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IN THE COURT OF COMMON PLEAS OF BUCKS COUNTY, PENNSYLVANIA CIVIL DIVISION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION vs. : : : : : : : : : File No. _____________________________ PRELIMINARY ORDER FOR HEARING AND NOW, this Petition and on motion of day of , , upon consideration of the foregoing , a hearing de novo is granted to determine whether the action of the Department of Transportation should be set aside. Hearing is fixed for the Bucks County, Pennsylvania. Petitioner to notify the Department forthwith. day of , at o'clock in Courtroom # , BY THE COURT: J. K-1F-1.1 American LegalNet, Inc. www.USCourtForms.com IN THE COURT OF COMMON PLEAS OF BUCKS COUNTY, PENNSYLVANIA CIVIL DIVISION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION vs. : : : : : : : : : File No. _____________________________ LICENSE / REGISTRATION SUSPENSION ORDER AND NOW, this day of , , after hearing de novo, the APPEAL in the above-captioned matter is DENIED / SUSTAINED and the Department of Transportation is ORDERED AND DIRECTED to REINSTATE/RESCIND the SUSPENSION of the motorist's OPERATING PRIVILEGE. BY THE COURT: J. K -1F-1.2 American LegalNet, Inc. www.USCourtForms.com IN THE COURT OF COMMON PLEAS OF BUCKS COUNTY, PENNSYLVANIA CIVIL DIVISION : : : : : : : : : COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION Appellee vs. File No.____________________________ Appellant PETITION FOR APPEAL FROM A SUSPENSION OF OPERATING PRIVILEGE / DENIAL OF DRIVER'S LICENSE / SUSPENSION OF MOTOR VEHICLE REGISTRATION 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. Department of Transportation, Bureau of Motor Vehicles, Harrisburg, Pennsylvania 17123. 3. By letter or notice dated ______________________, a copy of which is attached hereto as Exhibit A, the Department of Transportation ordered Appellant to surrender his / her operating license / motor vehicle registration for a period of . denied the issuance / renewal of a driver's license. K-1F-1.3 (Rev. 10/00) American LegalNet, Inc. www.USCourtForms.com 4. Supersedeas: Pursuant to 75 Pa.C.S.A. § 1550(b)(1)(i), Appellant is retaining driver's license until final determination of the suspension of operating privilege. Pursuant to 75 Pa.C.S.A. § 1550(b)(1)(ii), a hearing attended by the Appellant must be held before the Court of Common Pleas before an order of supersedeas can be issued. Pursuant to 75 Pa.C.S.A. § 1377(a), Appellant is retaining motor vehicle registration until final determination of the suspension of registration. 5. The said suspension of Appellant's operating privileges / registration 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 -2- K-1F-1.4 (Rev. 10/00) American LegalNet, Inc. www.USCourtForms.com 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:__________________ ________________________________________ Appellant -3- K-1F-1.5 (Rev. 10/00) American LegalNet, Inc. www.USCourtForms.com