Approved, SCAO Original - Court 1st copy - Secretary of State 2nd copy - Petitioner 3rd copy - Attorney general/Prosecutor STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY Court address ORDER TO ISSUE RESTRICTED DRIVER'S LICENSE OR FULL DRIVING PRIVILEGES CASE NO. Court telephone no. Petitioner name, address, and telephone no. Respondent v Driver's license no. Date of birth SECRETARY OF STATE OF THE STATE OF MICHIGAN Driver Assessment and Appeal Division PO Box 30196 Lansing, Michigan 48909-7696 Respondent's attorney, bar no., address, and telephone no. Petitioner's attorney, bar no., address, and telephone no. For alcohol related matters with arrest dates after 1/1/92 use either Form CC 268 or CC 269 as appropriate. Date of hearing: 1. On Date Judge: petitioner filed a petition seeking review of the Date Bar no. suspension restriction denial and/or revocation of driving privileges by the Secretary of State for: a. application denial for 2 convictions 3 years prior to application [MCL 257.303(1)(l)] b. administrative revocation/denial for 2 convictions of reckless within 7 years [MCL 257.303(1)(i) and (2)(a)] c. administrative revocation/denial for 2 convictions of felonies with vehicle [MCL 257.303(1)(j) and (2)(b)] d. application denial for medical reasons, road or sign test failure [MCL 257.303(1)(g), (h), or (k)] e. driver assessment action [MCL 257.310d, MCL 257.320] f. mandatory suspension [MCL 257.319] g. mandatory suspension for illegal use of license [MCL 257.324] h. first implied consent suspension [MCL 257.625f] i. mandatory additional sanction for driving while license suspended, etc. [MCL 257.904] j. administrative revocation/denial for alcohol with all arrest dates prior to January 1, 1992 [MCL 257.303] k. administrative revocation/denial for fleeing and eluding 1st/2nd degree [MCL 257.303(2)(g)] IT IS ORDERED: 2. The Secretary of State shall restore to petitioner an operator's license with full privileges. 3. The Secretary of State shall restore to petitioner an operator's license allowing him/her to drive with restrictions. a. If there is any evidence of drinking in the use of a motor vehicle, or if there is a violation of this order during the period that this order is in effect, police shall confiscate the operator's license and return it to the court. A hearing will be held if requested by the petitioner within 14 days from the date the license is confiscated. b. If the petitioner pleads guilty to, is convicted of, or is found responsible for any alcohol related offense or X3 crashes or 625G permits while this order is in effect, the operator's license shall be sent to the Secretary of State who shall reinstate the original licensing action. Reinstatement shall be for the time not served in the original Secretary of State order. c. Provided the petitioner abides by the conditions of this order, the restricted driver's license shall terminate on AND on that date the petitioner shall appear before the court for further examination and review. OR the court shall relinquish jurisdiction over this matter and the petitioner may apply to the Secretary of State and the Secretary of State may grant full or partial restoration of driving privileges. OR on that date the Secretary of State shall restore full driving privileges. (see other side for further orders) ORDER TO ISSUE RESTRICTED DRIVER'S LICENSE OR FULL DRIVING PRIVILEGES, MCL 257.323, MCL 257.323a-c FOR ARRESTS BEFORE 1/1/92 American LegalNet, Inc. www.FormsWorkflow.com CC 217 (3/06) 3. d. The restricted privileges shall be as follows: 1) Petitioner may: drive using the most direct route to and from the driver's residence and place of employment. OR drive during the course of employment. 2) Petitioner may drive from his/her residence to and from the probation office. 3) Petitioner may drive from his/her residence to and from community service. 4) Petitioner may drive from his/her residence to and from his/her educational institution. 5) Petitioner may drive from his/her residence or work location to where the petitioner or a family member receives regularly occurring medical treatment for a serious condition. 6) Petitioner may drive from his/her residence to and from alcohol treatment and AA meetings. 7) Petitioner may only operate a vehicle equipped with an ignition interlock system. 8) Petitioner shall satisfactorily complete the following traffic safety program(s): 9) Other: 4. Petitioner must carry proof of destination for restrictions. Examples include work and school schedules, probation order, etc. 5. Any relief granted in this order does not overrule any restriction, denial, suspension, or revocation imposed under · administrative denial for any arrest for drunk driving after January 1, 1992 - see MCL 257.323(6) [MCL 257.303(1)(d), (e), (f)(i), or (f)(ii), and MCL 257.303(2)(c), (d), (e), or (f)] · trial court sentence for drunk driving or under 21 blood alcohol content - see MCL 257.323(5)(a) [MCL 257.625 or 257.626b] · CDL - see MCL 257.323(8) [MCL 257.312f, MCL 257.319a, or MCL 257.319b] · failure to appear in court or failure to comply with judgment - see MCL 257.323(5) [MCL 257.321a] · unsatisfied judgment - see MCL 257.323(7) [MCL 257.512] · second implied consent - see MCL 257.323(4) [MCL 257.625f] · trial court sentence for a drug conviction - see MCL 257.323(5)(b) and (9) [MCL 257.303(1)(n) and MCL 257.319e] · court ordered relief is not effective for nonresidents - see MCL 257.303(m) 6. This order shall be void and without effect if a true copy of this order is not served on the Secretary of State, Driver Assessment and Appeal Division, PO Box 30196, Lansing, Michigan 48909-7696 within 7 days of the date this order is signed. Approved as to form: Date Judge Assistant attorney general/Assistant prosecuting attorney American LegalNet, Inc. www.FormsWorkflow.com