STATE OF OHIO;COUNTY COURT WARREN COUNTY OF WARREN CIVIL DIVISION IN THE WARREN COUNTY COURT LEBANON, OHIO CIVIL DIVISION : : : : : : : : : : : : NAME: ____________________________ ADDRESS: __________________________ CITY/STATE/ZIP:______________________ PHONE: ____________________________ PETITIONER v. BMV REGISTRAR, CAROLYN WILLIAMS P O BOX 16520 COLUMBUS, OH 43266 RESPONDENT CASE NO: ___________________ DOB: SS#: OL#: Suspension Date: Traffic Case #: NOTICE OF APPEAL OF ADMINISTRATIVE LICENSE SUSPENSION; REQUEST FOR DRIVING PRIVILEGES Now comes Petitioner and hereby gives notice of his/her intent to appeal the Administrative License Suspension and requests the following relief: DRIVING PRIVILEGES (NO HEARING REQUESTED) Petitioner hereby waives his/her right to an evidentiary hearing. The Judge will make a ruling without a hearing based upon a review of the facts and any materials you have attached to this Notice of Appeal. You will be notified by mail of the decision. DRIVING PRIVILEGES (HEARING REQUESTED) Petitioner requests a hearing in the event driving privileges are not granted. The Judge will make a preliminary ruling based upon a review of the facts and any materials you have attached to this Notice of Appeal. If your request for driving privileges is denied, the matter will be set for a hearing. STAY OF LICENSE SUSPENSION Petitioner requests the License Suspension be stayed for the following reason(s): Petitioner represents that he/she is under no other license suspension of driving privileges. Petitioner represents that the $ filing fee is NON REFUNDABLE. 7.00 civil filing fee for the Petition has been paid and has been advised that the Petitioner/Attorney for Petitioner Petition for Limited Driving Privileges - Judgment Entry and Order Revised 11.08 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF OHIO; COUNTY COURT WARREN COUNTY OF WARREN CIVIL DIVISION IN THE WARREN COUNTY COURT LEBANON, OHIO CIVIL DIVISION : : : : : : : : : : : : NAME: ____________________________ ADDRESS: __________________________ CITY/STATE/ZIP:______________________ PHONE: ____________________________ PETITIONER v. BMV REGISTRAR, FRANKLIN CALTRIDER P O BOX 16520 COLUMBUS, OH 43266 RESPONDENT CASE NO: ___________________ DECISION AND ENTRY EX PARTE ON NOTICE OF APPEAL OF ADMINISTRATIVE LICENSE SUSPENSION This matter came before the Court, ex parte, on the Notice of Appeal of Administrative License Suspension and Request for Driving Privileges filed by the Petitioner. It is hereby ORDERED, DECREED AND ADJUDGED as follows: Request for Driving Privileges is GRANTED. Petitioner shall be granted Driving Privileges to, from and during the course of employment; to seek work; to school; for medical needs and to Court beginning on __________________________________. Driving Privileges are not effective until the Petitioner has shown proof of financial responsibility/insurance AND has been issued a valid Letter to Drive. Request for Driving Privileges is DENIED. Petitioner has waived his right to a hearing. The matter shall be set for hearing on Tuesday, _______________________ at 3:00 p.m. Request for a Stay of the Administrative License Suspension is GRANTED. The Bureau of Motor Vehicles is hereby ORDERED to reinstate immediately full driving privileges to petitioner until further order of this Court. The Bureau of Motor Vehicles is further ORDERED to return petitioner's license or reissue an operator's license upon the application of petitioner. The petitioner is required to carry a certified copy of this entry when operating a motor vehicle until the operator's license is returned or reissued. Request for a Stay of the Administrative License Suspension is DENIED. _________________ Date Judge Petition for Limited Driving Privileges - Judgment Entry and Order Revised 11.08 American LegalNet, Inc. www.FormsWorkFlow.com