Reinstatement Fee Pay Plan

IN THE LAKEWOOD MUNICIPAL COURT CUYAHOGA COUNTY, OHIO ) ) ___________________________, ) Petitioner ) CASE NO. ) ) VS ) ) ) REINSTATEMENT FEE State of Ohio ) PAY PLAN Bureau of Motor Vehicles ) Respondent ) Now comes the Petitioner and hereby petitions the Court for a Reinstatement Fee Payment Plan and limited driving privileges as provided in Ohio Revised Code 4510.10(B)(2) and 4510.021(B). The Ohio Bureau of Motor Vehicles has suspended my driving privileges until_______________________, due to my failure to pay the reinstatement fee. I hereby represent that: 1. I reside within Cuyahoga County. 2. I have obtained current insurance (SR22 ), a copy of which is attached with this Petition. 3. I am including BMV Form 2006 with this Petition. 4. I understand that any limited driving privileges granted to me shall be contingent upon my maintaining proof of insurance and compliance with all BMV requirements. Wherefore, the Petitioner respectfully requests this Court t o grant a Reinstatement Fee Payment Plan and limited driving privileges. ___________________________________ Petitioners Signature Please Print: Name:__________________________ SS No.:_____________________________ Address:________________________ Date of Birth:________________________ _________________________Phone(home):________________________ Ohio Drivers Lic. No.:_____________ Phone(cell):_________________________ HEARING DATE ASSIGNED_________________________AT___________AM/PM. (08/04) American LegalNet, Inc. www.USCourtForms.com