STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 22nd JUDICIAL CIRCUIT McHENRY COUNTY ______________________________________________ vs. ______________________________________________ Case Number______________________________________ DUI Ticket Number_________________________________ 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) below ­ items 4 and 5 cannot both be checked): 1. 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 or 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 upon a public highway while under the influence of alcohol, 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 disclose a blood alcohol concentration of 0.08 or more: 2. 3. 4. 5. 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 to Rescind Statutory Summary Suspension" 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-PET1 revised 12/01/06 American LegalNet, Inc. www.FormsWorkflow.com