STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 22nd JUDICIAL CIRCUIT McHENRY COUNTY ______________________________________________ vs. Case Number______________________________________ ______________________________________________ DUI Ticket Number_________________________________ PETITION FOR JUDICIAL DRIVING PERMIT TO RELIEVE UNDUE HARDSHIP I do solemnly, sincerely, and truly declare and affirm that: 1. I am a first offender as defined in 625 ILCS 5/11-500 of the Illinois Vehicle Code (see definition below). 625 ILCS 5/11-500 Definitions: For the purposes of interpreting Sections 6-206.1 and 6-208.1 of this code, “first offender” shall mean any person who has not had a previous conviction or court assigned supervision for violation of Section 11-501, or a similar provision of a local ordinance, or a conviction in any other state for a violation of Driving While Under the Influence or a similar offense where the cause of action is the same or substantially similar to this Code or any person who has not had a driver’s license suspension for violating Section 11-501.1 within 5 years prior to the date of current offense, except in cases where the driver submitted to chemical testing resulting in an alcohol concentration of 0.08 or more, or any amount of a drug, substance, or compound in such person’s blood or urine resulting from the unlawful use or consumption of cannabis listed in the Cannabis Control Act or controlled substance listed in the Illinois Controlled Substance Act and was subsequently found not guilty of violating Section 11-501, or a similar provision of a local ordinance. 2. I have received, or will have received prior to a hearing on this Petition, a current evaluation of my alcohol or other drug use performed by a licensed professional evaluator. 3. I have not been convicted of Reckless Homicide within the previous 5 years. 4. My driver’s license will be valid (except for the Statutory Summary Suspension) during the period covered by the Judicial Driving Permit. 5. The undue hardship that would be caused if I do not receive a Judicial Driving Permit is:_________________________________ ________________________________________________________________________________________________________ 6. I have been convicted of the following traffic and/or alcohol related offenses on the below listed dates, and have the following pending traffic and/or alcohol related violations: _________________________________________________________________ ________________________________________________________________________________________________________ 7a. I am presently employed with ___________________________________________________________________________ and that I have no other means of commuting to my place of employment, or that I must drive as a condition of my employment; that my employer has certified the hours and days of employment and the parameters necessary for driving as a condition of employment and said certification is attached hereto. 7b. I am required to secure alcohol or other medical treatment for myself or a family member and have no alternative means of transportation; that the treating physician/counselor has certified the need for treatment, said certification is attached hereto. 7c. I am presently a registered student at ____________________________________________ and that I have no other means of commuting to school, that my school has certified the hours and days of classes and said certification is attached hereto. 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 this “Petition for Judicial Driving Permit to Relieve Undue Hardship” are true and correct. _______________________________________________ ____________________________________________ Prepared by Petitioner’s Signature _______________________________________________ ____________________________________________ Address Driver’s License Number _______________________________________________ ____________________________________________ City/State/Zip Street Address _______________________________________________ ____________________________________________ Telephone Number City/State/Zip PROOF OF SERVICE I, ______________________________________________________________, I served this notice by hand-delivering or mailing a copy (the attorney, certify) (a non-attorney, on oath state) to _______________________________________________ at ____________________________________________ and deposited the same in the U.S. Mail at _______________________________________at __________ on ________________________, 20____, with proper postage prepaid. (If not the attorney) Signed and sworn to before me ________________________________________________________________ Signature ____________________________, 20________ _______________________________________ Notary Public CR-PET2 revised 12/01/06 American LegalNet, Inc. www.FormsWorkflow.com