Name, Address, Phone # & State Bar # of Attorney or Party without Attorney Attorney for: SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF YOLO [ ] 725 Court Street, Room 111, Woodland CA 95695 (530)406-6705 [ ] 601 Court Street, Woodland CA 95695 (530)406-6702 Plaintiff: PEOPLE OF THE STATE OF CALIFORNIA CASE NUMBER: Defendant: PETITION FOR RESTRICTED LICENSE (VC 13202.5) 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 Section ___________________ of the California Vehicle Code on _____________________ and consequently my driving privilege 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: [ ] I am attending school and the transportation available is inadequate for my regular attendance. School: _______________________________________________________________ Course of Study: ________________________________________________________ Dates & times of attendance: ______________________________________________ I have attached a signed statement from the school principal or administrator verifying the above facts. I understand that if I am granted a restricted license for this purpose I will be restricted to operating a motor vehicle from my residence to the school and returning to my residence from school. [ ] The transportation available is inadequate and my operation of a vehicle is necessary due to illness of a family member. I have attached a signed statement from a physical familiar with the condition of the ill family member. That statement contains a diagnosis and probable date when the patient will be sufficiently recovered. I understand that if I am granted a restricted license for this purpose I will be restricted to operating a motor vehicle only for the purpose of transporting my ill family member to and from medical care. Page 1 of 2 PETITION FOR RESTRICTED LICENSE 02-07 American LegalNet, Inc. www.FormsWorkflow.com [ ] I am employed and the income from my employment is essential to the support of my family. Transportation is inadequate and the use of a motor vehicle is necessary for me to continue my employment. Current Employer: ________________________________________________________ Employer’s address: _______________________________________________________ Occupation: ______________________________________________________________ I support the following people: _______________________________________________ ________________________________________________________________________ Hours of employment: _____________________________________________________ I also need to drive during my employment because: _____________________________ ________________________________________________________________________ I have attached a signed statement from my parent or guardian that explains why I need to drive to work to help support my family. I understand that if I am granted a restricted license for this purpose I will be restricted to operating a motor vehicle from my residence to my work and returning to my residence from my work. In some cases, I may be allowed to drive while I am working, but only if driving is a necessary part of my employment. 7. I request that the Judge also consider the following information in determining if I have a critical need to drive. _____________________________________________________________________________ _____________________________________________________________________________ 8. Wherefore, I request the Court to authorize a restricted license permitting me to drive as indicated above. I declare under penalty of perjury of the State of California that the foregoing is true and correct. Executed this _________ day of _______________, 20___ at _____________________ CA. ________________________________ Petitioner ORDER OF THE COURT The forgoing petition is: [ ] DENIED – No critical need has been shown. [ ] GRANTED – DMV to issue a license restricted as follows: _________________________________________________________________________________ _________________________________________________________________________________ Dated: _____________________ ___________________________________ Judicial Officer WARNING: THIS ORDER DOES NOT AUTHORIZE YOU TO DRIVE. YOU MUST GO TO DMV AND APPLY FOR A RESTRICTED LICENSE. Page 2 of 2 PETITION FOR RESTRICTED LICENSE 02-07 American LegalNet, Inc. www.FormsWorkflow.com