PETITION FOR AUTHORIZATION FOR RESTRICTED |
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DRIVER’S LICENSE – CONVICTION FOR |
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UNAUTHORIZED DRIVING |
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Hearing Date: |
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Commonwealth of Virginia |
VA. CODE §§ 46.2-301(E), 18.2-271.1 |
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[ ] General District Court |
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] Circuit Court |
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[ ] Juvenile and Domestic Relations District Court |
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CITY OR COUNTY |
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PETITIONER |
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DRIVER’S LICENSE NUMBER |
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STATE |
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ADDRESS |
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DATE OF BIRTH |
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CITY/STATE |
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To the above-named court:
I, ................................................................................................................., the undersigned, respectfully request this Court to authorize the
PRINT NAME
Department of Motor Vehicles to issue to me a restricted driver’s license, for good cause shown, and further state the following:
My privilege to drive a motor vehicle on the highways of the Commonwealth was suspended by this Court pursuant to § 46.2-301(D) for a violation of § 46.2-301(B), specifically, driving any motor vehicle or any self-propelled machinery or equipment on any highway in Virginia after having my driver’s license, learner’s permit, or privilege to drive a motor vehicle suspended or revoked; after having been directed not to drive by any court or by the Commissioner; or after having been forbidden to operate a motor vehicle as required by statute or by ordinance, in connection with the following cases:
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CASE NUMBEROFFENSEOFFENSE DATECONVICTION DATE
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CASE NUMBEROFFENSEOFFENSE DATECONVICTION DATE
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CASE NUMBEROFFENSEOFFENSE DATECONVICTION DATE
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CASE NUMBER |
OFFENSE |
OFFENSE DATE |
CONVICTION DATE |
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] Additional sheet attached |
[] I have additional license suspensions in other Virginia courts pursuant to § 46.2-301(D) for a violation of § 46.2-301(B), specifically, driving any motor vehicle or any self-propelled machinery or equipment on any highway in Virginia after having my driver’s license, learner’s permit, or privilege to drive a motor vehicle suspended or revoked; after having been directed not to drive by any court or by the Commissioner; or after having been forbidden to operate a motor vehicle as required by statute or by ordinance.
[] Copies of the petitions seeking relief for those suspensions are attached.
Upon knowledge and belief, I am otherwise eligible for a restricted license, and the period of time for which my license was suspended by the court pursuant to § 46.2-301(D), if measured from the date of conviction, has expired even though the suspension itself has not expired.
I request the Court to authorize the Department of Motor Vehicles to issue to me a restricted driver’s license for the following purpose(s):
(a)[] travel to or from my place of employment as described below.
(b)[] travel to and from an alcohol rehabilitation or safety action program.
(c)[] travel during my hours of employment, because the operation of a motor vehicle is necessary to my employment described below.
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EMPLOYER NAME AND WORK LOCATION
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HOURS FOR TRAVEL TO AND FROM WORK |
HOURS OF EMPLOYMENT |
(d)[] travel to and from school. (I understand that I must provide proper written verification to the court that I am enrolled in a continuing program of education.)
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SCHOOL NAME AND LOCATION
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REQUESTED DATES AND TIMES FOR TRAVEL TO AND FROM SCHOOL
(e)[] medically necessary travel for [] me [] elderly parent [] person residing in my household. (I understand that I must provide written verification from a licensed health professional of the need for such travel for an elderly parent or household member.)
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NAME AND LOCATION OF PROVIDER OF MEDICAL SERVICES
FORM DC-273 (MASTER, PAGE ONE OF TWO) 10/09
(g 1-3) [] travel necessary to transport a minor child or children under my care
(1)[] to and from school (2)[] to and from day care
(3)[] to and from facilities housing medical service provider.
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NAME AND LOCATION OF SCHOOL/DAY CARE/MEDICAL SERVICE PROVIDER
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(h) [] travel to and from court ordered visitation with my child or children.
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NAME(S) AND LOCATION OF CHILD OR CHILDREN
(i-1) [] travel to and from appointments with my probation officer.
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NAME AND LOCATION OF PROBATION ENTITY
(i-2) [] travel to and from programs required by court or as a condition of probation.
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PROGRAM NAME AND LOCATION
(j) [] travel to and from a place of religious worship.
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NAME AND LOCATION OF PLACE OF RELIGIOUS WORSHIP
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REQUESTED DAY (ONE DAY PER WEEK) AND TIME FOR TRAVEL TO AND FROM PLACE OF WORSHIP
(k)[] travel to and from appointments approved by the Division of Child Support Enforcement of the Department of Social Services as 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 date and time of the appointment.
(m) [] travel to and from jail to serve a jail sentence that is to be served on weekends or on nonconsecutive days.
I understand that the court may decide not to authorize the Department of Motor Vehicles to issue to me a restricted driver’s license.
If this court does authorize the Department of Motor Vehicles to issue to me a restricted driver’s license, I understand that I may not drive unless all courts that suspended my driver’s license for a violation of § 46.2-301(B), specifically, driving any motor vehicle or any self-propelled machinery or equipment on any highway in Virginia after having my driver’s license, learner’s permit, or privilege to drive a motor vehicle suspended or revoked; after having been directed not to drive by any court or by the Commissioner; or after having been forbidden to operate a motor vehicle as required by statute or by ordinance, have authorized a restricted driver’s license and until receipt of such a restricted license from the Department of Motor Vehicles.
I understand that a restricted driver’s license will not permit me to operate a commercial motor vehicle.
I understand that a restricted driver’s license will not authorize visitation of my child or children if visitation is otherwise prohibited.
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PETITIONER’S SIGNATURE |
FORM DC-273 (MASTER, PAGE TWO OF TWO) 07/11