IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA

CIVIL DIVISION

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:
Appellant	:
vs.	:	FILE NO.
COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF TRANSPORTATION	:
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PETITION FOR APPEAL FROM A SUSPENSION OF AN INSPECTION MECHANIC / STATION CERTIFICATE

Appellant herein is residing at and having a mailing address of .

Appellee herein is the Department of Transportation of the Commonwealth of Pennsylvania, having a mailing address of:

PENNSYLVANIA DEPARTMENT OF TRANSPORTATION

OFFICE OF CHIEF COUNSEL

THIRD FLOOR, RIVERFRONT OFFICE CENTER

HARRISBURG, PA 17104-2516

By letter or notice dated , a copy of which is attached hereto as Exhibit A, the Department of Transportation suspended the Appellant’s inspection mechanic / station certificate and ordered Appellant to return the certificate of appointment immediately.

_____ Appellant has surrendered the certificate of appointment as directed by the Department of Transportation.

_____ Appellant has not surrendered the certificate of appointment as directed by the Department of Transportation. A hearing attended by the Appellant shall be held before the Court of Common Pleas before an Order of Supersedeas can be issued.

The said suspension of Appellant’s operating privileges / registration is improper and unlawful for the following reasons:

Appellant respectfully requests that this matter be set down for a hearing and that the Order of Suspension / Order of Denial be set aside:

Respectfully submitted by,

Appellant

Phone Number

Email Address

I verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904, relating to unswore falsification to authorities.

Date: ___________________	Appellant: ________________________________

Toni Dries

2023-07-20

Rachel A Wotring