INFORMA TION SHEET FOR L IMITED DRI VING PRIVI LEGE PET ITION NOTICE: You may be able to apply for limited driving privileges although your driver license is suspended. Please review the information contained on this page. If you believe that you meet the requirements, follow the instructions below. The court cannot give you privileges IF: You have had more than one prior suspension within the past 5 years for NOT having insurance coverage; or You have had a twelve (12) point suspe nsion in the last five years; or You have not paid for damages you caused in a motor vehicle accident. To receive limited driving privileges, you must do ALL of the following: 1. Pay for damages you caused if you were involved in a motor vehicle accident; 2. Obtain approved financia l responsibi lity (INSURA NCE) coverage , (means one of the following: a. An SR-2 2 Insurance or Surety Bond (must be obtained from a commercial insurance company.) b. A $60,000.00 real estate bond which may be obtained through the BMV, or c. A cash deposit of $30,000.00 which must be deposited with the BMV. 3. Pay all reinstatem ent fees unless you are applying for an extension payment plan and agree to pay all fees within no more than 180 days. 4. Fill out and sign the PETITION and INFORMATION SHEE T in this packet, along with copies of all requested information listed on the bottom of information sheet. 5. Bring or mail the petition (2 copies if you want one back) and the appropriate filing fee as listed in the petition form to: Cleveland Heights Municipal Court 40 Severance Circle Cleveland Heights, OH 44118 WAR NING: There may be a hard time period in which you cannot receive limited driving privileges of up to 15 days. 04/2005 Civilpetition04info American LegalNet, Inc. www.USCourtForms.com>>>> 2 IN THE CLEVELAND HEIGHTS MUNICIPAL COURT Case No. ___________________________________ _______________________________ _ G 12 POINT SUSPENS ION APPEAL PETITION Name of Petitioner R.C. 4510.037(G) $85.00 fee ______________________________________ Street Address G FINANCIAL RESPONSIBILITY SUSP ENS ION PETITION FOR LIMITED DRIVING PRIVILEGES ______________________________________ $85.00 fee City/State/ Zip G (Class E - 3 month suspension) Phone Number _________________________ R.C.4509.101(A)(2)(a)- 1st suspension G (Class C- 1 year suspension ) Social Security No._______________________ R.C.4509.101 (A)(2)(b)- 2nd suspension after 15 days License No. ____________________________ G PETITION FOR EXTENSION OF TIME TO PAY VS. REINSTATEMENT FEES $50.00 fee REGISTRAR, R.C. 4510.10(B)(2) BUREAU OF MOTOR VEHICLES Occupational/ Family Necess ity Privileges Drivers License Division Only P.O. Box 16520 Columbus, Ohio 43266-0020 G REINSTATEMENT FEE PAYMENT PLAN R.C. 4510.(B)(1) $50.00 fee BMV Case No. _________________________ Payments of not less than $50.00per month No Driving Privileges Permitted G I am requesting driving occupational driving privileges. I have attached proof of employment showing the location of my employer(s), hours and days of employment. G I am requesting driving privileges for educational, vocational, medical, or other reasons. I have attached a schedule showing the specific purpose, location, dates, and times that driving privileges are needed. G I have paid all reinstatement fees. Or G I have not paid my reinstatement fees and request up to 90 days to pay the fees. G I have not paid my reinstatement fees and request a payment plan of $_____ per month until the fee is paid in full. NO DRIVING PRIVILEGES REQUESTED G I did not cause any damage to any person/ property as a result of a motor vehicle accident. Or G I have paid for any damages I cause as a result of a motor vehicle accident. This information is true to the best of my knowledge and I have attached proof of financial responsibility. Signed ____________________________________________________ Jan 2004 BMVPETITIONS American LegalNet, Inc. www.USCourtForms.com>>>> 3 INF ORMATI ON FOR DRI VING PRI VIL EGES Must accompany any BMV P etition Name: Case # Employer Name: Phone: Employer Address: City: State: Zip: I work the following schedule: DAYS OF WEEK STARTING TIME QUITTING TIME Monday Tuesday Wednesday Thursday Friday Saturday Sunday I drive in the course of my employment: ___ Yes ___ No I need other driving privileges for the following necessities: PURPOSE LOCATION DATE TIME CHEC K OFF AND ATTACH THE FOLLOWING: 9 BMV Notice of Suspension 9 Receipt for BMV Payment 9 Letter from employer 9 Copy of insurance card or declarations page valid for at least 90 days Civilpetitiondriving 01/2004 American LegalNet, Inc. www.USCourtForms.com