Fill and Sign the Habitual Offender Virginia Department of Motor Vehicles Form

PETITION FOR RESTORATION OF DRIVING PRIVILEGE - HABITUAL OFFENDER COMMONWEALTH OF VIRGINIA Case No HEARING DATE AND TIME Circuit Court CITY OR COUNTY COMPLETE DATA BELOW IF KNOWN RACE SEX BORN HT. WGT. EYES HAIR Mo. DAY YR. FT. IN. PETITIONER'S NAME SSN ADDRESS VA. D.L. # (IF DIFFERENT FROM SSN) TO THE JUDGE OF THE ABOVE-NAMED COURT: I respectfully represent that on , I was adjudged/determined to be an habitual offender by DATE the Department of Motor Vehicles, the Court, based on the following convictions which brought me within the definition of ''habitual offender'': OFFENSE OFFENSE DATE CONVICTION DATE CONVICTING COURT OFFENSE OFFENSE DATE CONVICTION DATE CONVICTING COURT OFFENSE OFFENSE DATE CONVICTION DATE CONVICTING COURT I have attached a certified ''Habitual Offender Restoration Transcript'' of my driving record from the Department of Motor Vehicles. CHECK ONE BOX AS THE BASIS OF YOUR PETITION: A. Restoration under Va. Code § 46.2-360(l). (Eligibility only after five (5) years from the date of your adjudication or determination unless you are entitled to credit under subsection (iii) below.) I have been adjudged/determined to be an habitual offender based in part on and dependent upon convictions of Va. Code § 18.2-266, § 18.2-51.4 or Subsection A of § 46.2-341.24 or valid local ordinance or law of another state or jurisdiction relating to operating a motor vehicle under the influence of intoxicants or drugs. I represent that: (i) At the time of my convictions, I was addicted to or psychologically dependent on the use of alcohol or other drugs; and (ii) At this time I am no longer addicted to or psychologically dependent on the use of alcohol or other drugs; and (iii) At least five years have passed from the date on which I was adjudged/determined to be an habitual offender. [For the purposes of determining eligibility under this section, I rely on a period of credit for an administrative suspension by the Department of Motor Vehicles pursuant to Va. Code § 46.2-391(B) (for third offense drunk driving) prior to my adjudication/determination. Yes No if yes, period of suspension under § 46.2-391(B): to ]; and (iv) I do not constitute a threat to the safety and welfare of myself or others with respect to the operation of a motor vehicle. I request that the Court restore my privilege to operate a motor vehicle in the Commonwealth upon my evaluation by the Virginia Alcohol Safety Action Program. FORM CC-1465(B) 4/99 PDFVA. CODE ANN. §§ 46.2-358; 46.2-359; 46.2-360; 46.2-361(MASTER, PAGE ONE OF THREE) B. Restricted License under Va. Code § 46.2-360(2). (Eligibility only after three (3) years from the date of your adjudication or determination - unless you are entitled to credit under (iii) below.) I have been adjudged/determined to be an habitual offender based in part on and dependent upon convictions of Va. Code § 18.2-266, § 18.2-51.4 or Subsection A of § 46.2-341.24 or valid local ordinance or law of another state or jurisdiction relating to operating a motor vehicle under the influence of intoxicants or drugs. I represent that: (i) At the time of my convictions, I was addicted to or psychologically dependent on the use of alcohol or other drugs; and (ii) At this time I am no longer addicted to or psychologically dependent on the use of alcohol or other drugs; and (iii) At least three years have passed from the date on which I was adjudged/determined to be an habitual offender [For the purposes of determining eligibility under this section, I rely on a period of credit for administrative suspension by the Department of Motor Vehicles pursuant to Va. Code § 46.2-391(B) (for third offense drunk driving) prior to my adjudication/determination: Yes No if yes, period of suspension: to ]; and (iv) I do not constitute a threat to the safety and welfare of myself or others with respect to the operation of a motor vehicle. I request that the Court order the issuance of a restricted license to allow me to drive to and from work and during the course of my employment, upon evaluation by the Virginia Alcohol Safety Action Program. NAME AND ADDRESS OF EMPLOYER DAYS AND HOURS WORKED C. Restoration under Va. Code § 46.2-361(A). (Eligibility only after three (3) years from the adjudication/ determination and after all fines, court costs, forfeitures, restitution, penalties and/or judgments have been paid in full.) I have been adjudged/determined to be an habitual offender and such adjudication/determination was not based on any drunk driving conviction(s), but was based in part and dependent upon a conviction(s) of driving while my license or privilege to drive was suspended or revoked where the suspension or revocation was only for: