IN THE DELAWARE MUNICIPAL COURT, DELAWARE COUNTY, OHIO 70 North Union Street, Delaware, Ohio 43015 ! Voice: 740.203.1560 ! Facsimile: 740.203.1599 ! www.municipalcourt.org State of Ohio vs. Registrar, OBMV Respondent adv. CASE NO: ücourt number only Petition Regarding Driving Privilege Suspension imposed by OBM V / one> this case is [ ] new civil [ ]existing Crim-Traf (4510.73) CV · 12pt. Suspension - Appeal and / or Driving Privileges CV · Noncompliance Suspension - Driving Privileges (2+ w/in 5yrs) CV · Reinstatement Fee - Pay Plan or Driving Privileges CV · Foreign Jurisdiction OVI-Drug Offense Susp. - Driving Privileges CV · Other Appeals/Petitions TRCR · Other Appeal/Petition re OBMV Suspension TRCR · Suspension by this Court Concurrent with OBMV Suspension full name, please print address city, state email zip Petitioner - Appellant - Defendant 1. A. Petitioner received driving privilege suspension notice from the Ohio Bureau of the Motor Vehicles (OBMV) due to [check applicable field(s)] [ ]accumulation of points [ ]failure to show proof of financial responsibility [ ] suspension of privileges by foreign jurisdiction for drug or OVI offense [ ]pending payment of reinstatement fees required under R.C. §§ 4507.1612, 4507.45, 4509.101, 4509.81, 4511.191, or 4511.951 [ ]other B. A copy of Petitioner's OBMV driving record is attached [failure to attach may delay processing this petition]. C. The beginning date(s) of the suspension(s) is / are / was: . D. Petitioner presently maintains proof of financial responsibility, a copy of which is attached [except, in 12 point suspension and reinstatement fee deferral/payment plan petitions that do not seek driving privileges, and Administrative Appeals]. E. Petitioner certifies that all information provided on this petition and any attachment is true and accurate. F. Unpaid reinstatement fees currently due to OBMV total $ [if requesting payment plan or delay]. [Check one or more of the following sections that apply. Checking inapplicable sections will delay processing of the petition.] [ ]2. 12 Point Suspension Appeal R.C. § 4510.037(B). A. This petition is filed BEFORE the effective date of suspension. B. Petitioner can show cause why the suspension of driving privileges should be set aside. C. For reasons to be shown at the hearing, Petitioner requests an order vacating the Registrar's determination of accumulation of excess points and resulting imposition of suspension. [Oral hearing required.] [ ]3. 12 Point Suspension - Request for Driving Privileges R.C. § 4510.037(G). Petitioner appeals imposition of the suspension only for the purpose of requesting driving privileges as set forth on the attached Driving Privileges Request Supplement. [Privileges can be granted without oral hearing. Suspension is stayed only if appeal filed before suspension begins.] [ ]4. Noncompliance Suspension R.C. § 4509.101. A. Petitioner has complied with R.C. § 4509.101(A)(5) by submitting to the Ohio Bureau of the Motor Vehicles all of the following, where applicable: i. Financial responsibility reinstatement fee (copy of OBMV receipt attached). ii. Financial responsibility nonvoluntary compliance fee, if applicable (copy of OBMV receipt attached). iii. Proof of financial responsibility - SR22 (copy attached). B. Petitioner requests limited driving privileges as detailed on the attached Driving Privileges Request Supplement and as allowed by law. (On 1st suspension in 5 yrs, OBMV will restore privileges on payment of reinstatement fee and proof of insurance. Court privileges are prohibited during the first 15 days of 2nd noncompliance suspension w/in 5yrs of violation, and 1 st 30 days if there are two or more prior noncompliance suspensions within 5yrs of violation). [ ]5. Foreign Jurisdiction Suspension. R.C. § 4510.17(E). Due to OVI or drug suspension by a foreign jurisdiction, the OBMV imposed a suspension which will seriously affect Petitioner's ability to continue employment. Petitioner requests work related driving privileges during the suspension of Ohio driving privileges. [ ]6. Other Appeal or Petition. R.C. § 4510.73 (fully explain, use additional sheets if necessary). Petition Regarding OBM V Imposed Driving Privilege Suspension American LegalNet, Inc. www.FormsWorkFlow.com [ ]7. Plan or Delay to Pay Reinstatement Fees. R.C. § 4510.10. Petitioner cannot reasonably pay reinstatement fees as shown at ¶1(F) now due on the suspension(s) now in effect or about to begin; but for said fee(s) and any other suspension above mentioned, Petitioner would be eligible to operate a vehicle or obtain reinstatement of operating privileges in Ohio. Proof of financial responsibility and a copy of Petitioner's OBMV driving record are attached. Petitioner requests limited driving privileges shown on the attached Driving Privileges Request Supplement and as otherwise allowed by law. (Before filing this application, Petitioner should investigate eligibility for OBMV Fee Installment Plan (BMV Form 1152) which requires no filing fee and restores unlimited driving privileges.) Pending full payment of all reinstatement fees due, Petitioner requests [CHECK ONLY ONE]: A. [ ] A reasonable payment plan not less than $50 per month payable to the OBMV until all reinstatement fees are paid in full. R.C. § 4510.10(D)(1). (Monthly payments required to maintain limited driving privileges.) B. [ ] A payment delay not longer than 180 days at the end of which full payment of all reinstatement fees must be made to the OBMV in order to maintain or recover driving privileges (no payments required during delay period). (NO FURTHER DELAY IS PERMITTED. LIMITED PRIVILEGES EXPIRE AT END OF THE DELAY PERIOD PENDING PAYMENT OF ALL FEES DUE.) R.C. § 4510.10(D)(2). 8. W herefore, Petitioner requests that the court grant the relief above requested. If this is a traffic or criminal case and the court imposed a license suspension, Petitioner seeks driving privileges during the court suspension. Petitioner acknowledges that the clerk and court personnel cannot give legal advice and no information provided has been taken as such. Petitioner acknowledges that this form is provided as a convenience; nothing in the form constitutes legal advice. [Court cost deposits, where required, are not refundable if the court denies relief requested. For legal advice Petitioner must contact an attorney.] 9. Precipe for Service [in new civil case only]. Petitioner requests that the clerk serve a copy hereof on R