Fill and Sign the Hardship Vehicle Registration Form

Case No. _____________________ Court ________________________County _______________________ Division ____________________ Citation No. ___________________ APPLICATION AND ORDER FOR HARDSHIP VEHICLE REGISTRATION APPLICATION Pursuan t to KRS 189A.085(1), the Court has impounded license plates for all vehicles owned, either jointly or individually, by the above-named defendant. Comes ______________________________________________, and mov es the court to grant a hardship vehicle registration for a vehicle identi�ed as: ____ __________________________________ ___________________________ VIN Number License Plate No. (1.) My relationship to the defendant is ______________________________________. (2.) I a m adversely affected by the license plate impoundment because: _________________________________ _ __________________________________________________________________________________________ ___________________________________________________________________________________________ _____ ______________________________________________________________________________________ (3.) I understand that if the Court grants a hardship vehicle registration, the above-named defendant will not be permitted to operate the vehicle under any circumstances, and that I may face criminal penalties if I knowingly per mit said defendant to operate the motor vehicle . WHEREF ORE, applicant prays this application for a hardship vehicle registration will be granted for the above-described vehicle. ______ ___________________________________ ____________________________________________ Date Applicant Doc. Code: OHVR ORDER The Court being satis�ed applicant's inability to use the above-described vehicle for which the Court has impounded the license plate would pose an undue hardship to the applicant, the Court hereby ORDERS the county clerk to reinstate registration for the above-described vehicle. Under no circumstances shall the above- named offender,_______________________________________________, be permitted to drive the vehicle once registration has been been reinstated during the period of the offender's driver's license suspension . ______ ___________________________________ ____________________________________________ Date Judge Copy Distribution: White - Court File Yellow - Applicant Pink - If granted, Applicant delivers to County Clerk Operator License No. State Sex Race Date of Birth Height Weight AOC-495.3 Doc. Code: AH Rev. 1-15 OHVRPage 1 of 1 Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 189A.085(2) Commonwealth Vs. ___________________________________________ First Middle Last ___________________________________________ Address ___________________________________________