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Home My WebLink About14-7419S E C T I O N S E C T I 0 N Supreme Court of :Pennsylvania Couw;trof Common;Pleas Civil ' ove rrSheet CombecIck`r County For Prothonotary Use Only: /1/ -SI tt,.. Docket No: SL/ -- 7L// The information collected on this,fornt is used solely for court adnnnistration 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 M Transfer from Another Jurisdiction ❑ Lead Plaintiff's Nat ie: Teri 1—' .Le)14 Defenda it's Name: (hn-Jo Are money damages requested? ❑ YesNo Dollar AmMit Requested: within arbitration limits (check one) i outside arbitration limits Is this a Class Action Suit? - Yes 11 No Is this an MDJAppeal? - Yes M7No Name of Plaintiff ppellant'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 ❑ Malicious Prosecution ❑ Motor Vehicle ❑ Nuisance ❑ Premises Liability ❑ Product Liability (does not include mass tort) O Slander/Libel/ Defamation ❑ Other: MASS TORT O Asbestos ❑ Tobacco ❑ Toxic Tort - DES O Toxic Tort - Implant ❑ Toxic Waste O Other: PROFESSIONAL LIABLITY ❑ Dental ❑ Legal O Medical ❑ Other Professional: CONTRACT (do not include Judgments) ❑ Buyer Plaintiff ▪ Debt Collection: Credit Card ❑ Debt Collection: Other ❑ Employment Dispute: Discrimination ❑ Employment Dispute: Other ❑ Other: REAL PROPERTY O Ejectment ❑ Eminent Domain/Condemnation • Ground Rent ❑ Landlord/Tenant Dispute ❑ Mortgage Foreclosure: Residential O Mortgage Foreclosure: Commercial • Partition ❑ Quiet Title ❑ Other: CIVIL APPEALS Administrative Agencies O Board of Assessment ❑ •ard of Elections 7 Dept. of Transportation O Statutory Appeal: Other O Zoning Board O Other: MISCELLANEOUS ▪ Common Law/Statutory Arbitration O Declaratory Judgment • Mandamus ❑ Non -Domestic Relations Restraining Order • Quo Warranto 0 Replevin ❑ Other: Updated 1/1/2011 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,�PENNSYLVANIA No. ! 7( l (/T C/V:' -fre`"` ori \V.3r (Type your r ane) Vs. Driver's License/Auto Registration AppeA rri cn j c-7 `.f V > 4.J AND NOW, this (enter today's date) ��/,42 Q01(1 , comes the Appellant, (Type your name) , by his/her attorney, Commonwealth of Pennsylvania Department of Transportation Bureau of Drivers Licensing APPEAL OF DRIVER'S LICENSE/AUTO. REGISTRATION SUSPENSION rr C)`; �x- 1. Appellant's A operator'ssumber or automobile registration number is: 5"-- 660 o35— and states as follows: 2. PennDOT proposes, by Notice dated (insert "mailing" date here)) C rib r I, 20 1 , to suspend Appellant's ,-� driving privileges 1j'automobile registration • for a period of (Insert length of suspension) • , Bursuant to Section 17%(d) of the Vehicle Code, which suspension is to be effective (Insert suspension effective date) ",kY) Fsigto , 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). Other (Specify reason:) PLC, 75— `ik 5Oq7 ,2 1 -OR - The suspension of Appellant's automobile registration is contrary to law in that: X 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 _ c ;c\ e.V . ; 1(1SQ,CCO1C e cSV er -tie 3 l S , ‘00 okim Ck v\-ciwp. ci( c cA e e1 e s . 1 1w olte ha_ok t nJvro-r.c e, r 3 0, -ova\- S .o ogv k G ct)v-e x.v. E Cc s C3 G -c c% WHEREFORE, Appellant respectfully requests this Honorable Court to sustain the appeal from the suspension of operating privileges or automobile registration. Respectfully submitted, (Type name heo) 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: 2 CHRISTY JURAY 506 CHERRY CT CARLISLE, PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION BUREAU OF MOTOR VEHICLES PO BOX 68674 HARRISBURG, PA 17106-8674 www.dmv.state.pa.us WID11 143289999025325 001 TITLE! 71766231 PROCESSING DATE 141124 TRANSACTION CODE 00060 OFFICIAL NOTICE MAIL DATE: 12/01/14 Dear"Customer:—"°': - The Department recently requested that you provide us with proof of financial responsibility (insurance) for the following vehicle: MAKE: CHRYSLER YEAR: 1999 BODY TYPE: STATION WAGON LICENSE PLATE##: JFT2026 TffLE##: 71766231 VIN/#: 1C4GP54L7XB527852 This information was requested because STATE FARM FIRE AND CASUALTY CO notified us that the insurance policy covering the vehicle listed above was terminated on 09/24/14. 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 01/05/15 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 $88.00 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 0-4 Harrisburg, PA 17104-2516 `1\3 Irr i lc, , IN- • rn , Certified Fe ru D Return Racelet Fee 0 (Endorsement Required) C:1 Restricted Delivery Fe (Endorsement Required) 11 rIn Total Postage & Fee IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA (Type your na Vs. Commonwealth of Pennsylvania Department of Transportation Bureau of Driver Licensing No. Driver's License/Auto Registration Appeal C can, rW Fri CERTIFICATE OF SERVICE Psj , C.) C.) The undersigned hereby certifies that on „kn. a_ , 2013 , 1 cause to-be r\)— mailed by regular mail, postage prepaid, a copy of the Appeal, Order Scheduling Hearing, and all attachments, to: Date: //A. 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: ate / Zip Code: Telephone:On ) U.S. Postal Service,. CERTIFIED MAILTM RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) For delivery information visit our websfte at www.usps.como 9.411. 49 Sent To genet,Apt.No4 or PO Box No. City, State, Z1P+4 PS Form 3800, August 2006 See Reverse for Instructions Iled out and filed in the Prothonotary's office g the documents to PennDOT ** IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA A-)b 7�11vJ�3 No. { I (Print your nam 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 V M day of 0*11IA94Y , 20%/, a hearing is scheduled on the appeal of Petitioner for the day of MMACA 20-/�atQ :xA—M in Courtroom #J of the Cumberland County Courthouse, One Courthouse Square, 4`h 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. luj _ By th ou Jge #; 57 aJ cj-i4S�,