VN173 ATTORNEY OF PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA 4353 VINEYARD AVE, OXNARD, CA. 93036 IN THE MATTER OF: PETITION FOR RESTRICTED LICENSE UNDER AGE OF 21 YEARS (JUVENILE) I, the undersigned, say that: 1. I am the minor in the above-entitled action. 2. My date of birth is: _____________________________ 3. My driver's license number is: _________________________________ 4. I was convicted of a violation of __________________________ on _____________________ and consequently my driver's license was suspended for one year because I was under the age of 21. 5. My driving privilege is not suspended at this time for any other reason. 6. I have a critical need to drive, as follows: _____________________________________________________ CASE NUMBER: 7. Wherefore, I request the court to authorize a restricted license permitting me to do so. I declare under penalty of perjury that the foregoing is true and correct. Dated: ________________________________ Address: _______________________________ Petitioner: __________________________ Phone Number : __________________________ __________________________ The court orders that the petition is: ORDER Denied. No critical need has been shown. Granted. DMV to issue a license restricted as follows: Date: ______________________________ Judicial Officer's Signature __________________________________ CAUTION: THIS ORDER DOES NOT AUTHORIZE YOU TO DRIVE. YOU MUST GO TO THE DMV AND APPLY FOR A RESTRICTED LICENSE. Optional Form VN173 (rev. 7/05) PETITION FOR RESTRICTED LICENSE UNDER AGE OF 21 YEARS (JUVENILE) American LegalNet, Inc. www.USCourtForms.com