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Supreme CoiiT. ofnnsy1vania
Cour Commp Pleas
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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 re lace the ,filing and service ofpleadings or other papers as required by law or rules o court
Commencement of Action: .
Petition
Declaration of Taking
E3 Complaint D Writ of Summons F2
0 Transfer from Another Jurisdiction 0
Lead Plaintiffs Name:
Jennifer L. Walker
Lead Defendant's Name:
Commonwealth of Pennsylvania Department of Trans.
Are money damages requested? 0 Yes 0 No
Dollar Amount Requested: Owithin arbitration limits
(check one) 0 outside arbitration limits
Is this a Class Action Suit? 0 Yes 0 No
Is this an DJ Appeal? El Yes 0 No
Name of Plaintiff/Appellant's Attorney:
a Self -Represented [Pro Se] Litigant)
Ix 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)
O Intentional
O Malicious Prosecution
O Motor Vehicle
Nuisance
O Premises Liability
O Product Liability (does not include
mass tort)
O Slander/Libel/ Defamation
O Other:
MASS TORT
O Asbestos
O Tobacco
O Toxic Tort - DES
O Toxic Tort - Implant
O Toxic Waste
O Other:
PROFESSIONAL LIABLITY
O Dental
O Legal
• Medical
JJ Other Professional:
CONTRACT (do not include Judgments)
O Buyer Plaintiff
O Debt Collection: Credit Card
O Debt Collection: Other
O Employment Dispute:
Discrimination
O Employment Dispute: Other
O Other:
REAL PROPERTY
O Ejectment
0 Eminent Domain/Condemnation
O Ground Rent
O Landlord/Tenant Dispute
O Mortgage Foreclosure: Residential
0 Mortgage Foreclosure: Commercial
O Partition
O Quiet Title
O Other:
CIVIL APPEALS
Administrative Agencies
O Board of Assessment
O Board of Elections
O Dept. of Transportation
O Statutory Appeal: Other
O Zoning Board
Other:
111:
MISCELLANEOUS
O Common Law/Statutory Arbitration
O Declaratory Judgment
fl Mandamus
0 Non -Domestic Relations
Restraining Order
0Quo Warranto
0 Replevin
0 Other:
Updated 1/1/2011
ire
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JENNIFER L WALKER No. iq - 0 7 ax.:( 724 ia-09 r
(Type your name) :
: =
Vs. : Driver's License/Auto Registration Appeaie
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Commonwealth of Pennsylvania =-"w
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Department of Transportation
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Bureau of Drivers Licensing <c -9 cl-r,-;
APPEAL OF DRIVER'S LICENSE/AUTO REGISTRATION SUSPENSION
.(:)= ',.ir'• CDM7
...4TN,
• 11...'
..‹. AC) ...:: ' * ''•:
AND NOW, this (enter today's date) OCT 8
'2014, comes the Appellant, (Type your name)
JENNIFER L WALKER , by his/her attorney, and states as follows:
1. Appellant's PA operator's number or automobile registration number is:
25 611 536
2. PennDOT proposes, by Notice dated (insert "mailing" date here) SEPT 1
, 20 14 , to suspend
Appellant's r driving privileges n automobile registration for a period of (Insert length of suspension)
THREE MONTHS
pursuant to Section 1786(d) of the Vehicle Code, which
suspension is to be effective (Insert suspension effective date) OCT 6
2014
****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)
EThe police lacked reasonable grounds to stop Appellant and / or request Appellant to submit to a chemical
test.
n
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:)
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:)
See Addendum 1 (attached)
WHEREFORE, Appellant respectfully requests this Honorable Court to sustain the appeal from the suspension
of operating privileges or automobile registration.
Respectfully submitted,
JENNIFER L WALKER
(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 beliefThe 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:
1115 FLORIBUNDA LANE
City / State / Zip Code: MECHANICSBURG, PA 17055
Telephone Number: 717-728-6071
2
Addendum 1
RE: Jennifer |Walker
Other (specify reason:)
The subject vehicle is titled to Matthew D & Jennifer Walker, who were divorced on June 18, 2014. The
vehicle is the primary transportation for the defendant. The defendant was neither notified by her
former husband (who paid for the insurance) nor the insurance company (Esurance) that insurance
coverage had been terminated. It was at a Domestic Relations hearing on August 19, 2014, that
Matthew Walker informed the defendant that he terminated the insurance coverage on the subject
vehicle. The defendant immediately shopped for insurance and contracted a policy with Esurance
Insurance company on August 21, 2014 and paid for the ensuing six months of coverage. The policy
number is PAPA -005704389 effective August 21, 2014 through Feb 21,2014. Had the defendant been
advised either by Matthew D Walker or Esurance Insurance Company the policy had been canceled, the
defendant would have immediately purchased coverage as evidenced by the timely purchase of
insurance when finally apprised of the situation on August 19, 2014 at the Domestic Relations hearing.
It would seem the non -notification by Matthew Walker was either a willful or passive act of negligence.
Since Matthew Walker always purchased the insurance, it seems that Esurance would have confirmed
the termination of the coverage only to him and most likely by email, since Esurance is an "on-line"
insurance company. The suspension of registration will be of no consequence to Matthew Walker
because he does not operate or have possession of the vehicle. However, the suspension will cause
hardship to the defendant because this is her only means of transportation. It is requested the court
shows mercy to the defendant in Iight of the circumstances.
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JENNIFER L WALKER
No. 4/--- 57 7 c-51.-,1
(Type your name) Cl • W.
Vs.
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Driver Licensing
Driver's License/Auto Registraticorippe rnr--
CD r
CLW .
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CERTIFICATE OF SERVICE
- •
The undersigned hereby certifies that on OCTOBER 8 , 2014 , I caused to be
mailed by regular mail, postage prepaid, a copy of the Appeal, Order Scheduling Hearing, and
all attachments, to:
Date: OCTOBER 8 , 2014
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:
JENNIFER L WALKER
1115 FLORIBUNDA LANE
MECHANICSBURG, PA 17055
717-728-6671
** This form must be completely filled out and filed in the Prothonotary's office
promptly after mailing the documents to PennDOT **
rr?
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
JENNIFER L WALKER
(Print your name)
Vs.
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Driver Licensing
N. 19-- C117
Driver's License/Auto Registration Appeal
ORDER SCHEDULING HEARING ON APPEAL
AND NOW, this i4 day 20/4/, a hearing is scheduled
on the appeal of Petitioner for the a6 .4 day of dr,../.44-tea.4.y , 20/5 at 9 :30A- M
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.
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