HomeMy WebLinkAbout15-0037s
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Supreme Court of Pennsylvania
Court; of -Common
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Civil'Cove>i;Sheet
C(AWN A-ct.k6,Ltq(/ County
For Prothonotary Use Only:
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Docket No:
pgD/‘ - 003 7
The information collected 0/1 this_forni is used solely for cornu administration purposes. This ,form does not
supplenient or replace the filing and service of pleadings or other papers as required by law or rules of court.
Commencement of Action:
❑ Writ of Summons
Petition
Declaration of Taking
Complaint
• Transfer from Another Jurisdiction
Le d,,Plaintiff's Name:
fit"n
Gc0.l 0
Le Defendant's Name:
Id
�lVAPCYT-
Are money da ages
requested? ❑ Yes giNo
Dollar Amount Requested: within arbitration limits
(check one) outside arbitration limits
Is this a Class Action
Suit? YesNo
Is this an MDJAppeal? Yes 1b No
Name of PI intiff/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
❑ Malicious Prosecution
❑ Motor Vehicle
❑ Nuisance
❑ Premises Liability
O Product Liability (does not include
mass tort)
O Slander/Libel/ Defamation
O Other:
MASS TORT
O Asbestos
O Tobacco
❑ Toxic Tort - DES
O Toxic Tort - Implant
❑ Toxic Waste
❑ 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
• Other:
REAL PROPERTY
❑ Ejectment
❑ Eminent Domain/Condemnation
O Ground Rent
O Landlord/Tenant Dispute
O Mortgage Foreclosure: Residential
O Mortgage Foreclosure: Commercial
❑ Partition
❑ Quiet Title
• Other:
CIVIL APPEALS
Administrative Agencies
❑ Board of Assessment
O Board of Elections
,Dept. of Transportation
O Statutory Appeal: Other
O Zoning Board
O Other:
MISCELLANEOUS
O Common Law/Statutory Arbitration
• Declaratory Judgment
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
N
(Type your name
Vs.
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Drivers Licensing
No.
020 DOo37
car
Driver's License/Auto Registration ApiseA
APPEAL OF DRIVER'S LICENSE/AUTO REGISTRATION SUSPENSION
AND NOW, this (enter today's date) d 1 OS , 20 Ic
by his/her attorney,
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, comes the Appellant, (Type your name)
and states as follows:
1. Appellant's PA operator's number or automobile registration number is:
# 30S a -2)277
2. PennDOT proposes, by Notice dated (insert "mailing' date here)( D reYn bed_ , 20 / 5 , to suspend
Appellant's ,.( driving privileges
automobile registration for a period of (Insert length of suspension)
e R. pursuant to Section 1 C of the Vehicle Code, which
suspension is to be effective (Insert suspension effective date) (Jan uan j , 20/cj
****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 riot 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:)
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1' - Qo ki Cepa., `ice have, --A1rcen S C:Ir+cry SOrvob
(3-k \e.k i p Com' 10‘,v5 (ln,ive t Sk(IMO) t). 0
c e. Dq,o-t- LL car-6.hovqi-e, to NQ:wv 11(e , PA.
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-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,
VERIFICATION
The undersigned hereby states that the statements madein 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:
cd,
uache ca
J-/o/Iy Spring SJ PA, pc( -es""
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2
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF TRANSPORTATION
Bureau of Driver Licensing
Mail Date: DECEMBER 16, 2014
JADE MARY IGNACIO
236 N BALTIMORE AVE APT
5
MT HOLLY SPGS PA 17065
Dear MS. IGNACIO:
WID it 143439283011030 001
PROCESSING DATE 12/09/2014
DRIVER LICENSE it 30552327
DATE OF BIRTH 12/08/1993
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 12/08/2014 conviction of
violating Section 1543A of the Vehicle Code DRIVING WHILE
SUSP/REVOKE on 11/29/2014:
■ Your driving privilege is SUSPENDED for a period of 1
YEAR(S) effective 01/20/2015 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
You must return all current Pennsylvania driver's licenses,
learner's permits, temporary driver's licenses (camera
cards) in your possession on or before 01/20/2015. You may
surrender these items before, 01/20/2015, 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 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.
143439283011030
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 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), and/or a sworn
notarized letter, PennDOT will send you a receipt con-
firming the date that credit began. If you do not re-
ceive 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 pro-
ducts, 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 ad-
dress 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.
Please note: Paying the restoration fee DOES NOT satisfy
the requirement to acknowledge your suspension/revocation.
143439283011030
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 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.
APPEAL
You have the right to appeal this action to the Court of
Common Pleas (Civil Division) within 30 days of the mail
date, DECEMBER 16, 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 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 by 01/20/2015.
Sincerely,
Kara N. Templeton, Director
Bureau of Driver Licensing
143439283011030
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
Npc/S- 06193
Driver's License/Auto Registration Appeal
(Type your name
Vs.
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Driver Licensing
CERTIFICATE OF SERVICE
The undersigned hereby certifies that on J lAlilu nnj S'201 , I caused to be
mailed by regular mail, postage prepaid, a copy of the Appeal, Order Scheduling Hearing, and
all attachments, to:
Date: ja.huAq 1, '2
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:
Fri O.
rn3
M
City / State / Zip Code: l ` Holly 4t,/%/C )715e,
Telephone: % n _%(} (Q ` qt/
** 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
N J0/5 190037 LUQ
(Print your name)
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 day of�,4AI l.A _ 20/:;r, a hearing is scheduled
on the appeal of Petitioner for the day of�lLL/) 20Z.10at 9 : Q�M,
in Courtroom #-5 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,3rd 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.
By the Cgrtit,
Judge
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