PORTAGE COUNTY MUNICIPAL COURT www.co.portage.oh.us RAVENNA MUNICIPAL COURT 203 W. MAIN ST. P.O. BOX 958 RAVENNA, OH 44260 330-297-3536 KENT MUNICIPAL COURT 303 EAST MAIN STREET KENT, OH 44240 330-678-9 170 PETITION FOR 12 POINT SUSPENSION APPEAL NAME OF PETITIONER PETITION FOR 12 POINT SUSPENSION APPEAL APPEAL BEFORE SUSPENSION TIME HAS STARTED (BMV AUTOMATIC STAY OF 12 POINT SUSPENSION) PETITION FOR 12 POINT SUSPENSION APPEAL APPEAL AFTER SUSPENSION TIME HAS BEGUN ADDRESS $86.00 FILING FEE PHONE NUMBER DATE OF BIRTH SSN# (LAST 4 ONLY) VS DRIVER LICENSE NUMBER BUREAU OF MOTOR VEHICLES ................................................................................................... STATE REASON FOR APPEALING SUSPENSION: SIGNATURE OF ATTORNEY OR PETITIONER ATTENTION PETITIONER: THE STAY OF THE 12 POINT SUSPENSION IS ONLY APPLICABLE IF YOUR LICENSE IS OTHERWISE VALID. YOU MAY NOT HAVE ANY OTHER ACTIVE SUSPENSIONS AND OUTSTANDING REINSTATEMENT FEES DUE. YOU MAY CALL THE BMV AT 1-614-752-7500 IF YOU HAVE ANY QUESTIONS. .................................................................................................... JOURNAL ENTRY: THE 12 POINT SUSPENSION STAY IS HEREBY: GRANTED DENIED JUDGE, PORTAGE COUNTY MUNICIPAL COURT PETITIONER: YOUR 12 POINT SUSPENSION STAY (IF GRANTED) WILL NOT BE EFFECTIVE UNTIL THE BMV RECEIVED THIS JOURNAL ENTRY AND ENTERS IT INTO THEIR RECORDS. PETITION FOR 12 POINT SUSPENSION APPEAL.doc American LegalNet, Inc. www.FormsWorkFlow.com