IN THE LAKEWOOD MUNICIPAL COURT CUYAHOGA COUNTY ) ) ____________________________ ) Petitioner ) CASE NO. ) ) VS ) ) ) PETITION FOR LIMITED State of Ohio ) DRIVING PRIVILEGES Bureau of Motor Vehicles ) Respondent Now comes the Petitioner and hereby appeals the order of suspension issued by the Registrar of the Bureau of Motor Vehicles due to failure to maintain financial responsibility. The Petitioner submits that there is currently valid liability insurance in full force and effect for any vehicle driven by the petitioner. A copy of proof of insurance is attached to this petition. The petitioner requests this Court to grant the petitioner limited driving privileges for the following purpose(s): ________________________________________________________________________ ______ ________________________________________________________________________ ______ for the balance of the term of suspension. ____________________________________ Petitioners Signature Please Print : Name: _________________________________________ SSNo.:_______________ ________ Address:________________________________________ Phone (home):______ ___________ _________________________________________ (cell):__________________ ______ D.O.B._______________________ (09/04) American LegalNet, Inc. www.USCourtForms.com