IN THE MAUMEE MUNICIPAL COURT

 _____________________________________________
_____________________________________________
_____________________________________________       Case No. ______________                                                                               Petitioner

            -vs-

 Franklin R. Caltrider, Registrar                                                              PETITION OF APPEAL
Ohio Bureau of Motor Vehicles
P.O. Box 16520
Columbus, Ohio  43216-6520
                                             Respondent

             Now comes the Petitioner, _______________________________, and states that he/she resides in the jurisdiction of the Maumee Municipal Court, and that he/she is an adult.

             Petitioner further states that on __________________________, ___________, there was mailed to him/her at his/her last known address, a notice in accordance with the provisions of Section 4510.037 of the Ohio Revised Code, stating that his/her driving privileges would be suspended effective _______________________, __________,  said notice alleging that Petitioner had not less than twelve   (12) points charged against him/her within a period of two (2) years for traffic violations. 

            Petitioner states that he/she agrees to pay all costs of this proceeding. 

            Petitioner alleges that he/she can show cause why his/her driving privileges should not be suspended. 

            Petitioner has attached to this petition and marked as "Exhibit A" a copy of said Notice of Suspension. 

            Wherefore, _______________________________________, prays that the order of the Bureau of Motor Vehicles suspending his/her driver's license be set aside and held for naught and that his/her driving rights be restored.   

                                                                                                                          ________________________________________________
                                                                                                                           Petitioner/Petitioner's Attorney
                                                                                             Telephone No. ____________________

CERTIFICATION 

            This is to certify that a copy of the foregoing has been mailed by ordinary U.S. mail this ________ day of _________________________, ___________, to Franklin R. Caltrider, Registrar, Ohio Bureau of Motor Vehicles, P.O. Box 16520, Columbus, Ohio 43216-6520.  
                                                                                     _______________________________
                                                                                                Petitioner/Petitioner's Attorney