IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA CIVIL DIVISION : Appellant : : vs. : File No. : Commonwealth of Pennsylvania : Department of Transportation : Appellee : PETITION FOR APPEAL FROM A SUSPENSION OF AN INSPECTION MECHANIC / STATION CERTIFICATE 1. Appellant herein is residing at and having a mailing address of: 2. Appellee herein is the Department of Transportation of the Commonwealth of Pennsylvania, having a mailing address of: Department of Transportation, Bureau of Driver Licensing, Harrisburg, Pennsylvania 17123. 3. By letter or notice dated , a copy of which is attached hereto as Exhibit A, the Department of Transportation suspended the Appellants inspection mechanic / station certificate and ordered Appellant to return the certificate of appointment immediately. 4. Appellant has / has not surrendered the certificate of appointment as directed by the Department of Transportation. (Rev. 4/00) >>>> 2 5. The said suspension of Appellants certificate of appointment is improper or unlawful for the following reasons: Appellant respectfully requests that this matter be set down for a hearing and that the order of suspension / order of denial be set aside. Respectfully submitted by, Appellant Phone # I verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. 4904, relating to unsworn falsification to authorities. Date: A ppellant 2