Fill and Sign the Commissioner of Public Safety and the State of Form

IN THE CIRCUIT COURT OF_________ COUNTY, ____________ NAME OF PLAINTIFF ) ) ) V. ) NO. ) ) NAME OF DEFENDANT ) ) Commissioner of Public Safety and the State of ________________________ ) ) PETITION TO REINSTATE DRIVING PRIVILEGE COMES NOW the Petitioner, ____________, through counsel, and files this her Petition to Review Suspension for Refusal to Take Breath Test pursuant to ___________ and in support thereof would show unto the Court the following, to-wit: 1. That the Petitioner, _____________, is an adult resident citizen of ___________ County, ___________, whose mailing address is _____________________. 2. That pursuant to the Rules of Civil Procedure, the Defendant, _________________ may be served with process of this Court by duly serving said process on the Attorney General of the State of ___________. 3. That this Honorable Court has subject matter jurisdiction of the cause of action herei n pursuant to ___________ and other applicable statutes. 4. That on ___________, the Petitioner was charged with operating a motor vehicle while under the influence of intoxicating liquor and refusing to submit to a breath test in vi olation of ___________. 5. That on __________________, the Petitioner was found not guilty of said charges as shown by Exhibit "A" attached hereto. 6. That the Defendant has refused to reinstate the driver's license of the Petitioner here in, in violation of the due process rights of the Petitioner. WHEREFORE, PREMISES CONSIDERED the Petitioner, respectfully requests that this Honorable Court review the Decision of the Department of Public Safety to suspend the Defendant's driving privileges for failure to submit to a breath test and upon completion of said review, issue its Order reinstating the driving privileges of the Defendant. ___________ BY:_____________________________ ___________