VN172 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) Telephone Number FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF VENTURA 800 SOUTH VICTORIA AVE. VENTURA, CA 93009 4353 VINEYARD AVE, OXNARD, CA. 93036 PLAINTIFF: DEFENDANT: PEOPLE OF THE STATE OF CALIFORNIA PETITION FOR RESTRICTED LICENSE 13202.5 VC - Controlled Substance or Alcohol Related Offense (under age of 21 years) 13202.6 VC - Vandalism CASE NUMBER: I, the undersigned, say that: 1. 2. 3. 4. I am the defendant in the above-entitled action. My date of birth is: __________________________________________ My driver's license number is: _________________________________ I was convicted of a violation of __________________________ on _____________________ and consequently my driving privilege was suspended for _______________________ 5. 6. My driving privilege is not suspended at this time for any other reason. I have a critical need to drive, as follows: _________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________. 7. Wherefore, I request the court to authorize a restricted license permitting me to do so. months year(s). I declare under penalty of perjury that the foregoing is true and correct. Dated: ________________________________ Address: _______________________________ Signature of Petitioner: ___________________________________ Phone Number : ___________________________________ __________________________ ORDER Denied. No critical need has been shown. Granted. DMV to issue a license restricted as follows: The court orders that the petition is: 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 VN172 (Rev. 7/09) PETITION FOR RESTRICTED LICENSE American LegalNet, Inc. www.FormsWorkFlow.com