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Home My WebLink About14-6437S E C T I 0 N A S E c T I 0 N Supreme Court of Pennsylvania Court ofCommori Pleas Civil Cover Sheet County For Prothonotary Use Only: Docket No: /q.--‘37 aciilie;y7 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: Complaint 0 Writ of Summons 0 Petition Transfer from Another Jurisdiction ❑ Declaration of Taking Lead Plaintiffs Name: «&4Lw b + 61, L -,r' • Lead Defendant's Name: ?to v. Do --- Are money damages requested? 0 Yes '[ LNo Dollar Amount Requested: within arbitration limits (check one) ❑outside arbitration limits Is this a Class Action Suit? ❑ Yes No Is this an MDJAppeal? Yes Name of Plaintiff/Appellant's Attorney: 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 O Malicious Prosecution ❑ Motor Vehicle • Nuisance Premises Liability ❑ Product Liability (does not include mass tort) • Slander/Libel/ Defamation O Other: MASS TORT O Asbestos ❑ Tobacco ❑ Toxic Tort - DES O Toxic Tort - Implant ❑ Toxic Waste O Other: PROFESSIONAL LIABLITY O Dental O Legal ❑ Medical • Other Professional: CONTRACT (do not include Judgments) O Buyer Plaintiff O Debt Collection: Credit Card • Debt Collection: Other O Employment Dispute: Discrimination O Employment Dispute: Other 0 Other: REAL PROPERTY ❑ Ejectment ❑ Eminent Domain/Condemnation O Ground Rent O 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 la Dept. of Transportation 0 Statutory Appeal: Other O Zoning Board O Other: MISCELLANEOUS O Common Law/Statutory Arbitration ❑ Declaratory Judgment O Mandamus ❑ Non -Domestic Relations Restraining Order ❑ Quo Warranto 0 .Replevin 0 Other: Updated 1/1/2011 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA C IJ . itA ; \ k.--� (Type your name) Vs. Commonwealth of Pennsylvania Department of Transportation Bureau of Drivers Licensing c...„ No. /y` 6131 1�a s �_ Driver's License/Auto Registration Appeal _<> cji Q .< C3 zw.—I-1 (v -11 D C) = '::; = C3 _._. -4 r.) _4. ,,� x APPEAL OF DRIVER'S LICENSE/AUTO REGISTRATION SUSPENSION id AND NOW, this (enter today's date) /40V. 1 , 20 I 1 , comes the Appellant, (Type your name) 16Act.41-tc,„..) 1). iu; <<c , by his/her attorney, and states as follows: 1. Appellant's PA operator's number or automobile registration number is: 2. PennDOT proposes, by Notice dated (insert "mailing" date here) Q C,T(Jbct /G 20 / `/ , to suspend Appellant's gdriving privileges l0 r tcrL s automobile registration for a period of (Insert length of suspension) pursuant to Section / 3 1 (e of the Vehicle Code, which t� suspension is to be effective (Insert suspension effective date) Aio./��•.E tt (l , 20 l ****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:) Thi$ S Ct'S c. 15 -er-o s. (0 y C 4 ('S 454 i A t4.) C. 1 -i,/ C Y� a✓�.4`was.. t l n ` 1 � � /may Aevi d ( a q v;.c.�,<.✓►f-s I �.t t-� 4 re_ sIvr e rVty dt''('vi."G P(1\RJaj(S I'd OetS jivcr‘ pr1 /racy\ Se 10( Ute_ by P cel► oaf -<f secrvts vh! Y loo_oz 10 .�a,-s `air &Ad �Y a d e''4nc ,� .�,,-� aid �on�c Y -HA,; s s,,s�vcny;o►� !« 1spcLp/''' eaSti ,3i,3035 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:) WHEREFORE, Appellant respectfully requests this Honorable Court to sustain the appeal from the suspension of operating privileges or automobile registration. Respectfully submitted, Nedef-utJ (Sign name here) 6,1- b ; I(c,r- (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: Maf-' Lo 1) Aft 1(c..r Address: O AtIcA 1 City / State / Zip Code: /UC.-Gki 6/1416e f [avI� 1 /4 11O0 Telephone Number: 7I7' 311 - 9I 5 7 Email address: Met JMi��il @ s'lo(Litre/katnn�• c--o"T 2 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 1" & 1 J A; kkA-r No. (Type your name) 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: , 20 Office of Chief Counsel Vehicle and Traffic Law Division Riverfront Office Center, 3rd Floor 1101 South Front Street Harrisburg, PA 17104-2516 Signature: vv%1�1144,lec,) Type your Name: i' IQ' Cj.J D V1k ((cr Address: LIAd etrt.O Ucnut City / State / Zip Code: t tJ &Ant14cr`4v.d PA (761 a Telephone: 111-434- 9 l s- ** This form must be completely filled out and filed in the Prothonotary's office promptly after mailing the documents to PennDOT ** COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION Bureau of Driver Licensing Mail Date: OCTOBER 10, 2014 MATTHEW D MILLER 420 RENO AVE NEW CUMBERLND PA 17070 Dear MR. MILLER: WID 41 142766668021867 001 PROCESSING DATE 10/03/2014 DRIVER LICENSE # 27270050 DATE OF BIRTH 05/12/1985 This is an Official Notice of the Suspension of your Driving Privilege as authorized by Section 1532C of the Pennsylvania Vehicle Code. As a result of your 09/09/2005 conviction of violating Section 13A16 of the Controlled Substance, Drug, Device and Cosmetic Act, on 02/16/2005: ■ Your driving privilege is SUSPENDED for a period of 6 MONTH(S) effective 11/14/2014 at 12:01 a.m. Before PennDOT can restore your driving privilege, you must follow the instructions in this letter for COMPLYING WITH THIS SUSPENSION, PAYING THE RESTORATION FEE and PROVIDING PROOF OF INSURANCE. You should follow ALL instructions very carefully. Even if you have served all the time on the suspension/revocation, we cannot restore your driving priv- ilege until all the requirements are satisfied. COMPLYING WITH THIS SUSPENSION PennDOT records indicate that your driving privilege is currently suspended/revoked. You must return all current Pennsylvania driver's licenses, learner's permits, tempo- rary driver's licenses (camera cards) in your possession IMMEDIATELY. YOU MAY NOT RETAIN YOUR DRIVER'S LICENSE FOR IDENTIFICATION PURPOSES. However, you may apply for and obtain a photo identification card at any Driver License Center for a cost of $27.50. You must present two (2) forms of proper iden- tification (e.g., birth certificate, valid U.S. passport, marriage certificate, etc.) in order to obtain your photo identification card. You will not receive credit toward serving any suspension until we receive your license(s). Complete the following steps to acknowledge this suspension. 1. Return all current Pennsylvania driver's licenses, learner's permits and/or camera cards to PennDOT. If 142766668021867 you do not have any of these items, send a sworn nota- rized letter stating you are aware of the suspension of your driving privilege. You must specify in your letter why you are unable to return your driver's license. Remember: You may not retain your driver's license for identification purposes. Please send these items to: Pennsylvania Department of Transportation Bureau of Driver Licensing P.O. Box 68693 Harrisburg, PA 17106-8693 2. Upon receipt, review and acceptance of your Pennsylvania driver's license(s), learner's permit(s), camera card(s), and/or a sworn notarized letter, PennDOT will send you a receipt confirming the date that credit be- gan. If you do not receive a receipt from us within three (3) weeks, please contact our office. Otherwise, you will not be given credit toward serving this sus- pension. PennDOT phone numbers are listed at the end of this letter. 3. If you do not return all current driver license pro- ducts, we must refer this matter to the Pennsylvania State Police for prosecution under SECTION 1571(a)(4) of the Pennsylvania Vehicle Code. PROVIDING PROOF OF INSURANCE Within the last 30 days of your suspension/revocation, we will send you a letter asking that you provide proof of in- surance at that time. This letter will list acceptable documents and what will be needed if you do not own a vehicle registered in Pennsylvania. IMPORTANT: Please make sure that PennDOT is notified if you move from your current address. You may notify PennDOT of your address change by calling any of the phone numbers listed at the end of this letter. 142766668021867 APPEAL You have the right to appeal this action to the Court of Common Pleas (Civil Division) within 30 days of the mail date, OCTOBER 10, 2014, of this letter. If you file an ap- peal in the County Court, the Court will give you a time - stamped certified copy of the appeal. In order for your appeal to be valid, you must send this time -stamped certi- fied copy of the appeal by certified mail to: Pennsylvania Department of Transportation Office of Chief Counsel 1101 South Front Street Third Floor, Riverfront Office Center Harrisburg, PA 17104-2516 Remember, this is an OFFICIAL NOTICE OF SUSPENSION. You must return all current Pennsylvania driver license products to PennDOT IMMEDIATELY. SEND FEE/LICENSE/DL-16LC/TO: Department of Transportation Bureau of Driver Licensing P.O. Box 68693 Harrisburg, PA. 17106-8693 Sincerely, Kara N. Templeton, Director Bureau of Driver Licensing INFORMATION (8:00 AM TO 5:00 PM) IN STATE 1-800-932-4600 OUT-OF-STATE 717-412-5300 TDD IN STATE 1-800-228-0676 TDD OUT-OF-STATE 717-412-5380 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA �8 7� Jv\ tnr (Print your name) i�� p � »� �� e11. �� &m Vs. Driver's License/Auto Registration Appeal Commonwealth of Pennsylvania Department of Transportatlon Bureau of Driver Licensing ORDER SCHEDULING HEARING ON APPEAL '�� AND NOW, this A� yn day of ' ' , a hearing 15 scheduled �� w/ onthe appeal ofPe�honerfor the AT day ofat in Courtroom # if 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 responsibitity 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 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 Pennsylvanla. By the Court, //1/ � �D^_� _� C�f`��8�� -r L��,�7 �� oI��y �vpu f~ �� x'/�\ ^'//�y � ~ '� � � L��n.'�� m�^/,,^n �/�//y