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Petition For Restoration Of Driving Privilege Third Offense CC-1470 - Virginia
| Petition For Restoration Of Driving Privilege Third Offense Form. This is a Virginia form and can be used in Civil Circuit Court Statewide . |
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PETITION FOR RESTORATION OF DRIVING PRIVILEGE Case No. ............................................................. THIRD OFFENSE COMMONWEALTH OF VIRGINIA HEARING DATE AND TIME .................................................................... .................................................................... ............................................................................................................ CITY OR COUNTY Circuit Court .................................................................... ............................................................................................................ PETITIONER'S NAME RACE SEX MO. COMPLETE DATA BELOW IF KNOWN BORN DAY HT. YR. FT. IN. WGT. EYES HAIR ............................................................................................................ ADDRESS SSN: ............................................................................................................ TO THE JUDGE OF THE ABOVE-NAMED COURT: I respectfully represent that on ................................................................ , my driver's license was revoked by the Department of Motor DATE Vehicles, pursuant to Virginia Code § 46.2-391 (B), based on the following convictions: ............................................................................................................................................................................................................................................................. OFFENSE OFFENSE DATE CONVICTION DATE CONVICTING COURT ............................................................................................................................................................................................................................................................. OFFENSE OFFENSE DATE CONVICTION DATE CONVICTING COURT ............................................................................................................................................................................................................................................................. OFFENSE OFFENSE DATE CONVICTION DATE CONVICTING COURT I have attached a certified transcript of my driving record from the Department of Motor Vehicles. CHECK ONE BOX AS THE BASIS OF YOUR PETITION: [ ] A. Restoration under Va. Code § 46.2-391(C)(1). (Eligible only after five (5) years from the date of the last conviction.) My license was revoked based on and dependent upon three convictions pursuant to Va. Code § 18.2-266, § 18.251.4 or Subsection A of § 46.2-341.24 or valid local ordinance or law of another state or jurisdiction relating to operating a motor vehicle under the influence of intoxicants or drugs. I represent that: (i) At the time of my convictions, I was addicted to or psychologically dependent on the use of alcohol or other drugs; and (ii) At this time, I am no longer addicted to or psychologically dependent on the use of alcohol or other drugs; and (iii) At least five years have passed from the date of the last conviction upon which the revocation of my license was based; and (iv) I do not constitute a threat to the safety and welfare of myself or others with respect to the operation of a motor vehicle. I request that the Court restore my privilege to operate a motor vehicle in the Commonwealth upon my evaluation by the Virginia Alcohol Safety Action Program. FORM CC-1470 (MASTER, PAGE ONE OF TWO) 10/10 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ............................................................. [ ] B. Restricted License under Va. Code § 46.2-391(C)(2). (Eligible only after three (3) years from the date of your last conviction.) My license was revoked based on and dependent upon three convictions pursuant to Va. Code § 18.2-266, § 18.251.4 or Subsection A of § 46.2-341.24 or valid local ordinance or law of another state or jurisdiction relating to operating a motor vehicle under the influence of intoxicants or drugs. I represent that: (i) At the time of my convictions, I was addicted to or psychologically dependent on the use of alcohol or other drugs; and (ii) At this time I am no longer addicted to or psychologically dependent on the use of alcohol or other drugs; and (iii) At least three years have passed from the date of the last conviction upon which the revocation of my license is based; and (iv) I do not constitute a threat to the safety and welfare of myself or others with respect to the operation of a motor vehicle. I request that the Court order the issuance of a restricted license to allow me to for the following purposes, upon evaluation by the Virginia Alcohol Safety Action Program. [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] Travel to/from work Travel to/from school Travel to/from day care for child [ ] Travel to/from VASAP [ ] Travel to/from school for child [ ] Travel during work [ ] Ignition interlock Travel to/from medical service facility for [ ] you [ ] minor child [ ] elderly parent [ ] person residing in household: ...................................................................... Travel to/from court ordered visitation with child or children Travel to/from appointments with probation officer Travel to/from programs required by court or as a condition of probation Travel to/from a place of religious worship .................................................................................................................................................................................................................................. NAME AND LOCATION OF PLACE OF WORSHIP .................................................................................................................................................................................................................................. REQUESTED DAY OF WEEK AND TIME FOR TRAVEL [ ] Travel to/from appointments approved by the Division of Child Support Enforcement of the Department of Social Services as a requirement of participation in a court-ordered intensive case monitoring program for child support [ ] Travel to/from jail to serve a sentence on weekends or nonconsecutive days ............................................................................................................................................................................................................................................................. NAME AND ADDRESS OF EMPLOYER DAYS AND HOURS WORKED I reques
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