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Home My WebLink About14-6561S E I O A tE C 0 N Supreme Cou�t��of-Pennsylvania Cou r Civil eaAire Pleas Cover:Sh'et County For Prothonotary Use Only: Petition Declaration of Taking If iI Docket No: sft /— 6_56' .0 The information collected on this form is used solely for court administration purpose . ei 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 N Complaint 0 Writ of Summons 0 0 Transfer from Another Jurisdiction 0 Lead Plaintiff's Name: A,ZAA' %, ,',vCal d Defendant's Name: Gs.-tbL'.I ✓boy Are money damages requested? 0 Yes g No Dollar Amount Requested: 0within arbitration limits (check one) 0outside arbitration limits Is this a Class Action Suit? 0 Yes ( No Is this an MDJAppeal? 0 Yes fgl No 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) O Intentional • Malicious Prosecution O Motor Vehicle O Nuisance O Premises Liability O Product Liability (does not include mass tort) O Slander/Libel/ Defamation O Other: MASS TORT Asbestos O Tobacco O Toxic Tort - DES O Toxic Tort - Implant O Toxic Waste O Other: PROFESSIONAL LIABLITY O Dental O Legal O Medical O Other Professional: CONTRACT (do not include Judgments) O Buyer Plaintiff 0 Debt Collection: Credit Card 0 Debt Collection: Other 0 Employment Dispute: Discrimination O Employment Dispute: Other 0 Other: REAL PROPERTY 0 Ejectment O Eminent Domain/Condemnation O Ground Rent O Landlord/Tenant Dispute O Mortgage Foreclosure: Residential O Mortgage Foreclosure: Commercial 0 Partition O Quiet Title • Other: CIVIL APPEALS Administrative Agencies Board of Assessment Board of Elections Dept. of Transportation Statutory Appeal: Other 0 Zoning Board O Other: MISCELLANEOUS O Common Law/Statutory Arbitration 0 Declaratory Judgment • Mandamus ® Non -Domestic Relations Restraining Order 0 Quo Warranto El Replevin ID Other: Updated 1/1/2011 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA /14-711-549 7-1/6--Arceodii (Type your name) • No./f Cle/.1 Vs. Driver's License/Auto Registration Appeal Commonwealth of Pennsylvania Department of Transportation Bureau of Drivers Licensing APPEAL OF DRIVER'S LICENSE/AUTO REGISTRATION SUSPENSION z r"- -<> C) , c:D AND NOW, th_ifn,-rt,r today's date) 00 , 20 ) , comes the Appellant, (Type your name) 41 , 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) Appellant's driving privileges , 20 ,to suspend automobile registration for a period of (Insert length of suspension) pursuant to Section /643 of the Vehicle Code, which , A suspension is to be effective (Insert suspension effective date) ovaw I1,o 11 ****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:) 0-7-P5e, -7;i4-xer:be731-710k) • Pe-Lare, —reet-Al6P6,2-779-77.6e4 e_.#666=9 -46/;d6 LOCirrier;t1 ,4-7110 4)04 • Alo r -19 A /fir/r----Aiett6 4d2en(A-1i i ,9-bL a,e-e6. At q). vki&-AikAL/6-O 1. '/ V&_te- -7e) .az, epoiez, Fat. p414-1-, A--"cbotirkierAlro /of e-dzihaos The -OR- 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) (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 subjecto 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: _ . � ' ' ~.�A��_� ^14-773-51-71-4- &/ticiens-011 c)2005-^�^"9.7Q1 ~��'�/� =�z^� / _ 04 A4- , ^~~ `^ �7/ �/�� ' g666-- /y7 ��- � .. � ^^u'~ ^^~-`^ /975 @ ga,#)60 eadM/ 2 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA (Type your name) No. Vs. Driver's Registration Appeal Commonwealth of Pennsylvania Department of Transporttion Bureau of Driver Licensing CERTIFICATE OF SERVICE /// The undeBignedhereby cerb�esthat on /./01,)./��--,2U�~7~ , I caused to be mailed by regular mail, postage prepaid, a copy of the Appeal, Order Scheduling Hearin , and all attachments, to: Office of Chief Counsel Vehicle and Traffic Law Division Riverfront Office Center, 3' Floor 1101 South Front Street Harrisburg, PA 17104-2516 Date: A/w. 20 /'/ Signature: COL' /[/-l^ -^ �~ ' Type your Narne: �7/K-/v�/�f�r��+ � Address: «J{},-^�/��leg�/°�/r �� ^ �� City / State / Zip Code: °~�J^~ /705CJ Telephone: 1/7 ' 8/o • q-665 ** 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 13, 2014 NATASHA T HENDERSON 2005 WARREN WAY MECHANICSBURG PA 17050 Dear MS. HENDERSON: WID * 142799283147019 001 PROCESSING DATE 10/06/2014 DRIVER LICENSE * 26777203 DATE OF BIRTH 02/17/1973 This is an Official Notice of the Suspension of your Driving Privilege as authorized by Section 1543 of the Pennsylvania Vehicle Code. As a result of your 10/03/2014 conviction of violating Section 1543A of the Vehicle Code DRIVING WHILE SUSP/REVOKE on 09/26/2014: Your driving privilege is SUSPENDED for a period of 1 YEAR(S) effective 11/17/2014 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 privilege until all the requirements are satisfied. COMPLYING WITH THIS SUSPENSION You must return all current Pennsylvania driver's licenses, learner's permits, temporary driver's licenses (camera cards) in your possession on or before 11/17/2014. You May surrender these items before, 11/17/2014, for earlier credit; however, You may not drive after these items are surrendered. 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 identification (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. 142799283147019 1. Return all current Pennsylvania driver's licenses, learner's permits and/or camera cards to PennDOT. If you do not have any of these items, send a sworn notarized 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), and/or a sworn notarized letter, PennDOT will send you a receipt confirming the date that credit began. 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 suspension. PennDOT phone numbers are listed at the end of this letter. 3. If you do not return all current driver license products, we must refer this matter to the Pennsylvania State Police for prosecution under SECTION 1571(a)(4) of the Pennsylvania Vehicle Code. PAYING THE RESTORATION FEE You must pay a restoration fee to PennDOT to be restored from a suspension/revocation of your driving privilege. To pay the applicable restoration fee, payment can be made at anytime online a www.dmv.state.pa.us or mailed to the address listed below. Please include your driver number on your check, money order or correspondence. Pennsylvania Department of Transportation Bureau of Driver Licensing P.O. Box 68693 Harrisburg, PA 17106-8693 The Restoration Fee is based on the Consumer Price Index and subject to change. For the current restoration fee amount due, please visit PennDOT's website at www.dmv.state.pa.us to obtain a copy of your restoration requirements letter. If you do not have internet access, please call PennDOT's Customer Care Center at 1-800-932-4600 to request a copy of your restoration requirements letter. 142799283147019 Please note: Paying the restoration fee DOES NOT satisfy the requirement to acknowledge your suspension/revocation. If you have not acknowledged your suspension/revocation, please follow the instructions listed under "Complying with this Suspension/Revocation". 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 insurance 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. 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 13, 2014, 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 your appeal to be valid, you must send this time -stamped certified 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 by 11/17/2014. Sincerely, 04t Kara N. Templeton, Director Bureau of Driver Licensing 142799283147019 SEND FEE/LICENSE/DL-16LC/TO: Department of Transportation Bureau of Driver Licensing P.O. Box 68693 Harrisburg, PA 17106-8693 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 A/07 -7-46/79A/07-7-46/79- ,' //&~iawpv : (Print your name) ..'- N»��-656i'� Vs. Driver's Registration Appea Commonwealth of Pennsylvania Department ofTransportation Bureau of Driver Licensing ORDER SCHEDULING HEARING ON APPEAL AND NOW, this /I day of , a hearing is scheduled �� onthe appe�ofPe��one,for the �� day of .n»/5' at 20 `� M in Courtroom # of the Cumberland County Courthouse, One Courthouse Square, 4I Floor, Carlisle, PA 17013, at which time testimony will be taken and argument heard. A copy of this Order has beer, served on Appellant. It shaU 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 Vehicte and Traffic Law Division Riverfront Office Center, 3"I 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. coft'es /7224.k I1/4) � �^ �� ol