PETITION FOR REINSTATEMENT OF DRIVING PRIVILEGES ­ FAILURE TO SATISFY JUDGMENT Virginia Code § 46.2-427 Case No. ............................................................. (Underlying Case No., if applicable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hearing Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................................................................................ [ ] General District Court [ ] Circuit Court HT. YR. FT. IN. STATE COMPLETE DATA BELOW IF KNOWN .................................................................................... PETITIONER RACE SEX MO. BORN DAY WGT. EYES HAIR .................................................................................... STREET ADDRESS D.L.# .................................................................................... CITY STATE ZIP CODE To the judge of the above-identified court: My driving privileges, registration certificate and license plates have been suspended as a result of an unsatisfied judgment in an action for damages in a motor vehicle for the amount of $ ........................................................ entered by this court on ............................................................... DATE on behalf of ..................................................................................................... JUDGMENT CREDITOR I now petition this court for reinstatement of my driving privileges, registration certificate and license plates and, in support of this petition, I state the following: 1. I have attached a copy of [ ] the judgment of this court [ ] an abstract of the records of the Department of Motor Vehicles reflecting the judgment of this court. 2. After an examination of the records of the Department of Motor Vehicles and this court and after the exercise of due diligence [ ] I have been unable to locate the judgment creditor [ ] the judgment creditor being dead, I have been unable to identify and locate his heirs or assigns. FORM DC-472 (PAGE ONE OF TWO) 7/03 PDF American LegalNet, Inc. www.USCourtForms.com [ ] the following items are attached to document my due diligence: .................................................................................................................................. 3. I have paid into this court the sum of $. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , reflecting a judgment of $ ........................................., interest in the amount of $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . and court costs of $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Proof of this payment is attached. Should the court grant this petition, I understand that reinstatement of my driving privileges, registration certificate and license plates by the Department of Motor Vehicles will only occur after I give proof to the Department of my financial responsibility in the future and satisfy the other reinstatement requirements of the Department. ................................................ DATE _____________________________________________ SIGNATURE OF PETITIONER FORM DC-472 (PAGE TWO OF TWO) 7/03 PDF American LegalNet, Inc. www.USCourtForms.com