PETITION TO RESCIND STATUTORY SUMMARY SUSPENSION (This form replaces CCG-0506) (Rev. 1/8/01) CCTR 0506 _______________________________ _______________________________________ Date Driver's License Number _______________________________________ Case Number _______________________________________ County PETITION TO RESCIND STATUTORY SUMMARY SUSPENSION I hereby petition the court to rescind the Statutory Summary Suspension issued in this case because (check appropriate item(s)): ! I was not properly placed under arrest for an offense as defined in 625 ILCS 5/11-501 of the Illinois Vehicle Code (Driving Under the Influence of Alcohol/Drugs) or a similar provision of a local ordinance, as evidenced by the issuance of a Uniform Traffic Ticket to other form of charge: ! The arresting officer did not have reasonable grounds to believe that I was driving or in actual physical control of a motor vehicle while under the influence of alcohol and/or other drugs, or a combination thereof: ! I was not properly warned by the arresting officer as provided in 625 ILCS 5/11-501.1(c) of the Illinois Vehicle Code: ! I did not refuse to submit to and/or complete the required chemical test or tests, pursuant to 625 ILCS 5/11-501.1 (d) of the Illinois Vehicle Code, upon the request of the arresting officer: ! I submitted to the requested test or tests but the test sample of my blood alcohol concentration did not indicate a blood alcohol concentration of 0.08 or more: Under penalties as provided by law pursuant to 735 ILCS 1/1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in the "Petition to Rescind Statutory Summary Suspension" attached hereto and made a part hereof, are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he/she verily believes the same to be true. ________________________________ _______________________________________ Court Date Petitioner's Signature ________________________________ _______________________________________ Room Street Address ________________________________ _______________________________________ Time City/State/Zip Note: Any judicial hearing, request, or process pursuant to this Petition will not stay or delay the Statutory Summary Suspension. The hearing may be conducted upon a review by the court of the law enforcement officer's own official reports; provided however, that you may subpoena the arresting officer if you so desire. THE HEARING WILL BE LIMITED ONLY TO THE ISSUE(S) YOU HAVE MARKED IN THE BOXES NOTED ABOVE. The hearing will be held within 30 days after receipt of the Petition to Rescind Statutory Summary Suspension but subject to the discretion of the court, not sooner than 7 days following receipt of such petition by the Circuit Court having jurisdiction. DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Print This Form For your protection and privacy, please press the Clear This Form button after you have printed the form. Clear This Form