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PETITION AND ORDER TO SUSPEND DRIVER’S LICENSE – Case No. ................................................................... FAILURE TO PAY CHILD SUPPORT DCSE Case No. ..................................................... Commonwealth of Virginia VA. CODE § 46.2-320.1 HEARING DATE: ...................................................................................... ...................................................................................... ................................................................................................................................................................................................................................................................ . Court ............................................................................................................................................................................................................................................................................... ADDRESS OF COURT Department of Social Services ............................................................... v. ........................................................................................................................... PETITIONER RESPONDENT/OBILGOR .............................................................................................................................. ........................................................................................................................... ADDRESS ADDRESS .............................................................................................................................. ........................................................................................................................... .............................................................................................................................. ........................................................................................................................... CASE MANAGER SSN .............................................................................................................................. ........................................................................................................................... TELEPHONE NUMBER VIRGINIA DRIVER’S LICENSE NUMBER (IF DIFFERENT FROM SSN) Petitioner respectfully requests that this court fi nd that the respondent (i) is delinquent in the pa yment of child support by 90 days or more, or in the amount of $5,000 or more, and that this delinquency constitutes willful non-compliance with the order of support identified below or (ii) has failed to comply with a subpoena, s ummons or warrant relating to paternity or child support proceedings. Petitioner respectfully requests this court to autho rize the suspension or refusal to renew of respondent’s Virginia driver’s license pursuant to Virginia Code § 46.2-320.1 . .............................................................................................................................. ........................................................................................................................... NAME OF OBLIGEE COURT ISSUING SUPPORT ORDER .............................................................................................................................. ........................................................................................................................... DATE ORDER ENTERED DATE OF LAST SUPPORT PAYMENT .............................................................................................................................. ............................................................................ Per [ ] week [ ] month AMOUNT OF ARREARAGE AMOUNT OF PERIODIC SUPPORT PAYMENT ....................................................................... ______________________________________________________________ DATE PETITIONER ORDER [ ] The court finds that the obligor is delinquent in t he payment of child support by 90 days or more, or in an amount of $5, 000 or more, and that obligor’s noncompliance with the child support order was willful or that petitioner has failed to comply with a subpoena, summons or warrant relating to paternity or child support proceedings. Therefore, the court grants the petition to authorize the suspension or refusal to renew of the respondent’s driver’s license until such time as resp ondent has either (i) paid the delinquency in full, (ii) reached an agreement w ith petitioner to pay such delinquency within a period not to exceed ten years and has made at least one payment, representing at least five pe rcent of the total delinquency or $600, whichever is greater, (iii) complied with the subpoena, summons or warrant , or (iv) completed or is successfully participating in an intensive case monitoring program for child support as ordered by a juvenile and domestic relations district court or as administered by the Department of Social Services . Petitioner shall notify the Department of Motor V ehicles if the respondent satisfies such requirement. The Department of Motor Vehicles shal l restore respondent’s driving privilege upon receipt of said notice from petitioner. [ ] Petition denied. ....................................................................... ______________________________________________________________ DATE JUDGE FORM DC -280 MASTER 07/15