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Home My WebLink About14-1635Supreme Court offPYYennsylvania Ys Court-of Common-Pleas Civil .Cover Sheet CvYy1 Va oondt County For Prothonotary Use Only: Petition Declaration of Taking Docket No: i'2- N'13(' e'n_ The information collected on this form is used solely for court administration purposes. This form does not supplement or replace the filing and service of pleadings or other papers as required by law or rules of court. Commencement of Action: Petition Declaration of Taking ❑ Complaint ❑ Writ of Summons • ❑ Transfer from Another Jurisdiction ❑ Lead Plaintiff's s Name: Lead Defendant's Name: ;- Dollar Amount Requested: (check one) • within arbitration limits Are money damages requested? • Yes ?Er"-No • outside arbitration limits Is this an MDJAppeal? Is this a Class Action Suit? • Yes Q-No • Yes EVNo Name of Plaintiff /Appellant's Attorney: 4 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) ❑ Intentional ❑ Malicious Prosecution ❑ Motor Vehicle ❑ Nuisance ❑ Premises Liability ❑ Product Liability (does not include mass tort) ❑ Slander /Libel/ Defamation ❑ Other: MASS TORT ❑ Asbestos ❑ Tobacco ❑ Toxic Tort - DES ❑ Toxic Tort - Implant ❑ Toxic Waste ❑ Other: PROFESSIONAL LIABLITY ❑ Dental • Legal ❑ Medical ❑ Other Professional: CONTRACT (do not include Judgments) ❑ Buyer Plaintiff ❑ Debt Collection: Credit Card ❑ Debt Collection: Other ❑ Employment Dispute: Discrimination ❑ Employment Dispute: Other ❑ Other: REAL PROPERTY ❑ Ejectment ❑ Eminent Domain/Condemnation ❑ Ground Rent • Landlord/Tenant Dispute ❑ Mortgage Foreclosure: Residential ❑ Mortgage Foreclosure: Commercial ❑ Partition • Quiet Title ❑ Other: CIVIL APPEALS Administrative Agencies ❑ Board of Assessment ❑ Board of Elections S] -Dept. of Transportation ❑ Statutory Appeal: Other ❑ Zoning Board ❑ Other: MISCELLANEOUS ❑ Common Law /Statutory Arbitration ❑ Declaratory Judgment 0 Mandamus Non - Domestic Relations Restraining Order 0 Quo Warranto ❑ Replevin ❑ Other: Updated 1/1 /2011 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA SarahJean Miller (Type your name) Vs. Commonwealth of Pennsylvania Department of Transportation Bureau of Drivers Licensing No. S- /6 3-s Driver's License /Auto Registration Appeal APPEAL OF DRIVER'S LICENSE /AUTO REGISTRATION SUSPENSION AND NOW, this (enter today's date) February 26 2014 , comes the Appellant, (Type your name) Sarah Jean Miller , by his/her attorney, and states as follows: none 1. Appellant's PA operator's number or automobile registration number is: VIN #1HGEM219X1L124328 2. PennDOT proposes, by Notice dated (insert "mailing" date here) February 26. 2014 , to suspend Appellant's driving privileges automobile registration for a period of (Insert length of suspension) 3 months pursuant to Section of the Vehicle Code, 1786(d) which suspension is to be effective (Insert suspension effective date) Atoll 2.201.4. * * * *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; 11 i ❑ The conviction on which Appellant's suspension is based was overturned by successful appeal, cd xs_; currently tinder appeal. (Attach a copy of the court docket this Appeal). ❑ Other (Specify reason:) na _r, • 1.0 -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). $ /o3. ispd p /ei Cash 12716 3,03.27 21 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Other (s )eci reason:) Please see attached, letter of Appeal. WHEREFORE, Appellant respectfully requests this Honorable Court to sustain the appeal from the suspension of operating privileges or automobile registration. Respectfully submitted, cm ,e (Sign name here) Sarah J. Miller (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 unworn falsification to authorities. Signature: / Type Name: Sarah J. Miller, RN Address: 3609 Haywood St, City / State / Zip Code: Philadelphia, PA 19129 Telephone Number: 7046617927 Email address: Miller,sarahjeanagmail.com Sarah J. Miller, RN, BSN 3609 Haywood St., Philadelphia, PA 19129 Miller.SarahJean @gmail.com, 704.661.7927 1 Courthouse Square, Carlisle, PA 17103 Cumberland County Offices Common Pleas Court RE: Appeal of Suspension 2/26/2014 To the Honorable Court of Cumberland County, Good day. I am writing to appeal the registration and license plate suspension of the vehicle VIN #IHGEM219X1L124328, License Plate #HPJ -376, Driver's License #29 815 541, scheduled to occur on April 2, 2014. This is in relation to an insurance policy cancelled by Safeco Auto on December 31, 2013. I recently moved to Philadelphia from New Cumberland, PA. I have since then been commuting to work in York, PA, often staying out of town for work for several weeks at a time. For this reason, I chose electronic billing for my policy, to ensure I could monitor my coverage. I received an electronic bill that stated the new policy term started in February 2014. However, I mistook the policy date for the bill due date and therefore missed the due payment (December 6, 2013). I was out of town and out of state working for the month of December and part of January. I returned home January 14, 2014 to a paper mail notice (sent December 8, 2013) that stated my payment was overdue, as well as a notice stating they cancelled my policy as of December 31, 2013. I did not receive any electronic or phone communications reporting that my bill was overdue, nor regarding my policy cancellation. As soon as I received these notices and became aware of the situation, I had my coverage reinstated with Safeco, January 15, 2014. I then had active insurance with Safeco from January 15, 2014 to January 19, 2014, when I had my coverage switched to Progressive Auto Insurance (please see attached proof of insurance). When I received the notice from PENNDOT asking about my cancellation and lapse, I attempted to contact the agent at Safeco with whom I had previously communicated electronically about my policy. I had no responses from the representative after multiple attempts trying to contact her. I finally reached another representative from the company February 26, 2014 to gather the information I needed to respond to PENNDOT. Sarah J. Miller, RN, BSN The initial letter from PENNDOT has a mail date of January 10, 2014, and I was out of town working at that time. This notice did state that I needed to respond; however, it did not state a date by which I needed to respond. I therefore proceeded to gather thoroughly the necessary information to respond appropriately. Today, February 26, 2014, after returning home from 2 weeks out of town for work, I received a second letter from PENNDOT stating that my registration and plates would be suspended April 2, 2014 for 3 months, because I had not yet responded to their initial letter. I would like to appeal this suspension of my registration /license plates in relation to the facts presented above. I did not receive adequate notification via the selected method of communication (electronic) about this issue. I immediately had the insurance reinstated as soon as I learned of the issue, and PENNDOT gave no date by which I had respond; therefore, despite the trouble contacting Safeco, I gathered all the correct information to take care of this issue before responding. The lapse was not due to negligence. I do have current active insurance coverage at this time, and I do need my vehicle to continue commuting to work; therefore, I respectfully request this Honorable Court to sustain the appeal from suspension of vehicle registration. Thank you very much for your time. Sarah J. Miller, RN, BSN Enclosures 2 Sarah J Miller Silver Membership Form A023 PA (03/11) IF YOU'RE IN AN ACaDBIT 1. Remain at the scene. Don't admit fault. 2. Find a safe location, call the poke, and exchange driver information. 3. Call Progressive right away. TO REPORT A CIAIM Call 1-800-274-4499 or go to daims.progressive.com. Use your own repair shop, or choose one in our nenvork. Or, let us manage the process start-to-finish at our Service Center in Willow Grove, PA. IM711,7E9711YE KEEP BUS CARD IN YOUR VEHICLE WHILE IN OPERATION. FINANOAL RESPONSIBILITY IDENTIFICATION CARD PENNSYLVANIA Policy Number: 67050110-0 NAIC Number: 32786 Fffedive Date: 01/19/2014 Expiration Date: 07/19/2014 NOT VALID FOR MORE THAN 1 YEAR FROM EFFECTIVE DATE Insurer: Progressive Spedaky Insurance Co 1-800-876-5581 PO Box 6807 Cleveland. OH 44101 Named Insteed(s): Sarah] Miler 3609 Haywood St Philadelphia, PA 19129 Year Make Model 2001 Honda Civic VIN 1HGEM219X11.124328 This crud must be carried for produdion upon demand. It is suggested that you carry this card in the insured vehicle. WARNING Any owner or tvqisbantofa motor vehide who drives or permits a motor veldde to be driven in this State without the required Sundal responsilffrty may have his registration suspended or revoked. 18018: 1815 CARD IS REQUIRED WHEN (1) You are involved in an auto midden. (2) You are convicted of a traffic offense other than a parking offense that requires a court (3) You are stopped for vSitariTir provision of 75 Pa.CS. kel-ating to Vehicle (ode) and requ to produce it by a police officer. You must provide a copy of this and to the Department of Transportation when you request a restoration of your operatmg privilege and/or registration privilege, which has been previously suapended or revoked. 1 PENNSYLVANIA FINANCIAL RESPONSI C2C I'TY! (DENT IFICATION ;CARD Asuran AMERICAN ST/AT1 =S'i SlJRANCE.CdMPANY rte, U. • COMPANY _ _ � �; x t NX i+t y td•S` t r•" '....,• .'[ ▪ l w' 1• ... 1>.rtG./ !-3.1.-,..',-.=.f. f 1'r •� ▪ >£c tr v ♦ �•"" a .. •s• . r r _ < -... - • �+� , .�1.:�, n I Y =� `: �t' 'a�'r'J ,p0UcY NUMBER �t� 4EFFECT fiAT£ PE8 ->.6 X2014 ,, c Yti �r .X55,93465. ` `u . NOT VAIUD.MORE THAN YEAR•;FROM EFFE(`'IIVE'DATA . K { > „rd1I AODEI''x.j ';�yry ' VEHICLE IDENTIFICATION NUIMBER'r,.w �� R.`. "^ >��,�t .Mwi' �, g 1 M G`M219X 1 LL# 24'8> 1.� 210 u 1 ,.l ::.. . F� N DA , , ' .. , „ r: .f�. -7,..;;!.'-",?.:-.. A>a£NCYL�;OQMRANY;ISSUING CARD +? jr'r ,'rZ s° JNSUR CE.F ANSWER ,CENTER #. LCi ,,� ( <f 'j;= $00-49:5 y :57'8 ;�f `" ' `` �t�: ,� �Z �� 1• '•('�TN•1: -.P 'ICY-- `SU}!:PZ T,.. r :tr r.....�..:�k. •_.,- `., # • - t1' . -$;O X' -.: 4,'. 1 9 7 : ' -. .; 0's •ANGEL, S ' M :4 '' titiN tilEQk> ht :y s l ? , v< r 4 ✓' j • '' ' rvS"A RAH 'J .- MILLER .Y SK r,. • v r 6 9., HA 0100 ST,' r V15� s y� - �;,>- PHILAOE PHIA 'PAy' 19129,E 17 ri �t fy �, �' t , . •- ...„;„,-• : •.. vM'c' a. • x.�h•M�;�,A • . ,_ { �' ��s t • t r e. y >'x i♦ ti i;..f v> vyrtt- z �av,vyr •, ,`TFt:. '`•i!eJ, }” 0:.,,;'i;'>t*r*�a� t. t� .�3j'� 1�4N1 re, v ; 4 .1 ut••t CN,3704/PAEP 12/O8P";IEE IMPORTANT NOTICE�ON REVERSE SIDE ` ' ' t. >� r .;> °PENNSYLVANIA FINAN. CIAL" RESPONS141LITY 'IDENTIFICATION,CARD-'- • ,. Safeco `> COMPANY • .. 'S.4 - '> '; s ... Iti'surane AME_ RICAN STATES INSURANCE, COMPANY y 19704.`'5 O Y 'r 1 t FFECTiVE"DM- ;J: AN • 15 2>014 :{! 5 5 9 NUMBER 6 5 .- ti E , C� C IVE�DATE "`41- • NOT VAC.Ib'�I�ORE 7H�lFi �Y.EAft.'FROM EfFE ?, YEAR.. - r.:? H.ICLE IDENTIFICA1IO 1 NWMBER YE ;':; •. y k• .E. � 1t1KE/MODR.'4 w .. : Y 2D0I �. _,�. ' ';HON:DA` ,- 1 1:GE!'N219X1L.1.2 328 OENCY/COMPANY1SSUING^CARiS:•y Hr..a,� ... f n, r. ,i w.,'w... r .c w • f NS>URANC `ANSWER 5CEN7E • 411;N:.):01!. PO t:ICY„ Su -PORTT LOS ANGELES � r`1CA.:k�v ▪ �SARAIT' 'J N.I1 LFQ ;4 > ^" '3b0 = 'HAVwOOD .rPII I LADE l«;P%H_ I • COMMONWEAI, T1I OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION BUREAU OF MOTOR VF,IIICLES P() BOX 68674 HARRISBURG, PA 17106 -8674 www.dmv.state.pa.us SARAH JEAN MILLER 24 ROSS AVE APT D NEW CUMBERLND, PA 17070 Dear Customer: WID# 140109999007690 001 TITLEt 69878837 PROCESSING DATE 140110 TRANSACTION CODE 00030 MAIL DATE: January 10, 2014 The Department of 'Transportation recently received information from your insurance company regarding a cancellation of youry.automohile insurance. ...PennDOT. realizes that :ouanay haveon1y- chang, d•companies - •••• — -•-• • however, insurance companies are only required to notify us of a cancellation of insurance but not when they add you as a customer. Therefore, we need to verify your new coverage with this letter. Please take the time to read this letter carefully and provide PennDOT with necessary information. The insurance. company that notified us of the cancellation and the vehicle affected are listed below. TI1I~; INSURANCE CANCELLATION DATE IS 12/31/13. Insurance Information Vehicle Information INSURANCE CO: AMERICAN STA'1'1;S INSURANCE COMPANY POLICY NUMBER: X5593465 DATE INSURANCE WAS CANCELLED: 12/31/13 MAKE: IIOND YEAR: 2001 BODY TYPE.;: COUPE LICENSE PLA7F, NUMBER: TITLE: 69878837 VIN: 1IIGEM219XIL124328 11PJ3776 Below is a list of seven scenarios and information PennDOT will require: 1) If you obtained insurance with a new insurance company before or on the same date your previous insurance was cancelledi please send PennDOT proof of new insurance. A listing of acceptable proof of insurance is located on the second page. 2) If you obtained valid insurance within 30 days from when your previous insurance was cancelled; please send PennDOT your current proof of insurance with the new effective date. If you did not operate the vehicle referenced above, please complete the enclosed Statement of Non -Operation. of Vehicle. \fnte:..If vou.. - operated the ve-liicle during the lapse, lie vehicle registration will be suspended for three months. You will receive an official notice of suspension letter in the mail. Credit towards sewing a three month registration suspension will not begin until PennDOT receives the registration plate, card and sticker. 3) If your insurance policy was reinstated with the same company and there was no lapse of coverage; Please send PennDOT a signed letter from the insurance company's headquarters. This letter must he on the ' company's letterhead stating the date the policy resumed active coverage, policy number, policy effective and expiration dates, NAIC nurnher and. VIN. 4) If you cancelled your insurance and you are not going to obtain valid insurance on your vehicle listed above; the registration plate, card and sticker must he returned to Penn.DOT within 30 days from the insurance cancellation dale. NOTE: If you do not send PennDOT your registration plate, registration card and sticker within 30 days of the insurance cancellation date, the vehicle registration will he suspended for three months. You will receive an official notice of suspension letter in the mail. Credit towards serving a three month registration suspension will not begin until PennDOT receives the registration plate, card and sticker. 5) If you do not have insurance for the vehicle referenced above and more than 30 days elapsed from insurance cancellation date: the vehide registration will be suspended for three months. You will receive an official notice of suspension letter in the mail. Credit towards serving a three month registration suspension will not begin until PennDOT receives the registration plate, card and sticker. 6) If you sold, transferred or traded your vehicle; please send PennDOT a copy of the front and back of the Certificate of Title or a bill of sale. If you salvaged your vehicle., please provide PennDOT a copy of the salvage certificate. 7) If your vehicle was repossessed; please send PennDOT your registration plate, card and sticker within 30 days from the insurance cancellation date. Pennsylvania law requires you to maintain financial responsibility on a registered vehicle. Please send required information to: PA Department of Transportation Bureau of Motor Vehicles P.O. :Box 68.634 Ilarrisburg, I'A 17106- 8674 Acceptable Proof of Insurance * Insurance identification card. * A valid hinder of insurance.(Note: Policy information will be requested upon expiration of binder) * Declaration page of your insurance policy. * Application for insurance to the Pennsylvania Auto Plan. * A letter from the insurance company's headquarters or your insurance agent. Photocopies are acceptable. Originals will not be returned. If you believe -your insurance coverage was terminated in error or you did not receive proper notice of your insurance termination, you should file a complaint with the Pennsylvania Insurance Department, Bureau of Consumer Services. Complaints can be filed via the website at www.insurance.pa.gov or mailed to the Pennsylvania Insurance Department, Bureau of Consumer Services at 1209 Strawberry Square, Harrisburg, PA 17120. Please include your insurance company name and policy number with your complaint. Sincerely, Service Representative Team Bureau of Motor Vehicles Information (8:00 AM to 5:00 PM) Pennsylvania 800- 932 -4601) Out of State 717- 412 -5301) TDD Pennsylvania 800 -228 -0676 TDD Out of State 717 -412 -5380 Statement of Non - Operation of Vehicle NOTE: TIUS STATEMENT IS UNACCEPTABLE W INSURANCE LAPSE IS GREATER TIIAN 30 DAYS. ALL INFORMATION MUST BE COMPLETED BY THE VEHICLE OWNER ONLY. I, , hereby state that I did not operate or permit operation of the following motor vehicle between / / to VIN IIIGEM219XII,124328 TITLE 69878837 due to lapse of insurance. LICENSE PLATE NO. HPJ3776 Signature in ink Date COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION BUREAU OF MOTOR VEHICLES PO BOX 68674 HARRISBURG, PA 17106 -8674 www.dmv.state.pa.us SARAH JEAN MILLER 24 ROSS AVE APT D NEW CUMBERLND, PA 17070 WID# 140509999023076 001 TITLE# 69878837 PROCESSING DATE 140219 TRANSACTION CODE 00060 OFFICIAL NOTICE MAIL DATE: 02/26/14 Dear Customer: The Department recently requested that you provide us with proof of financial responsibility (insurance) for the following vehicle: MAKE: HONDA YEAR 2001 BODY "TYPE: COUPE LICENSE PLATE#: HPJ3776 TITLE#: 69878837 VIN #: IHGEM219X1I,124328 This information was requested because AMERICAN STATES INSURANCE COMPANY notified us that the insurance policy covering the vehicle listed above was terminated on 12/31113. 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 04/02/14 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.pa.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- slicker and card:lo._the Department you do not receive a letter stating your registration products— were received, please contact us immediately. 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 17104 -2516 • If you believe your insurance coverage was terminated in error or you did not receive proper notice of your insurance termination, you should file a complaint with the Pennsylvania Insurance Department, Bureau of Consumer Services. Complaints can be filed via the website at wwvv.insurance.pa.gov or mailed to the Pennsylvania Insurance Department, Bureau of Consumer Services 1209 Strawberry Square, Harrisburg, PA 17120. Please include your insurance company name and policy number with your complaint. By Order of Director Bureau of Motor Vehicles Department of Transportation. Information (8:00 Pennsylvania Out of State TDD Pennsylvania TDD Out of State AM to 5 :00 PM) 800- 932 -4600 717 -412 -5300 800 - 228 -0676 717 - 412 -5380 002 ?472000000875593465672 INSURANCE ANSWER CENTER LLC ATTN: POLICY SUPPORT PO BOX 515097 LOS ANGELES CA 90051 -5097 SARAH J MILLER 3609 HAYWOOD ST PHILADELPHIA PA 19129 -1517 December 8, 2013 Policy Number: X5593455 24 -Hour Claims: 1- 800 -495 -6578 Policy Service: 1 -800- 495 -6578 Online Account Services: www.safeco.com THIS IS NOT A BILL. IDENTIFICATION CARDS ENCLOSED Thank you for allowing Safeco to continue serving your auto insurance needs. We appreciate your business and the trust that you have placed in us. With this renewal the following changes were made, including those requested by you or your agent or broker: Your discounts or "surcharges have changed. Please read the enclosed policy declarations page carefully. Please place the enclosed insurance identification cards in the vehicle listed on the card. Your new 6- month policy period will begin on February 6, 2014. Your policy will renew automatically if you continue to pay the premium. The renewal premium is: $1,302.00 if you pay in full (includes a $109.40 billing plan discount) $1,411.40 if you use the monthly or 2 -pay billing plan This is not a bill. Your bill will be sent separately about 25 days before it is due. It will provide more information about amounts you may pay and your payment due date. For more information about fees, please see the enclosed policy declarations page and the back of your billing statement. A $412.86 payment for your recent bill was due on December 6, 2013. If you have any questions or wish to make any changes to your policy, you can do so by calling us at 1- 800 -495 -6578. 0C-429/EP 10/13 PLEASE SEE REVERSE AMERICAN STATES INSURANCE COMPANY Thank you for entrusting us with your insurance needs. Ai, Matthew D. Nickerson President, Safeco insurance 0C-430/EP 5/98 GI INIMIMMIOr sass ass* Safe, Insurance,. Liberty Mutual Company INSURANCE ANSWER CENTER LLC ATTN: POLICY SUPPORT PO BOX 515097 LOS ANGELES CA 90051 64.-4-11A -Sco&A)ocr-to SARAH J MILLER 3609 HAYWOOD ST PHILADELPHIA PA 19129-1517 NOTICE OF CANCELLATION DATE MAILED: December 12, 2013 The companies listed below are cancelling your policy for nonpayment of premium. The amount outstanding on your account is $427.86 which includes premium in the amount of $412.86 and fees in the amount of $15.00. State law requires that you be given a copy of this notice. Please read the entire notice carefully. If you have a question about this notice, please contact your agent or broker at 1-800-495-6578. POLICY # TYPE CO EFF DATE EFF TIME X5593465 AUTO AS DEC 31 13 1201 A.M. INSURANCE COMPANY: AS=American States Insurance Company CN-7036/PAEP 12/10 PLEASE READ IMPORTANT INFORMATION ON REVERSE SIDE. GI When coverage is being terminated due to non- response to a citation imposed under 75 Pa.C.S. 1553 (relating to suspension of operating privilege for failure to respond to citation) or non - payment of a fine or penalty imposed under that section, coverage shall not terminate if you provide the company with proof that you have responded to all citations and paid all fines and penalties on or before the termination date of this policy. You may be eligible to obtain automobile liability insurance through the Pennsylvania Automobile Insurance Plan. Please contact your agent or broker for details. Pennsylvania law requires that you obtain compulsory automobile insurance if you operate or register a motor vehicle in the Commonwealth. We must notify the Pennsylvania Department of Transportation that your policy is being terminated. You must notify the Department of Transportation when you replace your coverage. The following applies to private passenger automobile insurance. Right of Insured to Request the Insurance Commissioner to Review the Action by the Insurer: You may request in writing within 30 days of receipt of this notice that the Insurance Commissioner review the action taken by this company. To do this, sign and send a copy of this form to the PENNSYLVANIA INSURANCE COMMISSIONER at the HARRISBURG REGIONAL OFFICE: Pennsylvania Insurance Department Bureau of Consumer Services 1209 Strawberry Square Harrisburg, Pennsylvania 17120 Fax: (717) 787 -8585 Harrisburg Regional Office Phone: (877) 881 -6388 CN- 3703 /PAEP 7/10 G1 Signature of Insured 00290720000008755.93465314 Insurance.. al Company INSURANCE ANSWER CENTER LLC ATTN: POLICY SUPPORT PO BOX 515097 LOS ANGELES CA 90051 -5097 SARAH J MILLER 3609 HAYWOOD ST PHILADELPHIA PA 19129 -1517 January 14, 2014 Policy Number: X5593465 24 -Hour Claims: 1 -800 -495 -6578 Policy Service: 1 -800- 495 -6578 Online Account Services: www.safeco.com THIS 1S NOT A BILL. IDENTIFICATION CARDS ENCLOSED Your insurance is being continued following a lapse in coverage. Coverages and limits you selected are continued to the extent they are still offered and are shown on the Policy Declarations. Exclusions previously signed by you continue and are part of the terms of coverage. The policy-forms enclosed bring your policy up to date with the terms issued to new customers and may differ from terms prior to coverage lapse. Please carefully review all policy information including the effective dates of coverage shown on your Policy Declarations. The premium for this policy is $1,411.40. The billing for this amount will be explained on your next billing statement. If you have any questions or wish to make any changes to your policy, you can do so by calling us at 1- 800 -495 -6578. We appreciate the opportunity to serve you. Thank you. Personal Lines Underwriting 0C-429/EP 10/13 AMERICAN STATES INSURANCE COMPANY 0009072000000875.593465263 Insurance,. A L berty Mutual Company AMERICAN STATES INSURANCE COMPANY P 0 BOX 515097, LOS ANGELES, CA 90051 FEBRUARY 9, 2014 INSURANCE ANSWER CENTER LLC ATTN: POLICY SUPPORT PO BOX 515097 LOS ANGELES CA 90051 -5097 AGENT TELEPHONE: 1-800- 495 -6578 SARAH J MILLER 3609 HAYWOOD ST PHILADELPHIA PA 19129 -1517 Re: Notice of Cancellation — Automobile Policy X5593465 Dear Policyholder, Per your request, we are canceling your Automobile insurance policy. Coverage will end at 12:01 a.m. standard time on January 19, 2014. Thank you for your past business. We look forward to serving you again soon. AMERICAN STATES INSURANCE COMPANY Personal Lines Underwriting CN- 7055/EP 1/97 G5 INSURED'S COPY IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA (Print your name) /( 3 S/ 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 ✓V , 20 (4 , a hearing is scheduled on the appeal of Petitioner for the a day of _ , 20 1 at a: M in Courtroom # of 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, 3`d 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. copi.e.s ' l ScCJ�J Q. rrit.u.oz... 3/247/ y IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 5cv\-\ No. (`I 1 b J C-1 UI I (Type your name) 1-e..2r C) rv` Vs. Driver's License/Auto RegistratioftAj peal rn CT. r Commonwealth of Pennsylvania v -� Department of Transportation r-> Bureau of Driver Licensing CERTIFICATE OF SERVICE --4 The undersigned hereby certifies that on MCk 1 5 , 20 11-1 , I caused to be mailed by regular mail, postage prepaid, a copy of the Appeal, Order Scheduling Hearing, and all attachments, to: Date: 0'1cAV �� , 20 1 1-( Office of Chief Counsel Vehicle and Traffic Law Division Riverfront Office Center, 3rd Floor 1101 South Front Street Harrisburg, PA 17104-2516 Signature: Type your Name: ScAl\cv -S. 1\, 11 -e.� Address: '4 u- U0 ock S� City / State / Zip Code: 1hi1 eVV \-%`ct! ea VG\t1-°1 Telephone: OLI - (717 1 ` ** This form must be completely filled out and filed in the Prothonotary's office promptly after mailing the documents to PennDOT ** SARAH J. MILLER, Petitioner v. COMMONWEALTH OF PENNSYLVANIA, DEPARTMENT OF TRANSPORTATION, BUREAU OF MOTOR VEHICLES, Respondent IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY NO. 14-1635 CIVIL TERM VEHICLE REGISTRATION SUSPENSION APPEAL ORDER AND NOW, this 2nd day of June, 2014, the appeal filed in the above - captioned matter is: Attest: C (f) is REMANDED to the Department of Transportation for correction of its records. DISMISSED and the suspension which is the basis of this appeal shall be REINSTATED. SUSTAINED and the suspension which is the basis of this appeal shall be RESCINDED. WITHDRAWN and the suspension which is the basis of this appeal shall be REINSTATED. CONTINUED and RESCHEDULED for the 16 day of Qc,* 0\ , 2014, at 1:3t A .m., in Courtroom Room No. 5' of the Cumberland County Courthouse, Carlisle, Pennsylvania. BY THE COURT: /arch J. Miller, 3609 Haywood Street, Philadelphia, PA 19129 Atilip M. Bricknell, Esq., PennDOT, Riverfront Office Center, Office of Chief Counsel, 3rd Floor, 1101 South Front Street, Harrisburg, PA 17104-2516 SARAH J. MILLER, : IN THE COURT OF Petitioner : COMMON PLEAS OF : CUMBERLAND COUNTY v. : • COMMONWEALTH OF PENNSYLVANIA, : NO. 14-1635 CIVIL TERM DEPARTMENT OF TRANSPORTATION, • BUREAU OF MOTOR VEHICLES, : VEHICLE REGISTRATION Respondent : SUSPENSION APPEAL ORDER AND NOW, this 16th day of October, 2014, the appeal filed in the above- captioned matter is: REMANDED to the Department of Transportation for correction of its records. DISMISSED and the suspension which is the basis of this appeal shall be REINSTATED. SUSTAINED and the suspension which is the basis of this appeal shall be RESCINDED. WITHDRAWN and the suspension which is the basis of this appeal shall be REINSTATED. CONTINUED and RESCHEDULED for the day of , 2014, at .m., in Courtroom Room No. of the Cumberland County Courthouse, Carlisle, Pennsylvania. cC -p3 BY THE COURT: zr '' tecn r-:, A Q :1'7-1 (._ cJ �. J _, Attest: -c, z:° ' �- Sarah J. Miller, 3609 Haywood Street, Philadelphia, PA 19129 Philip M. Bricknell, Esq., PennDOT, Riverfront Office Center, Office of Chief Counsel, 3rd Floor, 1101 South Front Street, Harrisburg, PA 17104-2516 • Corti is ilAatied Ioh �'fi 1