Form Ccr O 24 PDF Details

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QuestionAnswer
Form NameForm Ccr O 24
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesCCR O 24 virginia courts website application for restricted operators license dc263 form

Form Preview Example

IN THE CIRCUIT COURT OF FAIRFAX COUNTY, VIRGINIA APPLICATION FOR RESTRICTED DRIVER’S LICENSE

Case No. CL - . . . . . . . . . . . . . . - . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PETITIONER

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ADDRESS

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CITY

STATE

ZIP

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PHONE NUMBER

ADJUDGED AS A HABITUAL OFFENDER ON: . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DRIVER’S LICENSE NUMBER

STATE

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DATE OF BIRTH

HEIGHT

WEIGHT

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SEX

EYE COLOR

HAIR COLOR

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DATE OF OFFENSE (IF APPLICABLE)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SOCIAL SECURITY NUMBER

ADJUDGED TO BE A HABITUAL OFFENDER BY:

DIVISION OF MOTOR VEHICLES

 

CIRCUIT COURT

. . . . . . . . . . . . . . . . . . . (Specify name of court)

THIRD OFFENSE RESTORATIONS:

DIVISION OF MOTOR VEHICLES REVOKED OPERATORS LICENSE ON . . . . . . . . . . . . . . . . . . PURSUANT TO VIRGINIA CODE §46.2-391(B)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NAME OF PETITIONER OR ATTORNEY REPRESENTING PETITIONER

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ATTORNEY ADDRESS (IF APPLICABLE)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PETITIONER OR ATTORNEY SIGNATURE

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ATTORNEY PHONE NUMBER (IF APPLICABLE)

My driver’s license has been suspended or denied but I am eligible for a restricted driver’s

 

(Court use only)

license; therefore, I request that the court grant a restricted driver’s license for travel to and

 

APPROVED

from the following locations for the following purpose(s):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

(a)

[ ]

 

Travel to and from primary job

 

 

 

 

Name and Address of Employer:

 

 

 

 

 

 

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

Days of Week:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

Leave Home:

. Arrive at Work:

 

 

 

 

 

 

 

 

 

Leave Work:

Arrive at Home:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VARIABLE SCHEDULE - WRITTEN VERIFICATION MUST BE CARRIED

[

] YES

[

] NO

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

 

[ ]

 

 

Travel to and from secondary job

 

 

 

 

Name and Address of Employer:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

Days of Week:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

Leave Home:

. Arrive at Work:

 

 

 

 

 

 

 

Leave Work:

. Arrive at Home:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VARIABLE SCHEDULE - WRITTEN VERIFICATION MUST BE CARRIED

[

] YES

[

] NO

(b)

[ ]

 

 

Travel to and from VASAP

 

[

] YES

[

] NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

(c)

[ ]

 

 

Travel during work hours only as required by my employer:

 

 

 

 

Hours of required travel:

 

 

 

 

 

 

 

 

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

 

VARIABLE SCHEDULE - WRITTEN VERIFICATION MUST BE CARRIED

[

] YES

[

] NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

(d)

[ ]

 

 

Travel to and from school

 

 

 

 

 

 

Name and Address of school:

 

 

 

 

 

 

 

 

 

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

Days of Week:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

Leave Home:

.Arrive at School:

 

 

 

 

 

 

 

 

Leave School:

Arrive at Home:

 

 

 

 

 

 

 

 

 

 

 

SCHOOL SCHEDULE REQUIRED - WRITTEN VERIFICATION MUST BE CARRIED

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CCR-O-24 ROL Worksheet Civil – Rev 7/1/2011

 

 

 

 

 

 

 

Medically necessary travel for:

 

 

 

 

me

 

my elderly parent

 

 

 

 

(e)

[ ]

 

 

[

] YES

[

] NO

 

 

 

 

 

 

 

 

 

 

 

 

a person residing in my household

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If for elderly parent or another person: Medical provider name:

 

 

 

 

 

 

 

 

 

 

 

Address:

. . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

(f)

[ ]

Ignition Interlock

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(g-1)

 

 

 

 

[

] YES

[

] NO

 

[ ]

Necessary travel to transport a minor child(ren), who is/are under my care, to & from his/her/their school

 

 

 

 

 

 

 

Name and Address of School:

 

 

 

 

 

 

 

 

 

 

 

 

 

. . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

 

 

Days and Times:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

(g-2)

[ ]

Necessary travel to transport a minor child(ren), who is/are under my care, to & from day care

 

 

 

 

 

 

 

Name and Address of Day Care Provider:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Days and Times:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

(g-3)

[ ]

Necessary travel to transport a minor child(ren), who is/are under my care, to & from medical providers

 

 

 

 

 

 

 

Name and Address of Medical Provider:

 

 

 

 

 

 

 

 

 

 

 

 

 

. . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

 

 

Days and Times:

. . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

(h)

[ ]

Necessary travel for Court Ordered visitation with child(ren)

 

 

 

 

 

 

 

Name(s):

 

 

 

 

 

 

 

 

 

 

 

 

 

. . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

 

 

Address of Child(ren):

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

 

 

Days and Times of Visitation:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(i-1)

 

 

 

[

] YES

[

] NO

[ ]

Travel to and from appointments with probation officer.

 

 

 

 

 

 

 

Name and Address of Probation entity

 

 

 

 

 

 

 

 

 

 

 

 

 

. . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

(i-2)

[ ]

Travel to and from programs required by court or as a condition of probation

 

 

 

 

 

 

 

Program Name and Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

 

 

 

 

 

 

 

 

 

 

 

Program Name and Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

(j)

[ ]

Travel to and from a place of religious worship:

 

 

 

 

 

 

 

Name and Address of place of religious worship:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Day of Week:

 

 

 

 

 

 

 

 

 

 

 

Leave Home:

Arrive at place of religious worship:

 

 

 

 

 

 

 

 

 

 

 

Leave place of religious worship:

. . . . .

. . . . . . . . . . Arrive Home:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WRITTEN VERIFICATION MUST BE CARRIED

[

] YES

[

] NO

 

 

 

 

 

 

 

(k)

[ ]

Travel to and from appointments approved by the Division of Child Support Enforcement of the

[

] YES

[

] NO

 

 

 

 

 

 

 

Department of Social Services as a requirement of participation in a court-ordered intensive case

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

monitoring program for child support for which I will have with me written proof of the

 

 

 

 

 

 

 

 

 

 

 

appointment, including written proof of the date and time of the appointment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[ ] YES

 

(l)

[ ]

Travel to and from court appearances in which I am a subpoenaed witness:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[

] YES

[

] NO

(m)

[ ]

Travel to and from jail to serve a jail sentence that is to be served on weekends or on

 

 

 

 

 

 

 

 

 

 

nonconsecutive days.

 

 

 

 

 

 

I certify that the above information is true and accurate, that my driving privileges are not revoked or suspended for any other reason, and that I have no other pending charges against me that have not been divulged to the court. I understand that a Restricted Driver’s License permits me to operate a motor vehicle only under the conditions approved by the Court. I further understand that should I be found driving outside the restrictions of the Restricted Driver’s License, I may be subject to the imposition of previously suspended sentences in this case and new criminal charges may be brought against me.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

_______________________________________________________

DATE

DEFENDANT’S SIGNATURE

___________________________________________________________________________________________________________________________________________________________

Reviewed and Approved as indicated:

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DATE

This restricted operator’s license is good until further order of the Court or until ___________________.

DATE

_______________________________________________________

JUDGE

IF THE COURT GRANTS A RESTRICTED OPERATOR’S LICENSE, PLEASE BE AWARE OF THE FOLLOWING:

The Restricted License will NOT be available to be picked up on the day of your hearing.

Upon entry of the Restricted License Order by the Judge, the Clerk will contact you to schedule a date and time for you to pick up your Restricted License Order.

IF YOUR DRIVING NEEDS AND/OR PERSONAL INFORMATION CHANGES, YOU MUST APPLY FOR AN AMENDED RESTRICTED LICENSE.

CCR-O-24 ROL Worksheet Civil – Rev 7/1/2011

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As for the fields of this specific document, here is what you should consider:

1. The Form Ccr O 24 necessitates specific details to be inserted. Ensure the next blanks are completed:

Step number 1 for filling in Form Ccr O 24

2. Given that the last section is finished, you should add the necessary details in THIRD OFFENSE RESTORATIONS, Leave Work, VARIABLE SCHEDULE WRITTEN, Travel to and from secondary job, b Travel to and from VASAP, c Travel during work hours only, d Travel to and from school, Name and Address of school, YES NO, YES NO YES NO, YES NO, YES NO, YES NO, YES NO, and YES NO so that you can move on further.

Leave Work, YES   NO, and d   Travel to and from school of Form Ccr O 24

3. In this step, look at Name and Address of school, SCHOOL SCHEDULE REQUIRED WRITTEN, CCRO ROL Worksheet Civil Rev, and YES NO. Each one of these must be completed with greatest precision.

Writing segment 3 of Form Ccr O 24

People who use this form often make errors when filling in YES NO in this section. Be sure you revise whatever you enter here.

4. This paragraph comes next with the following blanks to consider: e Medically necessary travel for, If for elderly parent or another, f Ignition Interlock, g Necessary travel to transport a, g Necessary travel to transport a, g Necessary travel to transport a, h Necessary travel for Court, YES NO, YES NO, YES NO, YES NO, YES NO, YES NO, i Travel to and from, and YES NO.

YES   NO, YES   NO, and If for elderly parent or another of Form Ccr O 24

5. This very last point to conclude this form is crucial. You'll want to fill in the displayed blank fields, like i Travel to and from programs, j Travel to and from a place of, WRITTEN VERIFICATION MUST BE, k Travel to and from, Department of Social Services as a, l Travel to and from court, m Travel to and from jail to, YES NO, YES NO, YES NO, YES, YES NO, and I certify that the above, before using the document. Neglecting to do this can give you an unfinished and possibly incorrect document!

Form Ccr O 24 completion process outlined (step 5)

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