Free    Petition/Points Suspension - Ohio

ASHTABULA MUNICIPAL COURT 110 WEST 44TH ST. ASHTABULA, OH 44004 NAME ADDRESS CITY Plaintiff -vsFranklin Caltrider, Registrar BUREAU OF MOTOR VEHICLES P O Box 16520, MVODIP Columbus, OH 43216 Defendant 1. Now comes the Plaintiff _____________________, and states that he resides within the jurisdiction of this court. Plaintiff further states on or about______________(date of notice from BMV) he received notice from the State of Ohio advising him that his Driver's License will be suspended under Ohio Revised Code, Section 4507.021(K), effective on or about _____________________(date of suspension) 2. Plaintiff states that he filed this complaint within the required twenty days from mailing of said notice of suspension. 3. Plaintiff can show cause why he should not be suspended. 4. Plaintiff states that he employment is of such nature that his ability to continue employment would be seriously affected if the suspension otherwise required under Ohio Revised Code, Section 4507.021 (K) be imposed. Plaintiff agrees to pay court costs of said proceedings. JUDGE ALBERT S. CAMPLESE PETITION/POINT SUSPENSION SSN: DOB: OPERATORS LICENSE NO. BMV CASE NO.

Signature of Plaintiff _________________________ Address ____________________________________ City _______________________________________ Phone _____________________________________ CERTIFICATE OF SERVICE I hereby certify that a correct copy of this complaint be set aside or modify suspension was sent by regular mail to FRANKLIN L. CALTRIDER, REGISTRAR, BUREAU OF MOTOR VEHICLES, P O BOX 16520, ATTN: MOVDIP, COLUMBUS, OHIO, 43216, this _________________day of ___________________20______. ________________________Petitioner(Plaintiff)