver Licensing
Mail Date,: JULY 17, 2012
JOHN STEPHEN ZAENGLE WID ~ 121926739585474 001
507 PARK DRIVE PROCESSING DATE 07/102012
DRIVEK LICENSE ~ 18I3~668
BOILING SPGS PA 17007 DATE OF 9IRTH 12/24/1857
Dear MR. ZAENGLE:
This is an Official Notice of the Suspension of your Driving
Privilege as authorized by Section 1532C of the Pennsylvania
Vehicle Code. As a result of your 06/05/2012 conviction of
violating Section 13A16 of the Controlled Substance, Drug,
Device and Cosmetic Act, on 03/02/2012:
^ Your driving privilege is SUSPENDED for a period of b
MONTH(S) effective 08/21/2012 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 verb
carefully. Even if you have served all the time on the
suspension/revocation,. we cannot restate your driving
privilege 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 08/21/2012. You may
surrender these items before, 08/21/2012, 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 513.50. You must present two (2) forms of proper
identification (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.
26739585474
2.
3.
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
notarized 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
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
confirming the date that credit began. If you do not
receive 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.
If you do not return all current driver license
products, we must refer this matter to the Pennsylvania
State Police for prosecution under SECTION 1571(a)(~)
of the Pennsylvania Vehicle Cade.
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 fallowing 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".
21926739585474
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
insurance 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, JULY 17, 2012, of this letter. Ifi you file an appeal
in the County Court, the court will give you a time-stamped
certifiied copy ofi 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. You
must return all current Pennsylvania driver license products
to PennDOT by 08/21/2012.
Sincerely,
~~e~
Janet L. Dolan, Director
Bureau of Driver Licensing
SEND FEE/LICENSE/DL-16LC/T0: INFORMATION (8:00 AM TO 5:00
Department of Transportation IN STATE 1-8'00-932-~
Bureau of Driver Licensing OUT-OF-STATE 7'17-412-!
P.O. Box~b8693 TDD IN STATE 1-8D0-228-I
Harrisburg, PA 17106-8693 TDD OUT-OF-STATE 717-412-!
PM)
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
s/?CY//?Csr/Lr/? No.
(Print your name)
Vs. Driver's License/Auto Registration Appeal
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Driver Licensing
ORDER SCHEDULING HEARING ON APPEAL
AND NOW, this day of ' SI: , 20_14, a hearing is scheduled
on the appeal of Petitioner for the day of 20
h J-4 at -:-? M
in Courtroom # & of the Cumberland County Courthouse, One Courthouse Square, 4`" Floor, Carlisle,
PA 17013, at which time testimony will be taken and argument heard.
A copy of this Order has been served on Appellant. It shall be Appellant's responsibility to serve
a copy of this Appeal, all attachments, and this Order on the attorney for the Commonwealth, at the
following address:
Office of Chief Counsel
Vehicle and Traffic Law Division
Riverfront Office Center, 3'a Floor
1101 South Front Street
Harrisburg, PA 17104-2516
It shall further be Appellant's responsibility to file a Certificate of Service with the Prothonotary
stating that service was made on the Commonwealth of Pennsylvania.
B ,
Thomas A. PI ?y 'ud
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