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13-5221
Supreme Coup-, Pennsylvania court;'"coud'�'r ceC41nrno1!T., eas For Prothonotary Use Only; C ><1OVer�Seet Docket No: r l��3 t. ► County The information collected on this form is used solely for court administration purposes. This fiorm sloes not supplement or replace the filing and service ofpleadings or other papers as required by I=or rules of court. Commencement of Action: S . Complaint n Writ of Summons ' Petition Transfer from Another Jurisdiction ] Declaration of Taking E:. Lead Plaintiff's Name: Lead Defendant's Name: C vCSSE- A M ►N c Uwe PCfJP sf 4,vAN1 "q OT, OF -Iyr�tvs T Dollar Amount Requested: Dwithin arbitration limits I Are money damages requested? R Yes 9 No (check one) F1 outside arbitration limits Q N Is this a Class Action Suit? n Yes No Is this an MDJAppeal? [] Yes 9 No A.- of Plaintiff/Appellant's Attorney: Check here if you have no attorney (are a Self-Represented [Pro Se[ Litigant) Nature of the Case: Place an"X"to the left of the ONE case category that most accurately describes your PRIMARY CASE. If you are making more than one type of claim, check the one that you consider most important. TORT (do not include Mass Tort) CONTRACT(do not include Judgments) CIVIL APPEALS Intentional M Buyer Plaintiff Administrative Agencies Malicious Prosecution n Debt Collection:Credit Card F1 Board of Assessment F� Motor Vehicle F7 Debt Collection:Other El Board of Elections 0 Nuisance Dept.of Transportation © Premises Liability Statutory Appeal:Other S F� Product Liability(does not include F1 Employment Dispute: mass tart) � ' E] Slander/Libel/Defamation Discrimination C 0 Other: F1 Employment Dispute:Other Zoning Board T Other: Q Other: „O MASS TORT El Asbestos N F Tobacco E] Toxic Tort-DES 0 Toxic Tort-Implant REAL PROPERTY MISCELLANEOUS F1 Toxic Waste Q Other: F1 Ejectment r] Common Law/Statutory Arbitration BQ Eminent Domain/Condemnation 0 Declaratory Judgment Ground Rent n Mandamus f Landlord/Tenant Dispute n Non-Domestic Relations Mortgage Foreclosure:Residential Restraining Order PROFESSIONAL LIABLITY rl Mortgage Foreclosure: Commercial Quo Warranto F1 Dental n Partition El Replevin F1 Legal 0 Quiet Title Other: © Medical Other: Q Other Professional: Updated 1/1/2011 A IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ` ' No. C (Type your name) rx tol r'n Vs. Driver's License/Auto Registration Appear` -1 oC:� -<)> c.n Commonwealth of Pennsylvania r Department of Transportation =C Bureau of Drivers Licensing r11 C-- -4 iRJ -< t3't APPEAL OF DRIVER'S LICENSE/AUTO REGISTRATION SUSPENSION AND NOW,this (enter today's date) AUG, i',� ,20 � � ,comes the Appellant, (Type your name) ��5S A M W t vM , by his/her attorney, and states as follows: 1. Appellant's PA operator's number or automobile registration number is: GDP 1-75-1 2. PennDOT proposes, by Notice dated(insert"mailing"date here) AU G 12 , 20 1 ,to suspend Appellant's R driving privileges automobile registration for a period of(Insert length of suspension) 3 M�� pursuant to Section 1.7 of the Vehicle Code,which suspension is to be effective (Insert suspension effective date) SEPT, 120 ****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 chemical test. F1Appellant did not knowingly or intelligently refuse a chemical test; F] 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:) 1 -ot ";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:) CHI (V kAS T5fM CP1v_r)N1JQ10'3Lt' I /VSV►'zCb 61 (>UJCO DAL I <; 40(oG 40 Sk-i 00 As OF T°Me' CAti6V-1,nT I'0 N OF ESvYz_A nie_C- POLt-LIr R1 RA _ 0H-7 5 S i(©"� WHEREFORE,Appellant respectfully requests this Honorable Court to sustain the appeal from the suspension of operating privileges or automobile registration. Respectfully submitted, Sign name 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. V Signature: n Type Name: J �Lr A Address: �Sd� AL'C'M City/State/Zip Code: 14 FZHi91 %-s/3X y PA /705-5 Telephone Number: -117 314) 96"51 Email address: 13M0k)13''4 333 @ f 19HO(i.<3m 2 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION BUREAU OF MOTOR VEHICLES PO BOY 68674 HARRISBURG, PA 17106-8674 www.dmv.state.pa.us WID# 132179999013748 001 TITLE# 70402338 PROCESSING DATE 130805 TRANSACTION CODE 00060 JESSE A MINIUM 805 ALLENVIEW DR MECHANICSBURG, PA 17055 OFFICIAL NOTICE MAIL DATE: 08/12/13 Dear Customer: The Department recently requested that you provide us with proof of financial responsibility (insurance) for the following vehicle: MAKE: SUBARU YEAR: 2003 BODY TYPE: SEDAN LICENSE PLATE,¢#: GPD1757 TITLE##: 70402338 VIN##: JF1GD29653G511422 This information was requested because ESURANCE PROPERTY AND CAS INS CO notified us that the insurance policy covering the vehicle listed above was terminated on 06/24/13. Either no response was received or the information you provided was not acceptable. As a result, the registration for the vehicle listed above will be suspended for three months effective 09/16/13 at 12:01 A.M. as authorized by Section 1786(d) of the Vehicle Code. THIS IS A FINAL ORDER OF SUSPENSION. You are required to return your current registration plate, sticker and card to the Department immediately. Credit toward serving this suspension will not begin until the Department receives your registration products. Additionally, you are required to pay a restoration fee in the amount of$50 to the Department in accordance with Section 1960 of the Vehicle Code. Please make check or money order payable to the PA Department of Transportation. Do not send cash. You can also pay by credit card online at www.dmv.state.na.us by selecting "Pay Your Financial Responsibility Restoration Fee". Within 30 days of your eligibility date for restoration, you will also be required to show proof of insurance for this vehicle. We have enclosed a self-addressed envelope for your use when corresponding and a mailing label to assist with the return of your registration plate, sticker and card. When the Department receives your registration products, we will send you a letter within 3 weeks confirming that they were received. If, after 3 weeks of mailing your registration plate, sticker and card to the Department you do not receive a letter stating your registration products were received, please contact us immediately. t" - - -- ° -I--*-'-- _ You have the right to appeal this suspension to the Court of Common Pleas of the county of your residence within thirty(30) days of the mail date 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 the appeal to be valid, you must send this time stamped certified copy of the appeal by certified mail to: Pennsylvania Dept of Transportation Office of.Chief Counsel 1101 S Front Street-3rd Floor Harrisburg, PA 171042516 GE1 Pennsylvania Financial Responsibility What to do at the time of an accident ° gei co.com Identification Card 1-800-841-3000 GEICO CASUALTY COMPANY Do not admit fault ONE GEICO BOULEVARD FREDERI0[i3}2G, VA 22412-0003 Do not reveal the limits of your liability coverage NAIC Code:41491 to anyone Policy Number Effective Datpiration Date Exchange contact Information;get year,make, 4066405400 06-05-13 >'; a12-05-13 model,plate number,Insurance carrier and Not valid More Tj ap<O 9 policy number of all Involved.Also identify Year From Effective.Paola witnesses and collect contact information Year Make Mod± l' Vehicle ID No. 2003 SUBARU IMPZRW J F1GD29653G511422 Contact the police or call 911 if applicable Insured:JESSE A MINIUM Contact GEICO by calling 1-800-841-3000 to 805 ALLENVIEW DR s>>;; report the accident MECHANICSBURG, PA 17055-6190':;; Authorized Representative SEE GJFORTANT NOTICE ON REVERSE SIDE IMPORTANT NOTICE Re-garding Your Financial Responsibility Insurance Identification Card. We are required by Pennsylvania law to send you an Identification (ID)card. The card shows that an insurance policy has been Issued for the vehicle(s)described satisfying the financial responsibility requirements of the law. If you lose the card,contact your insurance company or agent for a replacement. The ID card Information may be used for vehicle registration and replacing license plates. If your liability Insurance Is not In effect the card is no longer valid. You are required to maintain financial responsibility on your vehicle. It is against Pennsylvania law to use the ID card fraudulently such as using the card as proof of financial responsibility after the insurance policy is terminated. Please notify us promptly of any change in your address to be sure you receive all Important policy documents. Prompt notification will enable us to service you better. If you would like additional ID cards you can go online to igeico.com or call us at 1-800-841,3000. THIS CARD MUST BE CARRIED FOR PRODUCTION UPON DEMAND.IT IS SUGGESTED THAT YOU CARRY THIS CARD IN THE INSURED VEHICLE. WARNING:Any owner or registrant of a motor vehicle who drives or permit:a motor vehicle to " be driven in thiiState out the required financial responsibility may have his registration suspended orI voked NOTE:THIS C RD IS`REQUIRED WHEN: (a) You re'invdlved In a motor vehicle accident (b) You re coniricted of o traffic offense other than a parldng offense that requires a court app ranoa. (c) You re stopped for violating any provision of the Vehicle Code(75 Pa.C.S.Section 101-0910)and requested to produce it by a police officer. You must prove a copy of this card to the Department of Transportation when you request i . YC LQIII nCl'C .• - V1 Vr'vi _--�_.�- - .! �v�Y�.V 1�.� ' ca COMMONWEALTH OF PENNSYLVANIA REGISTRA7IQNCEZEg1T1AL , a' EXP IRY =FEB 28,-2014 VALID 2/112013 rT • Lf') .PLATE:.,:._ GPD1757 .... `�:•+ u, °. ., — — — — — R — — — — SIGNATURE f1J ;TITLE 70902338302 MI , •VIN 31GP29653SS13A22 YR/MAKE: 2003` SU(4RlJ I hereby acknowledge This day that I have received TYPE'.:` " I ' S0N notice of the provisions of Section 3709 of the Vehicle WID i �1309313427"023257 001 Code. _EMISSIONS INSPECTION REQUIRED/DIESEL VEHICLES EXEMPT COUNTY:CUMBERLAND . 039036 JESSE A MINIUM 805 ALLENVIEW DR MECHANICSBURG PA + 1 17055 'N7fj IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA JESSE A MINIUM No. ✓ (Type 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 SEPTEMBER 10 , 2013 , 1 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 h_.y Riverfront Office Center,3`d Floor C -'-; 1101 South Front Street Harrisburg,PA 17104-2516 -7a � - enr" ter; C�r� z Date:SEPTEMBER 10 20 i 3 , 2t CD Signature: > Type your Name: J SE A MINIUM Address: 805 ALLENVIEW DRIVE City/State/Zip Code: MECHANICSBURG, PA 17055 Telephone: 717-329-9651 **This form must be completely filled out and filed in the Prothonotary's office promptly after mailing the documents to PennDOT** IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA U� � � N A M / I Utz No. 3 �� (Print your name) C-3 CD C= Vs. Driver's License/Auto Registratic ' p (R) Commonwealth of Pennsylvania Department of Transportation 2 C(Z) - c� Bureau of Driver Licensing Z� ORDER SCHEDULING HEARING ON APPEAL = cads �— y .�J ch AND NOW, this day � 20 13 a hearing is scheduled on the appeal of Petitioner for the 1,341k day of boyWik , 20 13 at q: D jLm 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 do rt, Judge Thomas A. Ptacey I Common Pleas Judge J . M#j1*Uryx Q/tc/l3 IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY, PENNSYLVANIA JESSE A. MINIUM • NO. 13-5221 CIVIL v. • COMMONWEALTH OF PENNSYLVANIA, • DEPARTMENT OF TRANSPORTATION, • BUREAU OF MOTOR VEHICLES • ORDER AND NOW, this ‘`-0 day of MfAMIAAfic-P---.. , 2013, the appeal filed in the above referenced matter is DISMISSED as the appealed suspension has been removed from the Petitioner's record. BY THE COURT: • J. ATTEST: S P � Kelly Edward Solomon, Esq., Office of Chief Counsel, Department of Transportation, 1101 South Front Street, 3rd Floor, Harrisburg, PA 17104-2516 Jesse A. Minium, _ = (OZ3 C I& T& rc (4,400C. Q•oAO tu.sio P.4 r°A 1100‘ \ Ccr,i cs >t sc�a l.( �,� 6 J. �1b� � y y /0.3013 CIZ7 ° _.) 1 z to r` -- :fir f- C11