AOC-495.3 Rev. 1-15 Page 1 of 1 Doc. Code: AH OHVR Case No. _____________________ Court ________________________ County _______________________ APPLICATION AND ORDER FOR HARDSHIP VEHICLE REGISTRATION Division ____________________ Citation No. ___________________ Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 189A.085(2) Commonwealth First Vs. Sex Race Date of Birth Height Weight Middle Last ___________________________________________ ___________________________________________ Address Operator License No. State ___________________________________________ APPLICATION Pursuant to KRS 189A.085(1), the Court has impounded license plates for all vehicles owned, either jointly or individually, by the above-named defendant. Comes ______________________________________________, and moves the court to grant a hardship vehicle registration for a vehicle identified as: ______________________________________ ___________________________ VIN Number License Plate No. (1.) My relationship to the defendant is ______________________________________. (2.) I am adversely affected by the license plate impoundment because: _________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ (3.) I understand that if the Court grants a hardship vehicle registration, the above-named defendant will not be permitted to operate the vehicle under any circumstances, and that I may face criminal penalties if I knowingly permit said defendant to operate the motor vehicle. WHEREFORE, applicant prays this application for a hardship vehicle registration will be granted for the above-described vehicle. _________________________________________ Date Doc. Code: OHVR ____________________________________________ Applicant ORDER The Court being satisfied applicant's inability to use the above-described vehicle for which the Court has impounded the license plate would pose an undue hardship to the applicant, the Court hereby ORDERS the county clerk to reinstate registration for the above-described vehicle. Under no circumstances shall the abovenamed offender,_______________________________________________, be permitted to drive the vehicle once registration has been been reinstated during the period of the offender's driver's license suspension. _________________________________________ Date ____________________________________________ Judge Copy Distribution: White - Court File Yellow - Applicant Pink - If granted, Applicant delivers to County Clerk American LegalNet, Inc. www.FormsWorkFlow.com