IN THE LAKEWOOD MUNICIPAL COURT _____________________________ Name of Petitioner Case No.:________________________ BMV Case No.:____________________ ___________________________________ Full Street Address Date of Birth:______________________ ___________________________________ City/State/Zip ___________________________________ Phone number Social Security No.:_________________ 12 POINT APPEAL PETITION VS Registrar, Bureau of Motor Vehicles Driver's License Division P.O. Box 16520 Columbus, Ohio 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 American LegalNet, Inc. www.FormsWorkFlow.com