HomeMy WebLinkAbout14-6371s
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Supreme Court of Pennsylvania
Court of Common Pleas
Civil Cover Sheet
C...< 47 e '- 4
County
For Prothonotary Use Only:
Docket No:
/Li - 3 7/
The information collected on this fin -in 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 Name:
LS 4EPPL-T-
Lead Defendant's Name:
fttiNvT
Are money damages requested? Yes
Dollar Amount Requested:
(check one)
within arbitration limits
• No
• outside arbitration limits
Is this an MDJAppeal?
Is this a Class Action Suit? • Yes
:: No
■ Yes C No
Name of Plaintiff/Appellant's Attorney:
E - Check here if you have no attorney (are a Self -Represented [Pro Sel 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
O Malicious Prosecution
❑ Motor Vehicle
O Nuisance
❑ Premises Liability
❑ Product Liability (does not include
mass tort)
❑ Slander/Libel/ Defamation
❑ Other:
CONTRACT (do not include Judgments)
❑ Buyer Plaintiff
❑ Debt Collection: Credit Card
❑ Debt Collection: Other
❑ Employment Dispute:
Discrimination
O Employment Dispute: Other
CIVIL APPEALS
Administrative Agencies
❑ Board of Assessment
❑ Board of Elections
BP Dept. of Transportation
Statutory Appeal: Other
❑ Zoning Board
❑ Other:
MASS TORT
❑ Asbestos
O Tobacco
❑ Toxic Tort - DES
❑ Toxic Tort - Implant
❑ Toxic Waste
❑ Other:
PROFESSIONAL LIABLITY
❑ Dental
❑ Legal
❑ Medical
❑ Other Professional:
O Other:
REAL PROPERTY
❑ Ejectment
❑ Eminent Domain/Condemnation
❑ Ground Rent
❑ Landlord/Tenant Dispute
O Mortgage Foreclosure: Residential
❑ Mortgage Foreclosure: Commercial
❑ Partition
❑ Quiet Title
❑ Other:
MISCELLANEOUS
❑ Common Law/Statutory Arbitration
❑ Declaratory Judgment
❑ 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
h 44c 4epLz
(Type your name)
Vs.
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Drivers Licensing
No. N' / 31 ( (,4+(11`
L
1-11
Driver's License/Auto Registration Appeatr-
-4
APPEAL OF DRIVER'S LICENSE/AUTO REGISTRATION SUSPENSION
AND NOW, this (enter today's date) 11/ 0 3 , 20 I { , comes the Appellant, (Type your.name)
ISIgt. 'EerC.i , by his/her attorney, and states as follows:
1. Appellant's PA ()orator's number or automobile registration number is:
7._/-t S (C 7'1
2. PennDOT proposes, by Notice dated (insert "mailing" date here)
Appellant's
driving privileges
Arit
0/g=. / =o , 201 , to suspend
automobile registration for a period of (Insert length of suspension)
pursuant to Section PS Sj 6 (le)')
of the Vehicle Code, which
suspension is to be effective (Insert suspension effective date) / r7._ 0 , 20 1 I
****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;
I I 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).
Fl
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 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:)
1 NA -0 I Ai S u 2iivCe 5 c6 47TI C1-1 t 0 ft OO /NSca (z 4/vcA5
0 N 8/ ///L( W (T 1+ USAA
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)
4&Pp LT,
(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:
Type Name:
Address:
City /State / Zip Code:
Telephone Number:
Email address:
IS A 6GP(L'
s76,--64&4) to APT -6.1
Coni P 1-1(LL, (J pot(
570 - -/006
escgpe @ c.oAl
2
For Roadside Assistance: 800-531 -8555
Report a claim, get coverage and deductible information, request a tow from the accident
scene, schedule an appraisal or reserve a rental car using:
• usaa.com,
. USAA's Mobile App, or
• By calling 210-531-USAA (8722), our mobile phone shortcut number #8722 or
800-531 -USAA.
Important Notice
This identification card is evidence of liability insurance for your vehicle. The card is valid as long as
liability insurance remains in force.
You may be required to produce your identification card at vehicle registration or inspection, when
applying for-a-Jriver's license, following -an accident; or upon a- law enforcement officer's request.
FPA1 Rev. 6-13
r
50812-0513_02
9800
Fredericksburg Road Code
N. SanAntonioTexas78288 NAIC 25941
USAA° PENNSYLVANIA FINANCIAL RESPONSIBILITY
IDENTIFICATION CARD
This Card Must Be Carried For Production Upon Demand.
It is Suggested That You Carry This Card In The Insured
Vehicle.
ISAAC J AEPPLI
20 STEPHEN RD APT 8B
CAMP HILL PA 17011-1184
NOT VALID MORE THAN SIX
MONTHS FROM EFFECTIVE DATE
OFFICE ISSUING THIS CARD -
9800 Fredericksburg Road
SAN ANTONIO, TEXAS 78288
Policy Number 01709 92 96U 7102 0
Effective Date 08/01/14 o v�--
AUTHORIZED REPRESENTATIVE
Applicable with respect to the following Motor Vehicle
1999 MERCEDES WDBHA29G3XA723517
Year Make Vehicle Identification Number
CONTACT US: 210-531-USAA(8722)
OR 800-531-USAA
UNITED SERVICES AUTOMOBILE ASSN
Additional copies available at usaa.com
Back
WARNING: Any owner or registrant of a motor vehicle who
operates or permits a motor vehicle to be driven in this
Commonwealth without the required financial responsibility may have
his registration suspended or revoked.
NOTE: THIS CARD IS REQUIRED WHEN
f (a) You are involved in an auto accident.
0 (b) You are convicted of a traffic offense other than a parking
offense that requires a court appearance.
d (c) Upon request of a police officer when you are stopped for
violating any provision of the Vehicle Code (75 PA. C.S.
101-9910).
You must provide a copy of this card to the Department of
Transportation when you request restoration of your operating
privilege or registration privilege which has previously been
suspended or revoked.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF TRANSPORTATION
BUREAU OF MOTOR VEHICLES
PO BOX 68674
HARRISBURG, PA 17106-8674
www.dmv.state.pa.us
ISAAC JOSEPH AEPPLI
46 GREENMONT DR
ENOLA, PA 17025
WIDt 142829999022439 001
TITLE* 66633759
PROCESSING DATE 141009
TRANSACTION CODE 00060
OFFICIAL NOTICE MAIL DATE: 10/16/14
Dear Customer:
The Department recently requested that you provide us with proof of financial responsibility (insurance) for the
following vehicle:
MAKE: MERCEDES BENZ YEAR: 1999 BODY TYPE: SEDAN
LICENSE PLATE{#: JLG0659 TITLE#: 66633759 VIN#: WDBHA29G3XA723517
This information was requested because GEICO CASULTY CO notified us that the insurance policy covering
the vehicle listed above was terminated on 08/01/14. 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 11/20/14 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, sticker and card to 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 www.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
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
lsF
(Type your name)
Vs.
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Driver Licensing
No.
�y
6 37 / civ; /
Driver's License/Auto Registration Appeal
CERTIFICATE OF SERVICE
The undersigned hereby certifies that on /C ✓ 3) , 20 /11 , I caused to be
mailed by regular mail, postage prepaid, a copy of the Appeal, Order Scheduling Hearing, and
all attachments, to:
Date: i( � , 20 /6-(
Office of Chief Counsel
Vehicle and Traffic Law Division
Riverfront Office Center, 3rd Floor
1101 South Front Street
Harrisburg, PA 17104-2516
Signature: C f
Type your Name: JS A} -e iFPLi
Address: %O STPHCN (O 41°TE?6
City /State / Zip Code: C MAP N /L /. PA 1700
Telephone: 6.7 v " R4/ —10J6
rL�
** This form must be completely filled out and filed in the Prothonotary's office
promptly after mailing the documents to PennDOT **
U.S. Postal Service'°
CERTIFIED MAIL° RECEIPT
Domestic Mail Only
For delivery information, visit our website at www.usps.como.
1820 0001
r
O
N
Postage
Certified Fee
Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage & Fee
Sent To
0106
Postmark
Here
.,1201.4 P
PeoA 0 6 Pr a
Street&Apt.No., QVrladr('1{r
orPOBoxNo. !l i0) S._F2l?NT.-ST'
1
City, State, ZIP+4
(1-
PS Form 3800, July 2014
verse for Instructions
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
)5A4c /4 cPpLi
(Print your name)
Vs.
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Driver Licensing
No.
Iy-6,371
0
-,,rn ci
Driver's License/Auto Registration2prgeal-A‹
ORDER SCHEDULING HEARING ON
APPEAL
AND NOW, this LP day of ,14z22T ,
, 20/4/, a hearing is scheduled
on the appeal of Petitioner for the 011 day of��11,ll) , 20/5- at 9
in Courtroom # y 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.