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HomeMy WebLinkAbout14-5972s E C T I 0 N A s E C T I 0 N B Supreme Co�ufrt of�Peennsylvania At Courtrof,CommonIeas Ci ijI . ver;Sheet County For Prothonotary Use Only: Le PI, i tiffs Name: onq H, 3'00) -Pc )3 Docket No: /Y- s72 The information collected on this firm is used .solely for court administration purposes. This !Orin does not supplenient or replace the filing and service of pleadings or other papers as required by law or rules of court. Commencement of Action: ❑ Complaint pa Writ of Summons 0 Petition Transfer from Another Jurisdiction 0 Declaration of Taking Le PI, i tiffs Name: onq H, 3'00) -Pc )3 Lead Defendant's Name: Are money damages requested? 0 Yes No Dollar Amount Requested: ❑within arbitration limits (check one) ❑ outside arbitration limits Is this a Class Action Suit? 0 Yes No Is this an MDJAppeal? ED Yes 0 No Name of Plaintiff/Appellant's Attorney: XCheck here if you have no attorney (are a Self -Represented [Pro Set 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 ❑ jvlalicious Prosecution Motor Vehicle ❑ Nuisance © Premises Liability ❑ Product Liability (does not include mass tort) ❑ Slander/Libel/ Defamation O 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 O Employment Dispute: Discrimination ❑ Employment Dispute: Other O Other: REAL PROPERTY ❑ Ejectment O Eminent Domain/Condemnation ❑ Ground Rent ❑ Landlord/Tenant Dispute ❑ Mortgage Foreclosure: Residential O Mortgage Foreclosure: Commercial ❑ Partition ❑ Quiet Title ❑ Other: CIVIL APPEALS Administrative Agencies O Board of Assessment o Board of Elections ❑ Dept. of Transportation ❑ Statutory Appeal: Other ❑ Zoning Board ❑ Other: MISCELLANEOUS ❑ Common Law/Statutory Arbitration • Declaratory Judgment [] Mandamus o Non -Domestic Relations Restraining Order 0 Quo Warranto © Replevin ❑ Other: Updated 1/1/2011 7s—fel VW -vs -6 z IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, P NSYLVANIA AnV)3 (Type your nam Vs. Commonwealth of Pennsylvania Department of Transportation Bureau of Drivers Licensing 1---," r.....7 e/ -7)e) Driver's License/Auto Registration Appe -<›- I-- 0,--- ..<(-, CDrn (—) I APPEAL OF DRIVER'S LICENSE/AUTO REGISTRATION SUSPENSION ND TN, th's4eNcr 1) date) }fyg. 19 , 20 IL , comes the Appellant, (Type your name) and states as follows: ,U1 at• , , by his/her attorney, 1. Appellant's PA operator's n,ymber or automobile registration number is: (0 2 a otl091-1'3%0-00/ IL(051Q (00- 2. PennDOT proposes, by Notice dated (insert "mailing" date here) Appellant's driving privileges m As /420 , to suspend automobile registration for a period of (Insert length of suspension) pursuant to Section (d) of the Vehicle Code, which suspension is to be effective (Insert suspension effective date) beR /9 , 20 14 ****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:) -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 clays 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:) i we -o hod. 1n8uL Cm 41- TOY, 61 ottJs. nr norm -6 onIII to Ari /2 lieu le �a� 9 A me nen-L / g > v u WHEREFORE, Appellant respectfully requestsihis Honorable Court to sustain the appeal from the suspension of operating privileges or automobile registration. Respectfully submitted, (Sign na ; here) (nEh Q(Stif.�{'e%d (Type name herV) 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: Address: City / State / Zip Code: Telephone Number: Email address: 77---761- UP I ink ((l'LY0OCa 92it/Y).eo'( 2 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 43fd-Pai �8 SY_ : (Type your na e) Vs. Commonwealth of Pennsylvania Department of Transportation Bureau of Driver Licensing No. Driver's Registration Appeal CERTIFICATE OF SERVICE The undersinedhereby certifies that on — , 20 , 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 Riverfront Office Center3rd Floor 1101 South Front Street Harrisburg, PA 17104'2516 Signature: Type your Name: Address: City / State / Zip Code: Telephone: .._� \ at AateleAMItark ilaffIZINMed � �ft /�7 y�� //`f/� (/j.� //��7f, / /�7�- / /iJ/«�} /7 7q / ** 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 Ok\C\R)Ot\\ U • AV l iNo. / 51U nit nam (Print your 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/Li, a hearing is scheduled on the appeal of Petitioner for the oil e # day of kc.. ' o , 20/.5 at ?: 30 1). M in Courtroom # I of the Cumberland County Courthouse, One Courthouse Square, 4`n 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. co I'EStL /0/9/19