Free cc297.pmd - Michigan

Approved, SCAO

Original - Court 1st copy - Secretary of State 2nd copy - Petitioner 3rd copy - Attorney General/Prosecutor

STATE OF MICHIGAN JUDICIAL CIRCUIT COUNTY
Court address

PETITION FOR REVIEW OF DRIVER'S LICENSE DENIAL, RESTRICTION, OR SUSPENSION
FOR ARRESTS OR ACTIONS ON OR AFTER OCTOBER 1, 1999

CASE NO.

Court telephone no.

Petitioner's name, address, and telephone no.

Respondent

v
Date of birth

Driver's license no.

SECRETARY OF STATE OF THE STATE OF MICHIGAN Driver Assessment and Appeal Division PO Box 30196 Lansing, Michigan 48909-7696
Respondent's attorney, bar no., address, and telephone no.

Petitioner's attorney, bar no., address, and telephone no.

1. I request a review of the following action of the Secretary of State dated that resulted in Date suspension, restriction, or denial of my driving privileges. a. Application denial for medical reasons (MCL 257.303[1][d]). b. Driver assessment suspension or restriction (not a revocation) (MCL 257.310d, MCL 257.320). c. First implied consent suspension (MCL 257.625f). d. Mandatory additional suspension for driving while license suspended (not a revocation) (MCL 257.904[10] or [11]). 2. I am in need of driving privileges and will suffer undue hardship if relief from the Secretary of State action is not granted because:
(Provide details. If necessary attach separate sheets.)

3. I am not requesting a restricted license that would permit a person to drive a vehicle that requires a commercial driver's license. 4. Except for the action I am asking the court to review, I have no other suspensions, revocations, restrictions, or denials of my privilege to drive that would be inconsistent with the relief sought in this petition. 5. I request full driving privileges. restricted driving privileges for work and/or education, for treatment and/or counseling, and for community service.
Date Signature of petitioner

ORDER FOR HEARING IT IS ORDERED: A hearing on the petition shall be held on at
Date Day and date

at

Time

the court address above.

Location Judge

CERTIFICATE OF MAILING I certify that on this date I served a copy of this petition and order for hearing on the parties or their attorneys by first-class mail addressed to their last-known addresses as defined in MCR 2.107(C)(3).
Date CC 297 (3/08) Signature of petitioner

PETITION FOR REVIEW OF DRIVER'S LICENSE DENIAL, RESTRICTION, OR SUSPENSION MCL 257.323, MCL 257.323a-c FOR ARRESTS OR ACTIONS ON OR AFTER OCTOBER 1, 1999