Petition For Limited Driving Privilege Pretrial Revocation Implied Consent Offense {CVR-9}

File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Superior Court Division IN THE MATTER OF: Name And Address Of Applicant PETITION FOR LIMITED DRIVING PRIVILEGE PRETRIAL REVOCATION Race Sex Height Weight (IMPLIED-CONSENT OFFENSE) G.S. 20-16.5Hair Color Eye Color Date Of Birth Drivers License No. State Social Security No.Date Of Offense Date Of Revocation If Different From Offense Date I, the undersigned applicant, request the Court to issue a limited driving privilege to me pursuant to G.S. 20-16.5 (p). I certify that: 1. My license was revoked by the District Court Division of the General Court of Justice in the county shown above. 2. I meet all of the eligibility requirements for a limited driving privilege under G.S. 20-1 6.5 (p). (NOTE: See reverse side for eligibility requirements.) 3. I have attached a copy of the revocation order issued in this case. 4. I have attached the required documentation of my need to engage in employment-related driving at times other than 6:00 A.M. to 8:00 P.M. on Monday through Friday. 5. (Check if license revoked indefinitely.) I need a limited driving privilege to overcome undue hardship. NOTE TO APPLICANT: You may attach any documentation to support your allegation of undue hardship. You may be required to provideadditional documentation, which may include a copy of your driving record and/or evidence of financial responsibility (insurance).Date Signature Of Applicant NOTICE OF HEARING Notice To The District Attorney: The applicant named above will apply to the district court judge presiding at the date, time and place of hearing shown below for issuance of a limited driving privilege. Date Of Hearing Time Of Hearing DateAM PM Place Of Hearing Signature Deputy CSC Assistant CSC Clerk Of Superior Court CERTIFICATION I certify that on this date, I filed a copy of this Petition with the district attorneys office in person. by depositing same in the U. S. mail in an envelope bearing proper postage. Other: Date Signature Deputy CSC Assistant CSC Clerk Of Superior Court WAIVER I, the undersigned Prosecutor, waive the statutory requirement of the Clerk to file a copy of this Petition with the District Attorneys office and further waive the right to appear at a hearing on this Petition for limited driving privilege. Date Name Of Prosecutor (Type Or Print) Signature Of Prosecutor NOTE: The Clerk of Superior Court upon the filing of this Petition with a notice of hearing, should immediately file a copy with the District Attorneys office and sign the certification, unless the Prosecutor waives the right to having this Petition filed with his/her office.AOC-CVR-9, Rev. 7/98 1998 Administrative Office of the Courts (Over) American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 Eligibility requirements pursuant to GUS. 20-16.5(p) are as follows: If drivers license was revoked for a thirty (30) or forty-five (45) day period: 1. At the time of the alleged offense the defendant held either a valid drivers license or a license that had been expired for less than one year; 2. The defendant does not have an unresolved pending charge involving impaired driving except the charge for which the license is currently revoked or additional convictions of an offense involving impaired driving since being charged for the violation for which the license is currently revoked under 20-16.5; 3. The defendants license has been revoked for at least ten (10) days if the revocation is for thirty (30) days or thirty (30) days if the revocation is for forty-five (45) days; and 4. The defendant has obtained a substance abuse assessment from a mental health facility and registered for and agreed to participate in any recommended training or treatment program. If drivers license was revoked indefinitely: 1. At the time of the alleged offense the defendant held either a valid drivers license or a license that had been expired for less than one year; 2. At the time of the alleged offense the defendant had not within the preceding seven (7) years been convicted of an offense involving impaired driving; 3. Subsequent to the alleged offense, the defendant has not been convicted of, or had an unresolved charge lodged against him/her for, an offense involving impaired driving; 4. The defendant must have completed either: (i) thirty (30) days of the period of license revocation for the current offense if the defendant was present when the license was revoked or if the defendant was not present but surrendered his/her license within five (5) working days after the effective date of the revocation order, or (ii) forty-five (45) days of the period of license revocation for the current offense if the defendant was not present when the license was revoked and did not surrender his/her license within five (5) working days of the effective date of the revocation order. 5. The defendant has obtained and filed with the court a substance abuse assessment conducted by one of the entities authorized by the Department of Health and Human Services to conduct assessments; and 6. A limited driving privilege is necessary to overcome undue hardship. AOC-CVR-9, Side Two, Rev. 7/98 American LegalNet, Inc. www.USCourtForms.com 1998 Administrative Office of the Courts