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HomeMy WebLinkAbout13-3450 Supreme Co ,- o ennsylvania - k Cour f,Co`�mmo Pleas For Prothonotary Use Only: Ci i1r; ver Docket No: Srt County The information collected on this form is used solely for court administration purposes. This form does not supplement or replace the.rling and service ofpleadings or other papers as required by law or rules of court. Commencement of Action: S 1_ Complaint n Writ of Summons �l Petition Transfer from Another Jurisdiction 11 Declaration of Taking E C Lead Plaintiff's Name: Lead Defendant's Name: T Dollar Amount Requested: Owithin arbitration limits I Are money d mages requested? El Yes No (check one) noutside arbitration limits � O N Is this a Class Action Suit? Yes - No Is this an MDJAppeal? 0 Yes No I. A Name of Plaintif�f/ ppellant's Attorney: , EJ Check here if you have no attorney(are a Self-Represented [Pro Se] Litigant) r Nature of the Case: Place an"X"to the left of the ONE case category that most accurately describes your t PRIMARY CASE. If you are making more than one type of claim,check the one that F you consider most important. TORT(do not include Mass Tort) CONTRACT(do not include Judgments) CIVIL APPEALS El Intentional 0 Buyer Plaintiff Administrative Agencies M Malicious Prosecution E3 Debt Collection: Credit Card 0 Board of Assessment i Motor Vehicle M11 Debt Collection: Other 0 Board of Elections C] Nuisance Dept.of Transportation __.l Premises Liability © Statutory Appeal:Other S Product Liability (does not include 0 Employment Dispute: mass tort) E CI Slander/Libel/Defamation Discrimination C [J Other: D Employment Dispute:Other ! Zoning Board .h Other: i , Other: o MASS TORT I 0 Asbestos t N 0 Tobacco I =i Toxic Tort-DES Toxic Tort-Implant REAL PROPERTY MISCELLANEOUS Toxic Waste Other: 0 Ejectment C.l Common Law/Statutory Arbitration 0 Eminent Domain/Condemnation 0 Declaratory Judgment B 0 Ground Rent Lam' Mandamus ! n Landlord/Tenant Dispute 0 Non-Domestic Relations Mortgage Foreclosure:Residential Restraining Order PROFESSIONAL LIABLITY El Mortgage Foreclosure:Commercial l l Quo Warranto Ii' Dental 0 Partition 0 Replevin 0 Legal 17 Quiet Title - Other: Medical C Other: i J Other Professional: Updated 1/1/2011 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA • /ff No. J-3 , 3`� �I .(Type your nam t AST, i('ST, /yt�'DD�E C4 Vs. Driver's License/Auto Registrational rrx Commonwealth of Pennsylvania ' .i Department of Transportation r— - � Bureau of Drivers Licensing APPEAL OF DRIVER'S LICENSE/AUTO REGISTRATION SUSPENSI61\�4 AND NOW,this (enter today's date) , 20 , comes the Appellant, (Type your name) by his/her attorney, cyo 1 and states as follows: 1. Appellant's PA operator's number or automobile registration number is: 2. PennDOT proposes, by Notice dated (insert "mailing" date here) ::a 20_&J- to suspend Appellant's driving privileges ❑ automobile registration for a period of(Insert length of suspension) e pursuant to Section .l 4 of the Vehicle Code, which suspension is to be effective (Insert suspension effective date)'/ Aj,0 120 /J ****A copy of the Notice sent by PennDOT is attached to this Appeal**** 3. The suspension of Appellant's 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 chemical test. Appellant did not knowingly or intelligently refuse a chemical test; The conviction on which Appellant's suspension is based was overturned by successful appeal, OR is currently under appeal. (Attach a copy of the court docket this Appeal). Other(Specify reason:) nR n,,�tis�w h►.�G�F� , �,J�Oaf ��X�� u �� AX hy a'a D �103!16ed' )oJ 2V" / a 1 -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 I 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 suspension of operating privileges or automobile registration. Respectfully submitted, (Sign n a here) (Type name here) VERIFICATION The undersigned hereby states that the statements made in the attached Appeal of Suspension or Registration are true and correct to the best of my knowledge, information and belief. The undersigned understands that the statements in the attached Appeal are made subject to the penalties of 18 Pa. C.S. Sec. 4904 relating to unsworn falsification to authorities. Signature: Type Name: o L Address: City/State/Zip Code: Telephone Number: / Email address: @ 2 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA L No. (Typ your name) Vs. Driver's License/Auto Registration Appeal Commonwealth of Pennsylvania Department of Transportation Bureau of Driver Licensing CERTIFICATE OF SERVICE The undersigned hereby certifies that on U,)C , 20/� , 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'd Floor 1101 South Front Street Harrisburg, PA 17104-2516 Date: 1� , 20 Signature: Type your Name: �--- Address: -,-- x i City/State/Zip Code: )/ �J Telephone: / ** This form must be completely filled out and filed in the Prothonotary's office promptly after mailing the documents to PennDOT ** rcindef COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION Bureau of Driver Licensing Mail Date: 06/10/2013 MARYLOU CARTWRIGHT 230 F, GARFIELD ST SHIPPENSBURG PA 17257 Dear Ms. MA.RYLOU CARTWRIG.HT : This is an official Notice of the Recall of your Driving Privilege as authorized by Section 1519(c) of the Pennsylvania Vehicle Code. PennDOT has received medical information indicating you have a Substance Use and General Medical condition, which prevents you from safety operating a motor vehicle. As of 06/17/2013, you may no longer drive. Your driving privilege is hereby recalled until you have demonstrated your condition meets PennDOT's minimum medical standards. This decision has been made by comparing your medical information with the standards recommended by our Medical Advisory Board and adopted by PennDOT. This action will remain .in effect until PennDOT receives medical information indicating that your condition has improved, and you are able to safely operate a motor vehicle. If you feel our records are incorrect, you may have your health care provider submit updated information detailing your medical condition. in order to comply with the medical recall, you must return all valid Pennsylvania driver license products, including your driver's license, endorsement card, learner permits, temporary driver's license, and camera cards in your possession on or before the effective date listed above. If you cannot comply with the requirements stated above, a sworn affidavit stating yott are aware of the action against your driving privilege must be submitted. When PennDOT receives all of your valid products or a sworn affidavit, you will be mailed a receipt.. If you do not receive this receipt within 15 days, contact PennDOT's Driver and Vehicle Services Customer Care Center at 1-800-932-4600 immediately. If you do not return all current drivers license products, this matter-will be referred to the Pennsylvania State Police for prosecution under Section 1571 (a) (4) of the Pennsylvania Vehicle Code. YOU MAY NOT RETAIN YOUR DRIVER'S LICENSE FOR IDENTIFICATION PURPOSES. However, you may apply for and obtain a free photo identification card. The initial issuance of the photo identification card will be free by completing and following the instructions on the Application for Initial Photo identification Card (DL-54A), which is available on PennDOT's Driver and Vehicle Services website at wwwAnay.state.pa.us. The photo identification card will be valid for foie- years; however, you will be required to pay the renewal tee after the initial issuance, if you wish to continue to hold a photo identification card. You have the right to appeal to the Court of Common Pleas (Civil Division) within thirty (30) days of the mail date of this notice. 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 You still must send in your Pennsylvania driver's license products by the effective date of recall unless you appear in person before a judge and receive an order permitting you to continue drivin,,. If you have any questions, please contact the Medical Unit at (717) 787-9664, Monday through Friday, between the hours of 8 a.m. and 4:15 p.m. Sincerely, Janet L Dolan, Director Bureau of Driver Licensing Driver License# 24056216 Enclosure: DL-128 : Substance Use Form DL-123 : General Medical ;~oral DL-123 (4-12) GENERALMEDICAL FORM Bureau of Driver Licensing / pennsylvania Po.Box 686:32 PLEASE TYPE OR PRINT IN BLUE OR BLACK INK ALL INFORMATION /� DEPARTMENT OF TRANSPORTATION Harrisburg,PA 17106-8682 (717)787-9662 THIS FORM APPROVED BY THE MEDICAL ADVISORY BOARD 4/13112 Provider: For more information relating to Medical Reporting,visit http-//www.dmv.state.pa.us/centers/medicaIReportingCenter.shtm1. PATIENT INFORMATION (Please complete this form in its entirety) DRIVER'S LICENSE NO. LAST NAME(S) JR.ETC FIRST NAME 24056216 1 CARTWRIGHT MARYLOU HEIGHT I SEX EYE COLOR DATE OF BIRTH TELEPHONE NUMBER E-MAIL if applicable) I LhI INGIILS MONIFI UAY YEAR STREET ADDRESS:P.O.Box number may be used in addition to the actual CITY STATE I ZIP CODE address. but cannot be used as the only address. 1. How long have you been treating the patient? -------—___—_—_-----_----___ 2. With what diseases/conditions/disorders has the patient been diagnosed? _--_----_—_—_— _—_ 3. Do the diseases/conditions/disorders interfere with the patient's mental or physical ability to operate a motor vehicle? 4. Discuss the nature, extent, frequency and control of the relevant symptoms._—_--_— 5. Is the patient being treated with medication?_____—__—_ Ifyes, type:------------------------ — dosage: ---- If yes, does the medication make him/her unsafe to drive? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .�.I YES NO 6. Is the patient receiving any other types of treatment that affects his/her ability to drive? If yes, please describe: HEALTH CARE PROVIDER INFORMATION (Please print or type) HEALTH CARE PROVIDER'S NAME SPECIALTY HEALTH CARE PROVIDER'S LICENSE NUMBER STREET ADDRESS CITY STATE I ZIP CODE TELEPHONE NUMBER FAX NUMBER I hereby state that the facts above set forth are true and correct to the best of my knowledge,information and belief. I understand that the statements made herein are made subject to the penalties of 18 Pa.C.S.§4904(relating to unsworn falsification to authorities)punishable by a fine up to$2,500 and/or imprisonment up to 1 year. —----------- _.-- ---- -- -- --- - --------- Health Care Provider's Signature Date DL-128 (4-12) SUBSTANCE USE FORM Bureau of Driver Licensing r pennsylvania P•O. Box 68682 PLEASE TYPE OR PRINT ALL INFORMATION IN BLUE OR BLACK INK DEPARTMENT OF TRANSPORTATION Harrisburg, PA 17106-8682 (717)787-9662 THIS FORM APPROVED BY THE MEDICAL ADVISORY BOARD 4/13/12 Provider: For more information relating to Medical Reporting,visit httpJ/www.dmv.state.pa.ust centers/medica[Report!ngCenter.shtm]. PATIENT INFORMATION (Please complete this form in its entirety) DRIVER'S LICENSE NO. LAST NAME(S) JR. ETC FIRST NAME 24056216 1 CARTWRIGHT MARYLOU HEIGHT SEX EYE COLOR I DATE OF BIRTH ITELEPHONE NUMBER E-MAIL ADDRESS:(if applicable) rCCT- INCI ICS- - - - - MONTII DAY YCAH- STREET ADDRESS:P.O.Box number may be used in addition to the actual CITY STATE ZIP CODE address,but cannot be used as the only address. 1. How long have you been treating the patient? 2. Does this patient use any drug or substance, including alcohol, known to impair driving skills or functions? If yes, please specify what substance(s): ______________________________________ --------------- 3. In your opinion, does this patient abuse any drug or substance? If yes, what signs or symptoms of substance abuse does this patient currently have that would affect the safe operation of a motor vehicle? Discuss nature, extent, frequency, and control of pertinent symptoms: 4. Does this patient take any medication to control substance abuse? _ If so, please specify: Does this medication affect the patient's ability to drive? 5. Does this patient require treatment and/or counseling for substance abuse? _ 6. In your opinion, does the individual's substance use impair his/her ability to drive? . . . . .❑ Yes ❑ No HEALTH CARE PROVIDER INFORMATION (Please print or type) HEALTH CARE PROVIDER'S NAME SPECIALTY HEALTH CARE PROVIDER'S LICENSE# STREET ADDRESS CITY STATE I ZIP CODE TELEPHONE NUMBER FAX NUMBER I hereby state that the facts above set forth are true and correct to the best of my knowledge, information and belief. I understand that the statements made herein are made subject to the penalties of 18 Pa, C.S. § 4904 (relating to unsworn falsification to authorities) punishable by a fine up to$2.500 and/or imprisonment up to 1 year. Health Care Provider's Signature Date + � S IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA No. 13 el/ 12— / e//2 (Print your na ) 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 o?O__e1v day of _,�,2 , 2Q/ , a hearing is scheduled on the appeal of Petitioner for the ;?114 day of G��s-e.�.> , 20_ at AM in Courtroom # of the Cumberland County Courthouse, One Courthouse Square, 4th 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,3rd 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. By the Court, c� Iwdg6D . � � a -D 3 w --i M rri E ^ �J C .1 C-) CD ^_ �- C:), MARYLOU CARTWRIGHT, • IN THE COURT OF COMMON Petitioner : PLEAS OF CUMBERLAND : CUMBERLAND COUNTY v. COMMONWEALTH OF PENNSYLVANIA, : NO. 13-3450 CIVIL TERM DEPARTMENT OF TRANSPORTATION, : BUREAU OF DRIVER LICENSING, : DRIVER LICENSE Respondent : RECALL APPEAL ORDER AND NOW, this 2nd day of October, 2013, the appeal filed in the above- captioned matter is: REMANDED to the Department of Transportation for correction of its records. DISMISSED and the recall which is the basis of this appeal shall be REINSTATED. SUSTAINED and the recall which is the basis of this appeal shall be RESCINDED. WITHDRAWN and the recall which is the basis of this appeal shall be REINSTATED. _ l` CONTINUED and RESCHEDULED for the (3 ' day of NOu ,- , 2013, at q% 3d a- .m., in Courtroom s Room No. 6 of the Cumberland County Courthouse, Carlisle, Pennsylvania. BY THE COURT: X3_1 r— -i2j= t zi is z J. Attest: arylou Cartwright, 230 Garfield Street, Shippensburg, PA 17257 ./Philip M. Bricknell, Esq., PennDOT, Riverfront Office Center, Office of Chief Counsel, 3rd Floor, 1101 South Front Street, Harrisburg, PA 17104-2516 COFI.C.S /0/3//3 IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA • MARYLOU CARTWRIGHT • NO. 13-3450 CIVIL • v. • COMMONWEALTH OF PENNSYLVANIA, • DEPARTMENT OF TRANSPORTATION, • BUREAU OF DRIVER LICENSING 7441 111 0 V444.41A--• AND NOW, this I day of , 2013, the appeal filed in the above referenced matter is DISMISSED as moot as the Department of Transportation has restored the Petitioner's operating privileges. :Y THE Co . ATTEST: 010 % A- J Kelly Edward Solomon, Esq., Office of Chief Counsel, Department of Transportation, 1101 South Front Street, 3rd Floor, Harrisburg, PA 17104-2516 Marylou Cartwright, 230 Garfield, Street, Shippensburg, PA 17257 eop S eulta q«� 4 • )144£y* dP'LE, t � y y /1/13/13 C) c � ' rn m_ rn cp -u iy : t