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Supreme Court Of Pennsylvania
Court of-CdmmOn- Pleas
Civil Coven Sheet
�N/''I �,✓t'' o County
For Prothonotary Use Only:
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Docket No:
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The information collected on this form is used solely for court administration purposes. This form does not
supplement or replace the fr.lin g and service of pleadings or other papers as required 1?)i law or rules of court.
Commencement of Action:
Petition
Declaration of Taking
Complaint Writ of Summons
Transfer from Another Jurisdiction =
Lead Plaintiff's Name:
Jona (<( Ict?�
Lead Defendant's Name:
et0 in
Dollar Amount Requested: 1__I within arbitration limits
Are money damages requested? Yes gi No
(check one) outside arbitration limits
Is this a Class Action Suit? Yes F No
Is this an MDJAppeal? 1 Yes M No
Name of Plaintiff/Appellant's Attorney:
a Self -Represented [Pro Se] Litigant)
Check here if you have no attorney (are
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
O Malicious Prosecution
MP Motor Vehicle
Nuisance
O Premises Liability
O Product Liability (does toot include
mass tort)
O Slander/Libel/ Defamation
O Other:
MASS TORT
• Asbestos
O Tobacco
O Toxic Tort - DES
O Toxic Tort - Implant
• Toxic Waste
• Other:
PROFESSIONAL LIABLITY
O Dental
El Legal
O Medical
O Other Professional:
CONTRACT (do not include Judgments)
O Buyer Plaintiff
O Debt Collection: Credit Card
O Debt Collection: Other
O Employment Dispute:
Discrimination
l== Employment Dispute: Other
O Other:
REAL PROPERTY
O Ejectment
O Eminent Domain/Condemnation
O Ground Rent
• Landlord/Tenant Dispute
• Mortgage Foreclosure: Residential
O Mortgage Foreclosure: Commercial
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E1 Quiet Title
• Other:
CIVIL APPEALS
Administrative Agencies
0 Board of Assessment
O Board of Elections
O Dept. of Transportation
O Statutory Appeal: Other
O Zoning Board
O Other:
MISCELLANEOUS
O Common Law/Statutory Arbitration
O Declaratory Judgment
O Mandamus
0 Non -Domestic Relations
Restraining Order
0 Quo Warranto
0 Replevin
0 Other:
Updated 1/1/2011
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
Poo id ftrki.r
(Type your name)
No.
C7 i... -
Vs. Driver's License/Auto Registration Appe$ ` .
Commonwealth of Pennsylvaniai,1.
Department of Transportation c
Bureau of Drivers Licensing
APPEAL OF DRIVER'S LICENSE/AUTO REGISTRATION SUSPENSIOII $ f>;) Dr>
---1 1'
AND NOW, this (enter,today's date)' , 20 (Cf , comes the Appellant, (Typt your narrie)
()OP) O.. (QL Ve{ r -gr , by his/her attorney, and states as follows:
1. Appellant's PA operator's number or automobile registration number is:
Lrfft CD
2. PennDOT proposes, by Notice dated (insert "mailing" date here) 8-2-0 , 20 ( 9' , to suspend
Appellant's driving privileges n automobile registration for a period of (Insert length of suspension)
YQA1/- pursuant to Section 15747 7 of the Vehicle Code, which
suspension is to be effective (Insert suspension effective date) , 20 \
****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:)
ISI
n cop f crvi-- t - 2 1\o' 144, 5-ei-vie.
f S ham- d 4Oc.E'6P Ih"A tte ck -Pcp+A(114,
•" wo (4 d O G-ivr)1 a (Jr P 41) pr'f Y5 b°1114-
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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 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 name here)
J1v, (cf
(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: ,,,,, lid A7_ ------------
Type Name: DO/1 a ( gr/(41
Address: R' &' Ra,
City / State / Zip Code: 1VQ_A. (<; k t 9 J
Telephone Number: 7 17 Ci)--.WC-6
Email address: @
2
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
(Type your name)
N
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 , 20 , I caused to be
mailed by regular mail, postage prepaid, a copy of the Appeal, Order Scheduling Hearing, and
all attachments, to:
Date:
e --E5 ,
0
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:
Address:
City / State / Zip Code:
Telephone:
** 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 pi -1810
bovvc.i Par tra -
(Print your name)
No.
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 , 20 14 , a hearing is scheduled
AO
on the appeal of Petitioner for the 114k day of 6C-C-CatecelL, 20 iti at L:,t r M
in Courtroom # (0 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.
rem 1)9+
bDyta Id Parke(
eoPl es itcd 'ate/rn
- mas A. PIaMi0
Common PleasAdc
DONALD G. PARKER,
Petitioner
v.
COMMONWEALTH OF PENNSYLVANIA,
DEPARTMENT OF TRANSPORTATION,
BUREAU OF DRIVER LICENSING,
Respondent
IN THE COURT OF COMMON
PLEAS OF CUMBERLAND
CUMBERLAND COUNTY
NO. 14-4869 CIVIL TERM
DRIVER LICENSE
SUSPENSION APPEAL
ORDER
AND NOW, this 18th day of December, 2014, the appeal filed in the above -
captioned matter is:
Attest:
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
, 2015, at .m., in Courtroom
Room No. of the Cumberland County Courthouse,''
Carlisle, Pennsylvania.
11:6*6 APikecif
✓Donald G. Parker, 313 Nealy Road, Newville, PA 17241
Philip M. Bricknell, Esq., PennDOT, Riverfront Office Center, Office of Chief Counsel,
3rd Floor, 1101 South Front Street, Harrisburg, PA 17104-2516
C.O?Icesinvt(cc L_