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Home My WebLink About14-6790S E C T I 0 N A S E C T I 0 N Supreme Court _ofPennsylvania Court of Common Pleas Civil Cover Sheet er a County For Prothonotary Use Only: Docket No: 7/6 The information collected on this far -;n is used solely for court administration purposes. This form does not supplement or re lace the filing and service of pleadinUs or other papers as required by law or rules ofcou rt. Commencement of Action: Declaration of Taking ❑ Complaint ■ Writ of Summons [Petition ❑ Transfer from Another Jurisdiction ❑ Lead Plaintiff's Name: C1 J %�'OGt. LitLA-5t�aao's�,rt�.tT'+ Lead Defendant's Name: y� _ i �A �1/t : c_ /r Dollar Amount Requested: ■ within arbitration limits Are money damages requested? • Yes g No (check one) ❑outside arbitration limits Is this a Class Action Suit? ■ Yes cg- No Is this an MDJAppeal? • Yes I51- No Name of Plaintiff/Appellant's Attorney: g Check here if you have no attorney (are a Self -Represented fPro 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) 0 Intentional O Malicious Prosecution ❑ Motor Vehicle O Nuisance ❑ Premises Liability ❑ Product Liability (does not include mass tort) ❑ Slander/Libel/ Defamation ❑ Other: MASS TORT ❑ Asbestos O Tobacco ❑ Toxic Tort - DES ❑ Toxic Tort - Implant ❑ Toxic Waste ❑ Other: PROFESSIONAL LIABLITY O Dental O Legal ❑ Medical ❑ Other Professional: CONTRACT (do not include Judgments) ❑ Buyer Plaintiff ❑ Debt Collection: Credit Card ❑ Debt Collection: Other 0 Employment Dispute: Discrimination O Employment Dispute: Other ❑ Other: REAL PROPERTY 0 Ejectment O Eminent Domain/Condemnation O Ground Rent O Landlord/Tenant Dispute ❑ Mortgage Foreclosure: Residential O Mortgage Foreclosure: Commercial 0 Partition ❑ Quiet Title O Other: CIVIL APPEALS Administrative Agencies ❑ Board of Assessment ❑ Board of Elections Dept. of Transportation Statutory Appeal: Other ❑ Zoning Board ❑ Other: MISCELLANEOUS ❑ Common Law/Statutory Arbitration ❑ Declaratory Judgment ❑ Mandamus 0 Non -Domestic Relations Restraining Order 0 Quo Warranto ❑ Replevin ❑ Other: Updated 1/1/2011 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA C In -6) No. e'fra-7er+1-)if.,‘.Gjw1 (Type your name) 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 AND NOW, this (enter today's date) , 20 , comes the Appellant, (Type your name) , 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) ,20 , to suspend Appellant's Odriving privileges n automobile registration for a period of (Insert length of suspension) pursuant to Section of the Vehicle Code, which suspension is to be effective (Insert suspension effective date) , 20 ****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) riThe police lacked reasonable grounds to stop Appellant and / or request Appellant to submit to a chemical test. riAppellant 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). riOther (Specify reason:) ^ L nC o ONV-1 38 t73 OE :c 14d I? RON -106 0 4-1/57 i' 31377q c py /^"?. c) /1-Pr1 I -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, (Sign name here) (9111-k* Co t10\13 (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: (( -�(/' �, �e Type Name: C - r` i t tO N L , Co i +"i ras Address: l l &) Hi ChOly —nue c'1� � la, City / State / Zip Code: Coryrn►t C'+y Co • hoiaa Telephone Number: % 2-0 - OaA"',D(ol Email address: @ 2 11/17/2014 1:48 PM FAX 19374566497+ 00003/0005 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Clinton L. Collins No. /II- G7 ` p6 ,(Type your name) 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 AND NOW, this (enter today's date) October 21, ., 2014 , comes the Appellant, (Type your name) Clinton L. Collins . , by:his/her;attomey, 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) , 20 , to suspend Appellant's Eldriving privileges II automobile registration fora period of (Insert length of suspension) pursuant to Section of the Vehicle Code, which suspension is to be effective (Insert suspension effective date) , 20 ****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). TY(Specify reason:) 1d' SLtS1°�z - e€4/466 eyI-J fl y kq 1 11/17/2014 1:49 PM FAX 19374566497+ . Ij 0005/0005 Ocithr fliauq (iu. Ile J ud C I'►n��.R. 111.05 is wc.1--i• Q.lt_ I ,r on bthAlic t7� LO2tb auc3 Vcb rm 0133 Ctee (oF ).kcTfiS dcne.,p 0,1„0,U \venkt, upq&)1.4- Duaoz,_ c",on L1(1'4 -1'I `al-.Carnart0 ke:eica, °i- \c\Aca CSP m C-00 30= QM c. � �".�ovc*-i rig) 4-hotelib\e....,Biafotto(\ le\ tc\ .\fx2N.o., 0\4 °A6' °c"O\ mQ e- 11/17/2014 1:47 PM FAX 19374566497+ 00001/0005 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Clinton L. Collins (Type your name) No. P6740 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: October 21 , 2014 Office of Chief Counsel Vehicle and Traffic Law Division Riverfront Office Center, 3'd Floor 1101 South Front Street Harrisburg, PA 17104-2516 Signature: Type your Name: Address: City / State / Zip Code: Telephone: Clinton L. Collins 359 N. Hanover Street Carlisle Pa. 17013 720-822-3679 ** 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 C .'116N 60IMS (Type your name) No. Pk alo9iZei9 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, 3'd Floor 1101 South Front Street Harrisburg, PA 17104-2516 Signature: Type your Name: Cl ril--00 CDL1,r Address: 7030 Hr3bLQ)ay 17.1.) n 1 a, City / State / Zip Code: Telephone: a 4:1 co-eooaa ** 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 1 -67.96 OAI4-I/At C. 'n+-01,1 L.C_OIIitQS (Print your name) No. 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 01 day of / , 20/y, a hearing is scheduled on the appeal of Petitioner for the a� day of ..4u, , 20/at ' : 30 ]] _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, 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. / O_CL%of ac' es"%e'- ma, /d /1 lacy, v By the Court, Judge Cr) .,'