IN THE MUNICIPAL COURT OF SYLVANIA, LUCAS COUNTY, OHIO MOTION FOR LIMITED DRIVING PRIVILEGES VIOLATION DATE: ___________________________________ CASE NO: ____________________________________________ DEFENDANT: ________________________________________ DATE: ___________________________________________ COURT DATE:____________________________________ ATTORNEY:______________________________________ Pursuant to Section 4509.45 O.R.C. proof of current financial responsibility is attached along with a copy of the Court required assessment. The Defendant respectfully requests the Court to consider granting limited driving privileges as follows FOR: OCCUPATIONAL, EDUCATIONAL, MEDICAL, DRIVER EXAM, COURT ORDERED TREATMENT PURPOSE: 1)______________________________________________________________________________________________ PLACE/ADDRESS/CITY/ST:________________________________________________________________________________________ __________________________________________________________________________________________________________________ DATE/TIMES: ____________________________________________________________________________________________________ __________________________________________________________________________________________________________________ JUDICIAL USE ONLY [ ] APPROVED [ ] DENIED [ ] DEFERRED DATE_________________________ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- PURPOSE: 2)______________________________________________________________________________________________ PLACE/ADDRESS/CITY/ST:________________________________________________________________________________________ ________________________________________________________________________________________________ DATE/TIMES: ____________________________________________________________________________________ ________________________________________________________________________________________________ JUDICIAL USE ONLY [ ] APPROVED [ ] DENIED [ ] DEFERRED DATE_________________________ ------------------------------------------------------------------------------------------------------------------------------------------------PURPOSE: 3)______________________________________________________________________________________________ PLACE/ADDRESS/CITY/ST:________________________________________________________________________________________ __________________________________________________________________________________________________________________ DATE/TIMES: ____________________________________________________________________________________________________ __________________________________________________________________________________________________________________ JUDICIAL USE ONLY [ ] APPROVED [ ] DENIED [ ] DEFERRED DATE_________________________ ***FURTHER UNDERSTAND THAT THESE LIMITED DRIVING PRIVILEGES DO NOT APPLY TO ANY VEHICLE REQUIRING A COMMERCIAL DRIVER'S LICENSE*** ___________________________________________________ Defendant's Phone Number:____________________________________ Signature of Defendant and/or Attorney --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------[ ] RESTRICTED PLATES ARE REQUIRED [ ] FOR EMPLOYMENT VEHICLES, PROOF OF NOTICE SIGNED BY EMPLOYER MUST BE SHOWN PRIOR TO ISSUING PRIVILEGES. [ ] INTERLOCK REQUIRED DRIVING PRIVILEGES EFFECTIVE UPON COMPLIANCE, BUT NO ____________________________________ SOONER THAN ____________________________________________ REV 11/2012 M. SCOTT RAMEY, JUDGE American LegalNet, Inc. www.FormsWorkFlow.com