IN THE CLEVELAND HEIGHTS MUNICIPAL COURT Case No Name of Petitioner BMV Case No. Full Street address with Apt. Policy No. City/State/Zip Date of Birth Social Security # Phone # with area code 12 POINT APPEAL PETITION v s . Registrar, Bureau of Motor Vehicles Driver’s License Division P.O. Box 16520 Columbus, OH 43266-0020 I hereby appeal the attached notice of suspension from the Bureau of Motor Vehicles for the following reason(s): Signature of Petitioner Date 2001 © American LegalNet, Inc.